Ms. Kim is 38-year-old BRCA2 positive woman with personal history of left breast invasive carcinoma status post mastectomy and right breast lumpectomy for DCIS. She developed liver metastasis in 2013. She submitted outside studies for review which include mammograms (2/22/2016; 2/24/2026) and MRI (2/23/2016) performed at M.D. Anderson Cancer Center. There are no comparisons study available. MAMMOGRAM 2/22/16: The patient is status post left mastectomy and therefore right mammograms are submitted. Three standard and spot magnification views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There are postsurgical/posttreatment changes in the upper outer quadrant. Calcifications are noted in upper outer quadrant. These persist on the spot magnification views and appear amorphous and a loosely grouped to segmental distribution. No suspicious masses identified in the right breastMRI 2/23/16:Axial T1, and fat saturated axial and sagittal postcontrast as well as diffusion weighted sequences were submitted. There is moderate heterogeneous fibroglandular elements in the right breast. Minimal background enhancement is present. There is no suspicious mass or non mass enhancement. Specifically, there are no abnormal findings and distribution of the calcifications seen on mammogram in the upper outer quadrant.There are postsurgical changes of left mastectomy and reconstruction. There is no suspicious enhancement in the mastectomy bed or chest wall.No gross axillary lymphadenopathy.MAMMOGRAM 2/24/2016:Static images from right breast stereotactic biopsy targeting the calcifications in the upper-outer quadrant were submitted. Targeted and is appropriate. Biopsy marking clip was applied. Postbiopsy mammograms demonstrate the clip to be in good position in the upper outer quadrant of the right breast, along with postbiopsy changes, about 1 cm displaced from some residual calcifications. Specimen radiograph showed calcifications.Pathology report is not available at this time.
Status post stereotactic biopsy of low suspicion right breast calcifications. Correlation with biopsy pathology is recommended. A benign result could be considered concordant based on the low level of suspicion and negative MRI. Status post previous left mastectomy with reconstruction and previous right lumpectomy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.