Help interpreting MRI report?

TwinkleCat

I had my fist appointment with the medical team today. I feel much better knowing -- at least some -- of what we're dealing with. There is still more testing to be done, but at least I now have an idea of what is coming... Quick history -- I noticed that my right breast was larger and very swollen at the end of June. I had a diagnostic bilateral mammo and u/s of the right breast, which came back with an ill-defined mass in my right breast, BI-RADS 4. I had an u/s guided core needle biopsy of the mass on 7/16. I received the initial pathology results on 7/23.

I have a decent understanding of the pathology reports -- but hoping some of you may be able to help me interpret the MRI report? (Does djmammo hang out in this forum?) The surgeon showed me the MRI images (it was actually pretty cool!) and explained to me the noteworthy findings, but I did not read through the actual report until I got home.

Surgical pathology report from biopsy on 7/16 (right breast)

Diagnosis: invasive mammary carcinoma with ductal and lobular features, intermediate grade, 1.3cm

Report of ERA/PRA/DNA and/or HER-2-NEU from biopsy on 7/16 (right breast)

Interpretation: ER+ (87%); PR+ (72%); HER-2/NEU-negative; KI-67 proliferation rate 23%

MRI report from 7/30

Reason for exam: 41 yo female with right breast cancer and extremely dense breast tissue -- MRI to assess.

Findings: Marked right and moderate left parenchymal enhancement.

Right breast: There is diffuse asymmetric parenchymal enhancement and edema with asymmetric skin thickening, particularly along the medial breast, worrisome for diffuse infiltrating malignancy. At least 3 pathologically enlarged level I axillary lymph nodes, several with morphology suggesting extracapsular extension of disease. Largest lymph node measures 2.7x1.6cm. Subcentimeter level II and II axillary lymph nodes without clear fatty hila, equivocal for malignant involvement. No internal mammary adenopathy.

Left breast: Solid 0.9x0.8cm mass in the upper inner quadrant near 11:00, about 3cm from the nipple. Mass is circumscribed with oval configuration, shows primarily plateau enhancement. Scattered simple cysts. No suspicious axillary or internal mammary lymph nodes.

Impression:

1. Right breast shows diffuse abnormal parenchymal enhancement associated with parenchymal, skin and nipple areolar complex edema, highly worrisome for inflammatory breast cancer. Pathologic right level I axillary adenopathy with small indeterminate morphology level II and II axillary lymph nodes.

2. Solid 0.9cm left breast mass near 11:00, indeterminate.

Recommendation:

1. Limited left breast ultrasound... If not identified by ultrasound, would suggest MRI guided biopsy.

2. Consider right axillary lymph node biopsy to confirm nodal involvement. Given presumed nodal metastatic disease, would also consider PET/CT to assess for distant metastatic disease.

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My breast surgeon put in orders for a PET scan and additional ultrasound of the left breast. I am waiting on nuclear medicine to call me back to schedule. I also had blood drawn for genetic testing, which should take a couple of weeks. The medical team has already recommended mastectomy on the right (will consider bilateral, pending the results of further testing on the left breast and genetic testing), as well as radiation. Waiting on PET scan to assess for metastases -- if none, they are not recommending chemo -- just 5 years of endocrine therapy.

beach2beach

Hi,

Djmammo has the posting under not diagnosed forum and the topic is interpreting your report.

Im glad you have all your hormonal factors in and you are, as scary as it is, moving along. Hopefully before long you can start to put this behind you.