Wk 1, Case 4 - Review

HISTORY: New diagnosis of invasive ductal carcinoma in left UOQ.

Summary of prior imaging:

Mammography: Palpable irregular isodense mass at 1:00. No calcifications

Ultrasound: 1.5 cm hypoechoic microlobulated mass with internal perfusion and posterior shadowing at site of palpable mass.

Breast MRI: None.

FINDINGS

Quality control issues: X None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐ Susceptibility ☐Movement ☐Other: Click or tap here to enter text.

Background Parenchymal Enhancement: None/Minimal.
Amount of Fibroglandular Tissue: Heterogenous.

LEFT BREAST
Narrative: 1.7 cm enhancing mass containing a clip artifact at site of known malignancy with 4cm of segmental NME extending anteriorly from the mass.

Left breast lesion 1
Lesion type: Mass
1.7 cm. Upper outer Quadrant. 2:00 Radian. 9 cm from the nipple
Mass/post-surgical change: Shape:Oval/lobulated. Margins:Not circumscribed-irregular .
Enhancement: Heterogenous. Kinetics: upslope -Fast, delayed-Plateau
BI-RADS:6: Known biopsy-proven malignancy – Appropriate action should be taken

Left breast lesion 2
Lesion type: Non-mass enhancement
4 cm. Upper outer Quadrant. 2:00 Radian. 4.5 cm from the nipple
Non mass enhancement: Distribution: Segmental, Internal enhancement: Clumped, Kinetics:
delayed-Subthreshold
BI-RADS:4: Suspicious abnormality – Biopsy should be considered


Associated findings LEFT breast:X NONE ☐Nipple retraction, ☐Nipple involvement,
☐ Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐ Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings LEFT breast X NONE: ☐High ductal signal pre contrast T1,
☐ Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening,
☐ Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips

Fat containing lesions LEFT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary: description, ☐ Abnormal internal mammary: description


RIGHT BREAST
Narrative: No abnormalities
Associated findings RIGHT breast:X NONE ☐Nipple retraction, ☐Nipple involvement,
☐ Skin retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐ Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings RIGHT breast: X NONE ☐High ductal signal pre contrast T1,
☐ Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening,
☐ Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips

Fat containing lesions RIGHT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

Lymph nodes RIGHT: ☒Normal axillary, ☐Abnormal axillary: description, ☐ Abnormal internal mammary: description


Extramammary findings: None

SUMMARY: 1.7 cm left biopsy proven IDC with findings suspicious for 4cm DCIS anterior to mass.

LEFT BI-RADS:6: Known biopsy-proven malignancy: Surgical excision when clinically appropriate
RIGHT BI-RADS:1: Negative: Routine breast MRI screening if cumulative lifetime risk =>20%

RECOMMENDATIONS: Consider MRI guided biopsy of lesion 2 or more extensive anterior resection at the time of surgery.