Wk 5, Case 5 - Review

HISTORY: 42-year-old woman presenting with a palpable mass in the RLOQ sent for breast MRI at outside institution following a BIRADS 5 US. (note, this is not recommended standard of practice, we would recommend US guided biopsy before MRI).

Summary of prior imaging:

Mammography: Focal asymmetry extreme lateral right breast
Ultrasound: 1.5 cm hypoechoic spiculated mass at site of palpable mass
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: Scattered fibroglandular tissue

LEFT BREAST

Narrative: Scattered foci consistent with FCD/hormonal changes. No suspicion of malignancy.

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, ☐ Abnormal internal mammary

RIGHT BREAST
Narrative: 1.5 cm spiculated mass in the lateral right breast involving pectoralis and intercostal muscles. 3 cm of linear non mass enhancement extending anteriorly from this mass.

Right breast lesion 1
Lesion type: Mass
1.5 cm. Lower outer Quadrant. 8:00 Radian. 5 cm from the nipple

Mass/post-surgical change: Shape:Irregular. Margins:Not circumscribed-spiculated , Enhancement: Heterogenous. Kinetics: Cannot assess

BI-RADS:5: Highly suggestive of malignancy – Appropriate action should be taken

Right breast lesion 2
Lesion type: Non-mass enhancement

3 cm. Lower outer Quadrant. 8:00 Radian. 2 cm from the nipple

Non mass enhancement: Distribution: Linear, Internal enhancement: Clumped, Kinetics: Cannot assess

BI-RADS:4: Suspicious abnormality – Biopsy should be considered

Associated findings RIGHT breast: ☐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, ☐ Abnormal internal mammary

Extramammary findings: None

SUMMARY: 1.5 cm mass with findings suspicious for local chest wall invasion and suspected DCIS extending 3 cm towards the nipple

LEFT BI-RADS:2: Benign
RIGHT BI-RADS:5: Highly suggestive of malignancy – Appropriate action should be taken

RECOMMENDATIONS: Oncological/surgical referral. Consideration of MRI guided biopsy of Lesion 2 if it will affect management