Wk 2, Case 3 - Review

HISTORY: 37 year old woman with a history of recently diagnosed left breast cancer. Evaluation for extent of disease.

Summary of prior imaging:

Mammography: Patient presents for diagnostic mammogram and US for a palpable abnormality in the upper outer left breast. Diagnostic mammogram demonstrates diffuse coarse heterogeneous and fine pleomorphic calcifications in the upper outer left breast. There is no definite underlying mass.

Ultrasound: Targeted ultrasound of the left breast demonstrates a vague hypoechoic mass with indistinct margins in the left breast at 2 o’clock. In addition, there is mass or densely shadowing area in the left breast at 7 o’clock. An abnormal lymph node is also identified in the left axilla. Biopsies of all of these areas was subsequently performed with ultrasound guidance demonstrating invasive ductal carcinoma at each site in the breast, and metastatic carcinoma in a lymph node. The patient also underwent a biopsy of a mass in the right breast with benign results.

Breast MRI: NA

FINDINGS
Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐Susceptibility ☐Movement ☐Other

Background Parenchymal Enhancement: Mild

Amount of Fibroglandular Tissue: Heterogenous glandular tissue

LEFT BREAST

Narrative: There is extensive non mass enhancement throughout the left breast extending from anterior to posterior depth, and involving the nipple. The overall extent of non mass enhancement measures up to 11 cm (CC). There is associated nipple retraction and skin thickening, with areas of periareolar and inferior breast skin enhancement. There is focal susceptibility artifact in the left breast at 2 o’clock, posterior depth and 7 o’clock anterior depth
compatible with biopsy marker clips. There is also focal susceptibility artifact within a node in the left axilla, also compatible with a biopsy marker clip.

Associated findings LEFT: ☐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: ☐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: ☒NONE, ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

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

RIGHT BREAST

Narrative: No suspicious enhancement or lymphadenopathy. There is focal susceptibility artifact in the superior right breast compatible with a biopsy marker clip.

Associated findings RIGHT breast: ☒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: ☐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: ☒NONE, ☐Fat necrosis, ☐Hamartoma, ☐Post-operative seroma/hematoma with fat

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

Extramammary findings: None

SUMMARY:
1) Extensive non-mass enhancement throughout the left breast measuring up to 11 cm on MRI, larger than the extent demonstrated on mammography or ultrasound. The abnormal enhancement extends anteriorly to involve the nipple and periareolar skin.

2) Biopsy-proven malignant level I axillary adenopathy.

3) There is no internal mammary adenopathy.

LEFT BI-RADS: 6: Known biopsy-proven malignancy: Surgical excision when clinically appropriate

RIGHT BI-RADS: 2: Benign: Routine breast MRI screening if cumulative lifetime risk =>20%

RECOMMENDATIONS: Follow up with the surgeon or medical oncologist.