• US tends to provide the most accurate 3D volume mass measurement.

• Surgeons need to know:

  • How deep/far away the lesion is from the skin. especially if < 1 cm (skin involvement).

  • Distance from nipple areolar complex

  • Distance from pectoralis mm.

  • Location of additional lesions: multifocal (same quadrant; no second bx recommended) vs multicentric (preoperative bx typically pursued)

• About 5 cm of dz > recommend lumpectomy or partial mastectomy.

• When it comes to chest wall involvement, only describe what is enhancing

  • Fibers of pectoralis major or minor mm enhancing

    • Dont say chest wall involvement.

  • Which bones are enhancing if direct extension.

    • If osseous involvement, cardiothoracic surgery typically gets involved.

  • It is up to the surgeon and pathologist to assign the final staging. Just say what you see.

• Mammogrpahically occult breast primaries w/ mets to axilla require MRI

• Focus of enhancement greater 0.3 cm can be bx'd and localized for surgeons

• Anatomic relationships of axillary LNs are important.

STERNAL BONE LESIONS

• DDX:

  • Islands of red marrow

  • Atypical lipid poor hemangioma

  • Metastatic disease