The patient submitted outside studies for review. Submitted for review are standard mammogram (7/01/2015, 7/9/2015, 7/13/2015), ultrasound (7/13/2015) and MRI (7/30/2015) performed at Aspirus Hospital Wausau WI. No prior year comparisons are available. MAMMOGRAM 7/01/2015, 7/9/2015): Two standard views of both breasts were obtained. Additional right ML view and spot compression views of the right breast were obtained. The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram. Given breast density, there is no definite abnormality seen in either breast. A questionable asymmetry on the right CC view may represent dense tissue. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND (7/13/2015):RIGHT: There is a 1.2 x 0.4 x 1.4 cm hypoechoic area in the right breast 4:00 position "5 FBFN", indeterminate. Also seen is a 1.2 x 0.5 x 1.3 cm hypoechoic area in the right breast 10:00 position "4 FBFN", indeterminate.LEFT: There is a 0.9 x 0.4 x 1.2 cm hypoechoic mass in the left breast 1:00 position "2FBFN" anterior depth, indeterminate. Also seen in the left breast 1:00 position middle depth "3FBFN" is a cluster of cysts, not measured on the ultrasound.ULTRASOUND BIOPSY AND POST BIOPSY MAMMOGRAM (7/13/2015):Static images were submitted from ultrasound guided biopsy of 1.6 cm hypoechoic area in the right breast 1:00 position, with appropriate targeting. This mass was not seen on the submitted diagnostic ultrasound images.Static images from ultrasound-guided biopsy of a mass in the left breast 1:00 position anterior depth annotated "area 1" (previously seen on ultrasound 7/13/2015 as a hypoechoic mass in the left breast 1:00 position "2FBFN") and a mass in the left breast 1:00 position middle depth, annotated "area 2" (previously seen on ultrasound 7/13/2015 as a cluster of cysts in the left breast 1:00 position "3FBFN").Postbiopsy mammogram show percutaneously placed biopsy clip in the right breast middle depth near 12:30-1:00 position. Two percutaneously placed clips are also seen left breast 1:00 position anterior and middle depth, along with postbiopsy changes.OUTSIDE PATHOLOGY REPORT:Pathology report of the right breast mass 1:00 position as indicates proliferative fibrocystic changes with several foci of atypical ductal hyperplasia. Pathology report of the mass in the left breast 1:00 position anterior depth indicates benign fibroadenoma.Pathology report from the mass in the left breast 1:00 position middle depth indicates proliferative fibrocystic changes with intraductal papilloma.BREAST MRI (7/30/2015):There is moderate background enhancement which limits sensitivity. The technique of the exam is also suboptimal. Nonspecific patchy foci of enhancement are seen in both breasts, asymmetric and regional on the right central and inner breast. It is not known if this study was performed at the optimal time in the patient's menstrual cycle. Two small hematomas are seen in the left breast from sites of prior biopsies. No definite focal enhancing mass in either breast or abnormal enhancement in either axilla. Drs. Abe and Sheth concurred with this interpretation.
Bilateral ultrasound findings biopsied with concordant results. Pathology should be reviewed at University of Chicago. Patchy foci of enhancement in both breasts on MR, asymmetric on the right inner breast, nonspecific. Breast MRI is recommended in 6 months, preferably during days 7-10 of her menstrual cycle to try to minimize the effect of background parenchymal enhancement which may have contributed to the degree of right breast enhancement on the outside MRI.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.