0:01

And this is another case of 49 year old woman with a

0:05

recent diagnosis of right inflammatory breast cancer.

0:08

So she had a red inflamed

0:11

right breast with orange peel skin, or peau d'orange.

0:19

And this is usually related to

0:22

breast cancer metastasis within the dermal lymphatics.

0:27

Sometimes we see

0:30

just a very edematous breast over a breast cancer,

0:33

but in this case, it was inflammatory breast cancer

0:36

and we were asked to assess extent of disease.

0:40

So just showing you her maximum intensity projection image.

0:44

You can see that the entire right breast is abnormal,

0:49

the skin is enhancing, most of the breast enhances.

0:53

There are abnormal lymph nodes.

0:56

The left breast looks relatively quiet.

0:59

And we'll take a look at this a little further.

1:03

So here are our T1-weighted

1:07

non-fat saturated images and our T1-weighted first post

1:11

contrast subtraction images.

1:13

And you can see that the patient is prone and you can

1:17

see that the breast don't move in the same way.

1:21

So this breast is moving normally,

1:23

but this breast is just kind of

1:26

solid,

1:27

it doesn't have the same kind of contour as the left breast.

1:32

Her skin is diffusely thick.

1:34

And you can see that on this T1-weighted image.

1:37

And on the post contrast image,

1:38

you can see that the skin enhances diffusely.

1:41

There's also diffuse enhancement of the,

1:45

of the breast.

1:48

And you can see that there is a mass here in the upper outer

1:54

right breast, and that has already been biopsied with

1:58

diagnosis of breast cancer.

2:00

But there's fairly extensive non mass enhancement,

2:04

mostly in the lateral breast, but really throughout the breast.

2:08

And then the skin is very,

2:10

very thick and enhances diffusely.

2:14

So this is an inflammatory breast cancer and a BI-RADS 5.

2:19

I mean, it was known that this was a breast cancer but the extent

2:22

of disease was not known at the time of the MRI.

2:26

The other thing that we noticed that we were very

2:29

worried about is that she has bilateral axillary adenopathy.

2:35

So just looking at that again.

2:39

So all of these lymph nodes in the underarm are abnormal,

2:45

both on the right and the left, and there,

2:48

as we scroll through, there are a lot of abnormal lymph nodes.

2:53

And we thought that these were probably involved

2:58

and we recommended a biopsy of an

3:01

axillary lymph node on each side.

3:03

And what we got us our answer,

3:06

So that was done with ultrasound guidance and we

3:08

thought metastatic disease with the breast primary

3:12

and we got that result from both

3:14

the right and the left side.

3:17

So BI-RADS 5 inflammatory breast cancer on the

3:20

right bilateral axillary adenopathy.