A patient submitted outside study for review. Submitted for review areDiagnostic mammogram dated 11/5/2015Diagnostic mammogram and ultrasound 11/10/2015 Ultrasound biopsy and post mammogram dated 11/13/2015MRI dated 12/8/2015 All of the images were performed at Advocate Christ Medical Center, Oaklawn Illinois. No comparison studies are available. SCREENING MAMMOGRAM: Two standard views of both breasts and static tomosynthesis views were submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is a focus of architectural distortion the left upper outer breast seen best on the static tomosynthesis views. Loosely scattered benign calcifications are seen bilaterally.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. DIAGNOSTIC MAMMOGRAM:Focal architectural distortion and asymmetry in the left breast upper outer quadrant on persists on the additional mammographic views. This spans approximately 1.2 cm on the mammogram.LEFT BREAST ULTRASOUND: Static images of the left breast 2:00 position 3 cm from nipple demonstrate a hypoechoic mass with posterior acoustic shadowing and spiculated margins measuring up to 1.5 x 1.8 x 1.2 cm, highly suspicious for malignancy (these largest measurements are shown on pre-biopsy ultrasound). Normal left axillary nodes are also shown. ULTRASOUND GUIDED BIOPSY AND POST MAMMOGRAM:Ultrasound core biopsy of the left breast 2:00 position 3 cm from nipple mass demonstrates appropriate targeting. Marking clip placement is not shown.Post biopsy mammogram show a coil-shaped clip in the left upper-outer quadrant along the posterior aspect of the architectural distortion with post biopsy hematoma/changes.Pathology indicated on the report report as "malignant infiltrating lobular carcinoma, grade 2, a single focus of LCIS also present."BILATERAL BREAST MRI:There is mild background parenchymal enhancement. Moderate amount of heterogeneously fibroglandular tissue seen bilaterally. Dynamic images could not be interpreted on DynaCad and were reviewed instead on PACS without kinetic data.In the left upper outer quadrant near the 2:00 o'clock location, there is a heterogeneously enhancing mass with irregular borders measuring up to 1.3 x 1.1 x 0.7 cm. Clip artifact is seen along the posterior aspect of the mass. This correlates with the findings on mammogram and ultrasound. There is no additional enhancing mass, suspicious morphology or focus of temporal enhancement in the left breast.No abnormal findings in the right breast. A few typically benign foci are present, scattered in the right breast. No suspicious axillary lymph nodes.
Unifocal biopsy-proven concordant left upper-outer cancer measuring up to 1.3 cm on MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.