A patient submitted outside study for review. Submitted for review are breast imaging studies performed at Ingalls Memorial Hospital, Harvey, Illinois. For comparison,standard mammogram (8/27/12) is available. UNILATERAL MAMMOGRAM 11/3/2015: Three standard and spot magnification views of the right breast were submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is architectural distortion in the right upper-outer quadrant with associated asymmetry. There are calcifications overlapping the suspicious finding as well. There is a well-circumscribed oval mass with benign calcification in the medial right breast, unchanged from mammograms dating back to 8/27/2012. Loosely scattered calcifications are seen in all 4 quadrants, also true on the comparison study.STEREOTACTIC BIOPSY RIGHT BREAST AND POST BIOPSY MAMMOGRAM 11/3/2015: Submitted images demonstrate stereotactic biopsy targeting the right upper outer quadrant breast calcifications that are at the location of the distortion. A clip was placed at the biopsy site and there are significant residual calcifications. The clip is about 1 cm lateral to the site of distortion. Per the outside hospital records, pathology demonstrated a "small focus of infiltrating tubular carcinoma, grade 1, with atypical ductal hyperplasia."BREAST MRI 1/13/2016: Axial T1, pre and postcontrast sequences are submitted. Moderate heterogeneous fibroglandular tissue is present. Marked background parenchymal enhancement in both breasts limit the sensitivity and specificity of the exam. The sequences were unable to be uploaded on Dyna CAD for dynamic evaluation, and the submitted images are reviewed in a limited fashion without dynamic data on PACS. Right breast: In the upper outer quadrant, there is a heterogeneous masslike faint enhancement measuring 1.8 x 1.0 cm consistent with the biopsy-proven cancer (series 13, image 100). Clip artifact may be present just lateral to the enhancement. There is a benign intramammary lymph node in the right breast 3:00 position (series 13, image 100) which has a clear normal fatty hilum on the fat sensitive sequences. There are innumerable patchy and nodular areas of enhancement none of which are more dominant than the rest. These may be related to background parenchymal enhancement. A 12 month follow-up MRI is recommended for these foci to assess stability.Left breast: There are innumerable patchy and nodular areas of enhancement none of which are more dominant than the rest. These may be related to background parenchymal enhancement. A 12-month follow-up MRI is recommended for these foci to assess stability.A few normal size and morphology lymph nodes are seen in both axilla. Liver cysts are noted.ULTRASOUND BREAST 1/14/2016:Static images of both breasts are submitted.In the left breast, 8:00 position, 3 cm the nipple, there is a hypoechoic area without internal vascularity measuring 9 x 5 x 8 mm. Static images of the left breast labeled 6:00, 7:00, and 9:00 demonstrate no abnormality.Static images of the right breast upper inner quadrant 3:00 position 1 cm from the nipple demonstrate a 3 x 4 mm hypoechoic area. Static images of the right breast upper quadrant at the 12:30 position demonstrate a similar 4 mm hypoechoic area.ULTRASOUND BIOPSY AND MAMMOGRAM 1/14/2016: Ultrasound images from the left 8:00 and right 1:00 show that biopsies were performed. Postbiopsy mammograms are submitted which demonstrate a newly placed marking clip near 1:00 and postbiopsy changes in the medial right breast. The previously placed lateral biopsy clip is again noted. Per the outside hospital report, pathology report from this biopsy showed "LCIS, classic type, sclerosing adenosis and intraductal calcifications."  Postoperative changes and a lock shaped marking clip are now seen in the lower inner quadrant of the left breast. Per the outside hospital report, pathology report from this biopsy presumably at the 8:00 position of the left breast demonstrated "apical metaplasia, fibrocystic change, usual ductal hyperplasia, and intraductal microcalcifications." MAMMOGRAM 1/19/2016: Static images from stereotactic biopsy of the left breast are submitted. Calcifications in the left breast upper breast are targeted. A marking clip is noted at the biopsy site, along with postbiopsy changes. Per day outside hospital radiology report, pathology demonstrating "microcalcifications with focal LCIS, grade 1."
(1) Biopsy proven malignancy in the right upper outer quadrant with enhancement on MRI measuring up to 1.8 cm. (2)Additional sites were biopsied in both breasts at the outside hospital with benign pathology reported. Given marked nodular enhancement and bilateral enhancing foci in both breasts, a 12-month follow-up MRI is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.