Wk 3, Case 1 - Practice

39-year-old woman with a history of recently diagnosed locally advanced right breast cancer with skin invasion and axillary nodal metastases.

Summary of Prior Imaging:

Mammography: Patient presented with a palpable abnormality in the right breast and axilla. Diagnostic mammogram demonstrated a 57 x 42 x 67 mm oval mass with circumscribed margins and associated skin thickening at 11:00 anterior depth.

Ultrasound: Subsequent ultrasound demonstrated a correlating 57 x 53 x 57 mm irregular, hypoechoic mass with angular margins at 11:00 5 cm from the nipple. The mass invades the dermis. Morphologically abnormal axillary lymph nodes are also identified.

Breast MRI: Extending from 9 to 12:00 in the upper outer right breast anterior to middle depth, there is a 6.3 cm (CC) irregular mass with irregular margins and rim internal enhancement. Worst curve kinetics are initial phase rapid and delayed phase washout. There is central decreased enhancement compatible with necrosis. The mass invades the adjacent dermis. There is focal susceptibility artifact at the superior lateral aspect of the mass compatible with a biopsy clip. There are two small adjacent masses or intramammary lymph nodes at the posterior superior aspect of the mass compatible with satellite lesions. There are multiple abnormal level I axillary lymph nodes, the largest of which contains focal susceptibility artifact compatible with a biopsy clip. Abnormal level II axillary adenopathy is also demonstrated.

What is the overall BI-RADS assessment for this case?