Wk 3, Case 3 - Review

HISTORY: High risk screening MRI.
LEFT LOQ breast cancer IDC excised 6 months prior to this exam. Preoperative MRI showed 2 foci of lateral enhancement in the RIGHT breast . Lesion 1 RIGHT breast was a fibroadenoma at US biopsy (UOQ). Lesion 2 was biopsied by MRI guidance and was LCIS (LOQ) which was then excised. Patient status post LEFT breast radiation treatment.

Summary of prior imaging:

Mammography: Post-surgical changes both breasts
Ultrasound: NA
Breast MRI: See above.

FINDINGS

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

Background Parenchymal Enhancement: Moderate but asymmetric BPE R>>L
Amount of Fibroglandular Tissue: Extreme fibroglandular tissue

LEFT BREAST

Narrative: 3.5 cm post-surgical seroma with smooth benign peripheral enhancement. No additional lesions.

Left breast lesion 1
Lesion type: Post-surgical change
3.7 cm. Lower outer Quadrant. 7:00 Radian. 6 cm from the nipple

Mass/post-surgical change: Shape:Oval/lobulated. Margins:Circumscribed . Enhancement: Rim. Kinetics: sub threshold
BI-RADS:2: Benign: Routine breast MRI screening if cumulative lifetime risk =>20%

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: X NONE, ☐Fat necrosis, ☐Hamartoma, Post-operative seroma/hematoma with fat

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

RIGHT BREAST

Narrative: Post surgical seroma in the RLOQ at site of LCIS excision. Biopsy proven fibroadenoma containing a clip artifact is in the RUOQ. No additional lesions.

Right breast lesion 1
Lesion type: Mass
1.2 cm. Upper outer Quadrant. 10:00 Radian. 3.5 cm from the nipple

Mass/post-surgical change: Shape:Oval/lobulated. Margins:Circumscribed . Enhancement: Homogenous. Kinetics: delayed-Progressive

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

Right breast lesion 2
Lesion type: Post-surgical change
3 cm. Lower outer Quadrant. 5:00 Radian. 9 cm from the nipple

Mass/post-surgical change: Shape:Irregular. Margins:Circumscribed . Enhancement: Rim. Kinetics: delayed-subthreshold

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

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

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

RECOMMENDATIONS: Continue high risk annual screening with MRI and Mammography