Wk 2, Case 5 - Review

HISTORY: 65 year old female with recently diagnosed left breast invasive lobular carcinoma.

Summary of prior imaging:

Mammography: Diagnostic mammogram performed after recall for screening demonstrates an irregular mass in the left breast at 12 o’clock middle depth which measures approximately 2.7 cm (CC). There are associated fine pleomorphic calcifications.

Ultrasound: Targeted ultrasound of the left breast at 12 o’clock 2 cm from the nipple demonstrates an irregular hypoechoic mass with indistinct margins which measures 2.4 cm. There are no abnormal lymph nodes in the left axilla

Breast MRI: NA

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

Background Parenchymal Enhancement: Minimal
Amount of Fibroglandular Tissue: Heterogenous glandular tissue

LEFT BREAST
Narrative: Centered at 12-1 o’clock there is segmental non mass enhancement extending from anterior to posterior depth and measuring up to 5.9 cm in AP dimension. The area of non mass enhancement extends from anterior to posterior depth, and to the base of the nipple. There is focal susceptibility artifact in the central superior aspect of the area of non mass enhancement
compatible with a biopsy marker clip.

Left breast lesion 1
Lesion type: Non-mass enhancement
5.9 cm (AP). Upper outer Quadrant. 12- 1:00 Radian, Non mass enhancement: Distribution: Segmental, Internal enhancement: Heterogenous, Kinetics: delayed-Choose an item

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

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.

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: description, ☐Abnormal internal mammary

Extramammary findings: None

SUMMARY:
1) Biopsy-proven malignancy in the left breast at the 12-1 o’clock position extending from anterior to posterior depth, measuring up to 5.9 cm on MRI, greater than the extent identified on mammogram or ultrasound.
2) There is no axillary adenopathy

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: Follow up with the surgeon or medical oncologist is recommended. If it would impact clinical management and breast conservation is being considered, then additional biopsies are needed to define the extent of disease.