A patient submitted outside study for review. Submitted for review are:1. Diagnostic mammogram and ultrasound dated 2/24/2016 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/20163. Breast MRI dated 9/24/2016 For comparison,1/21/2015, 7/14/2014, 7/3/2014 are available. Imaging performed at Northwestern Memorial Hospital. 1. Diagnostic mammogram and ultrasound dated 2/24/2016:Patient has a history of 2 stereotactic biopsies in 2014 with pathology reported as FEA.2 standard views of the right breast with spot magnification were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. X shaped and a hourglass trimark clip in the central inner right breast are unchanged from prior examination, consistent with prior benign biopsies.Grouped pleomorphic, linear branching calcifications spanning almost 40 mm are noted in the right lower inner quadrant medial to the 2 clips on CC view and between the 2 clips on the LM view.Ultrasound performed showed a few simple cyst in the right breast 3 and 4:00 position. An irregular hypoechoic area with few calcifications and blood flow is identified in the right breast 3:00 position 3 cm from the nipple.A diagnostic mammogram with ultrasound was performed on 8/17/2016, mammogram images have not been provided. Ultrasound dated 8/17/2016 shows a 6 mm irregular mass in the right breast 3:00 position for which ultrasound-guided biopsy was recommended. 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/2016:An irregular hypoechoic lesion is identified in the right breast 3:00 position 3 cm from the nipple which was subsequently biopsied under ultrasound guidance. Targeting appears adequate and a coil clip was placed. Pathology is benign as per the report and appears concordant.As per the report is a coil clip did not correspond to the medications, subsequent surgical biopsy was performed and a venous clip was placed. Specimen radiograph has not been provided.Pathology revealed DCIS on samples with and without calcifications. Postprocedure mammogram demonstrates 2 additional clips, a venous clip from the stereotactic biopsy and a coil clip from the ultrasound biopsy in the right lower inner quadrant.3. Breast MRI dated 9/24/2016: Outside hospital protocol MRI uploaded on DYNACAD for post processing. Heterogeneously dense breast parenchyma noted bilaterally. Multiple cysts noted bilaterally. Multiple enhancing foci noted bilaterally none of them are uniquely enhancing.Extensive non mass enhancement in the right lower inner quadrant extending from 4 to 5:00 position measures 66 x 35 x 46 mm (AP X ML X CC) extending anteriorly to the nipple. 2 clip artifacts identified in the medial right breast from the venous and the coil clip. Nonmass enhancement is seen adjacent to the venous clip. The medialmost coil clip is close to the skin and nonmass enhancement is seen lateral to the clip.Outside hospital mentions an enhancing focus in the right upper-outer quadrant which appears to be in the spectrum of multiple enhancing foci or a benign intramammary lymph node. No abnormal axillary lymph nodes in the partially visualized axillary regions.
Stereotactic biopsy of increasing calcifications in the right lower inner quadrant, pathology revealed DCIS in samples with and without calcifications. MRI shows extensive nonmass enhancement, more than the calcifications seen on MRI, approximately 66 mm extending anteriorly to the nipple. MR guided biopsy of the anterior nonmass enhancement can be performed for tissue confirmation if needed.Multiple enhancing foci bilaterally none of them are uniquely enhancing.No abnormality in the left breast or visualized axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.