Right breast DCIS. Additional left breast calcifications noted on review of outside images. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.At the site of known malignancy in the right outer breast, there is tightly clumped non-mass enhancement measuring 2.2 x 2.1 x 1.6 cm. Artifact compatible with biopsy clip is seen along the medial inferior aspect of the enhancement. Two additional enhancing findings are present in the right breast. Near 10:00 anterior depth, a 5 mm focus with central non-enhancement is present. The finding is probably benign, though a second look ultrasound will be done. Additionally, there is a 2.9 cm area of linear/branching non-mass enhancement in the central breast at mid to anterior depth. This is morphologically suspicious, though less enhancing than the proven malignancy.In the left outer breast extending from anterior to posterior depth there is highly suspicious clumped non-mass enhancement. This measures 11.2 x 1.9 x 3.0 cm. The enhancement extends to within 1 cm of the pectoralis muscle, but the muscle enhances normally. The left nipple enhances normally and symmetrically compared to the right. The immediate retroareolar tissues are also normally enhancing.  No abnormal lymph nodes are identified in either axillary region.
1. Area of enhancement spanning up to 2.2 cm at the site of biopsy proven malignancy in the right upper outer breast.2. Highly suspicious contralateral enhancement spanning up to 11.2 cm in the left outer breast. Additional magnification views will be performed today to evaluate the left breast calcifications. Two site stereotactic biopsies versus MRI guided biopsies can be considered to establish extent.3. Additional 2.9 cm area of linear/branching non-mass enhancement in the central right breast enhances less than either of the two areas above, but is nonetheless suspicious in morphology. MRI guided biopsy should be performed presuming breast conservation is being considered on the right.4. Probably benign 5 mm focus in the right 10:00 position. Second look ultrasound will be performed today. If that is negative and the patient has breast conservation on the right, then this focus should be followed in 6 months with MRI. The patient will see Dr. Jaskowiak today. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.