A patient submitted outside study for review. Submitted for review are digital mammographic images (6/3/15, 6/10/15), ultrasound images of both breasts (6/10/15), images from ultrasound guided biopsy of right breast and postprocedural mammographic images (6/11/2015), breast MRI (6/17/2015) performed at Silver Cross Hospital. DIGITAL MAMMOGRAPHIC IMAGES (6/3/15, 6/10/15):The breast parenchyma is composed of scattered fibroglandular elements. An irregularly shaped asymmetry is seen at 12:00 position in the right breast measuring approximately 35 mm.In the left breast at the medial aspect, there is a subcentimeter circumscribed oval mass, likely benign.No suspicious microcalcifications are seen in either breast.ULTRASOUND IMAGES OF BOTH BREASTS (6/10/15):In the right breast at 12:00 position, there is a irregularly shaped hypoechoic/isoechoic lesion, corresponding to the asymmetry on the mammogram. The lesion measures at least 12 mm.In the left breast there is a small cyst measuring 5 mm, corresponding to the circumscribed benign-appearing mass seen on the mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL MAMMOGRAPHIC IMAGES (6/11/2015):Ultrasound guided biopsy for the evaluation shaped hypoechoic lesion in the right breast at 12:00 position is performed. A biopsy needle is placed at the anterior aspect of the lesion. Postprocedural right mammographic images show a marker clip placed anterior aspect of the abnormal asymmetry. Per outside radiology report, the pathology result was benign breast tissue, which is discordant.BREAST MRI (6/17/2015):Imaging protocol is described in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast, an irregularly shaped enhancing mass measuring 36 x 21 x 18 mm at 12:00 position, corresponding to the area of abnormalities on mammogram and ultrasound. Enhancing intramammary lymph node is seen at lower outer quadrant in the left breast. No suspicious enhancement is seen in the left breast. No abnormal lymph nodes are seen in either axilla.
1. Suspicious MR enhancing lesion at 12:00 position in the right breast, corresponding to mammographic and sonographic abnormalities. Benign pathology result of this lesion is discordant with imaging findings. Repeat ultrasound guided biopsy of the right breast lesion is recommended. 2. No imaging evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.