A patient submitted outside study for review. Submitted for review are digital mammographic images (10/25/16, 11/9/2016), ultrasound images of left breast (11/9/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (11/16/2016), breast MRI (12/7/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (10/25/16, 11/9/2016):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). There is a small focal asymmetry in the central aspect of the left breast.No other abnormal findings are present elsewhere in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016):There is a lobulated, hypoechoic mass measuring 5 x 2 mm at 3:00 position, 8 cm from the nipple in the left breast. Note is made that a later biopsy of this lesion proved that this lesion did not correspond to the focal asymmetry in the left breast seen on the mammogram. At least 2 normal-appearing lymph nodes are present in the left axilla.ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016), IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/16/2016):Ultrasound guided biopsy of the lesion at 3:00 position of the left breast was performed with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip at 3:00 position in the left breast. The focal asymmetry at central aspect in the left breast appears unchanged. This marker clip is located approximately 38 mm lateral and anterior from the focal asymmetry in the left breast.Per outside radiology report, biopsy result was malignant; infiltrating ductal carcinoma, grade 3 with DCIS intermediate to high-grade.BREAST MRI (12/7/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.A metallic artifact is present at 3:00 position in the left breast, from the marker clip placed at the recent ultrasound guided biopsy.There is a linear non-mass enhancement extending posteriorly from the marker clip, measuring 17 mm.Small enhancing masses seen in the central aspect in the left breast, measuring 6 x 5 x 5 mm (AP x LR x CC), corresponding to the focal asymmetry.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.
1. Biopsy-proven invasive and in situ carcinoma in the left breast at 3:00 position. Breast MRI showed linear non-mass enhancement posteriorly from the marker clip for 17-mm. If lumpectomy is planned, posterior generous excision should be considered.2. A focal asymmetry in the left central breast, showing an enhancement on MRI. The lesion has not been biopsied. Stereotactic biopsy can be performed. Ultrasound study may be performed before a stereo biopsy to look for a target.3. No MRI or mammographic evidence of malignancy in right breast. 4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.