A patient submitted outside study for review. Submitted for review are MRI dated February 2, 2015, and ultrasound and mammogram dated February 4, 2014 performed at Lutheran General Hospital . For comparison, diagnostic mammogram and left breast ultrasound, images from ultrasound guided left breast biopsy and post biopsy mammogram, and images from left stereotactic biopsy and post biopsy mammogram performed at Lutheran General Hospital dated January 27, 2015 are available. DIAGNOSTIC MAMMOGRAM and LEFT BREAST ULTRASOUND (1/27/2015): Two standard views of the right breast and 3 standard views, one spot compression, and two magnification views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements, distributes fairly symmetrically in both breasts. Multiple clusters of calcifications are present throughout the left breast, predominating within the central inner aspect. Notably, branching calcifications are present within the central slightly inner left retroareolar breast, mid depth. Total extent of calcifications spans approximately 7.2 cm AP x 5.6 cm transverse x 5.5 cm craniocaudal, extending to the level of the nipple. A 9 mm focal asymmetry is present within the upper inner left breast posteriorly, subjacent to a palpable marker (BB), and persists on spot compression imaging. No dominant mass, suspicious calcifications, or areas of architectural distortion are present in the right breast.Diagnostic ultrasound shows an irregular hypoechoic mass at the 11 o'clock position of the left breast, 8 cm from the nipple measuring 1.1 x 0.8 x 0.8 cm. Mild increased vascularity is present. Other images labeled left axilla show no lymph nodes. STEREOTACTIC GUIDED LEFT BREAST BIOPSY and SPECIMEN RADIOGRAPH (1/27/2015): Images from stereotactic biopsy of linear, branching calcifications within the central left breast are provided. Targeting appears appropriate. Calcifications are noted within the biopsy specimen.ULTRASOUND GUIDED LEFT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (1/27/2015): Images from ultrasound guided biopsy of the left breast mass at the 11 o'clock position, 8 cm from the nipple are provided. Targeting appears appropriate.Three standard views of the left breast were obtained post stereotactic and ultrasound guided biopsies. An X-shaped biopsy clip is present at the stereotactic biopsy site within the nipple central left breast. Residual calcifications are present extending anteriorly to the nipple. A coil-shaped biopsy marking clip is present within the upper inner left breast, corresponding to the site of ultrasound guided biopsy. Distance between these clips is 6.5 cm on the MLO view.BILATERAL BREAST MRI (2/2/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol. Susceptibility artifact is present from biopsy clips within the upper inner and mid central left breast. There is diffuse non-mass enhancement within the central and inner left breast extending from the pectoralis muscle posteriorly to the nipple base anteriorly, spanning 10.2 cm AP x 5.3 cm transverse x 8.0 cm craniocaudal. No pectoralis enhancement is present to suggest muscular involvement.Within the outer right breast, there is a circumscribed, enhancing, mass measuring 0.8 x 0.9 x 0.8 cm. No further suspicious areas of morphology or enhancement are present in the right breast. No suspicious axillary nodes. ULTRASOUND RIGHT BREAST (2/4/2015): Targeted right breast ultrasound was performed. At the 10 o'clock position of the right breast, 5 cm from the nipple there is a 0.9 x 0.7 x 1.1 cm circumscribed hypoechoic mass without internal vascularity. This is correlative to the MRI finding. ULTRASOUND GUIDED RIGHT BREAST BIOPSY and POST-BIOPSY MAMMOGRAM (2/2/2015): Images from ultrasound guided biopsy of the right breast mass at the 10 o'clock position are submitted. Targeting appears appropriate. Two standard views of the right breast were obtained post biopsy. A wing shaped clip is present within the upper outer right breast, corresponding to the mass on MRI.PATHOLOGY: Per outside report, pathology results for the ultrasound guided biopsy of the left breast mass resulted invasive ductal carcinoma, grade 2. Pathology results for the stereotactic guided biopsy of left breast calcifications resulted ductal carcinoma in situ, grade 2. Pathology results of the ultrasound guided biopsy of the right breast mass resulted fibroadenoma.
1. Left breast mass and extensive calcifications status post biopsy revealing invasive ductal carcinoma and DCIS, respectively. There is diffuse non-mass enhancement of the central and inner left breast on MRI, corresponding to calcifications on mammogram, copmpatible with extensive DCIS. Total area of enhancement spans 10.2 x 5.3 x 8.0 cm (AP x ML x CC).2. Right breast biopsy proven fibroadenoma. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.