Ms. Schiller submitted outside studies for review. Submitted for review are:-Right breast diagnostic mammogram: 8/1/2016-Bilateral breast ultrasound: 8/1/2016-Left breast ultrasound-guided biopsy: 8/2/2016-Bilateral breast MRI: 8/17/2016-Bilateral breast ultrasound: 8/24/2016-Left breast diagnostic mammogram: 8/24/2016The right breast diagnostic mammogram and bilateral breast ultrasound dated 8/1/2016, and left breast ultrasound-guided biopsy dated 8/2/2016 were performed at Diagnostic Imaging Specialists of Chicago. The bilateral breast MRI dated 8/17/2016, bilateral breast ultrasound dated 8/24/2016, and left breast diagnostic mammogram dated 8/24/2016 were performed at Rush University Medical Center.For comparison, bilateral screening mammograms dated 11/4/2013, 12/4/2014, and 11/19/2015 and bilateral breast ultrasound dated 5/19/2015 are available. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot compression views of the right breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. There is a BB marker overlying the lower inner right breast. No suspicious masses, microcalcifications or areas of architectural distortion are seen in the right breast. BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the area labeled palpable in the right breast, along the 1:00 radian, there is an 8 x 7 x 4 mm simple cyst. There are subcentimeter cysts in the right breast at the 4:00 and 9:00 positions.In the left breast, 2-3:00 position, 5 cm from the nipple, there is an irregular mass with posterior shadowing and internal vascularity. This mass measures 9 x 7 x 5 mm. There are additional subcentimeter cysts in the left breast at the 12:00, 1:00, 2:00, 7:00, 9:00, 10:00, and 11:00 positions.ULTRASOUND-GUIDED BIOPSY, LEFT BREAST: Static ultrasound images are submitted.The irregular mass in the left breast at the 2-3:00 position was targeted for biopsy. Targeting appears appropriate. Biopsy clip is seen within the target mass.Postprocedure mammogram demonstrates a lock-shaped biopsy clip in the central outer left breast at posterior depth. There are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement. There are bilateral enhancing foci, none more suspicious than the rest.Left breast:There is susceptibility artifact from biopsy clip centered within a 9 x 9 x 9 mm enhancing mass in the central outer left breast, corresponding to biopsied malignancy. A few typically benign foci of enhancement with internal non-enhancing areas are seen. These may represent small fibroadenomas. Right breast:There is a 6 x 6 x 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. This mass demonstrates mixed enhancement kinetics with areas of rapid wash in and washout. Elsewhere a few typically benign enhancing foci are also seen.BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the left breast, 3:00 position, there is a 6 mm hypoechoic mass, corresponding to biopsied malignancy. There is a subcentimeter cyst in the left breast at the 6:00 position.There are subcentimeter cysts in the right breast at the 9:00 and 2:00 positions.LEFT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot magnification views of the left breast were submitted.A lock-shaped biopsy clip is seen in the central outer left breast at posterior depth. Again seen are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013 and demonstrate benign morphology on spot magnification views.OUTSIDE PATHOLOGY (per outside report):Left breast mass, ultrasound-guided biopsy: Invasive ductal carcinoma, grade 1
1. Biopsy-proven left breast invasive ductal carcinoma. Surgical management of known malignancy is recommended.2. Indeterminate 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. No sonographic correlate was identified on outside imaging. MR-guided biopsy is recommended based on the lack of sonographic correlation. Follow up MRI in 6 months for the typically benign enhancing foci is also recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.