A 50-year-old woman undergoes breast MRI for newly diagnosed left breast cancer. MRI reveals an additional 8 mm enhancing lesion in the contralateral right breast, separate from the known malignancy, with irregular margins and rapid enhancement with washout. What is the most appropriate management for this finding?
- A Ignore, as it is likely a benign focus
- B Follow-up MRI in 6 months
- C MRI-guided biopsy of the contralateral lesion ✓
- D Proceed with left mastectomy only
Correct answer: C. MRI-guided biopsy of the contralateral lesion
Explanation
MRI-detected contralateral lesions with suspicious morphology (irregular margins, rapid enhancement with washup) have a significant probability of being malignant, reported in 20-30% of cases. MRI-guided biopsy is required to characterize such findings before definitive surgical planning. Ignoring or following up without tissue diagnosis risks missing a synchronous contralateral cancer that would change surgical management.
Reference: ACR BI-RADS Atlas, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.