Ms Neher submitted outside study for review. Submitted for review are:- Bilateral screening mammogram dated 10/21/2016- Left breast ultrasound dated 10/25/2016- Stereotatic biopsy dated 10/25/2016- Bilateral MRI without and with contrast dated 10/31/2016- MRI biopsy dated 11/8/2016- Postprocedure mammogram dated 11/8/2016These imaging studies were performed at Northwest community health care. For comparison,bilateral screening mammograms dating back to 9/7/2013 are available. BILATERAL SCREENING MAMMOGRAM DATED 10/21/2016:Bilateral CC and MLO views were acquired, though only the CAD overlay image is available. Further evaluation was performed for developing calcifications in the left breast and probable cysts on the right based on these mammograms. LEFT BREAST ULTRASOUND DATED 10/25/2016:Targeted ultrasound of the left upper breast at 12:00 3 cm from the nipple reveals clustered microcysts spanning 0.6 x 0.4 x 1.0 cm.Targeted ultrasound of the left upper outer breast at 1:00 3 cm from the nipple, reveals a 0.6 x 0.4 x 0.5 cm oval parallel circumscribed anechoic mass with posterior acoustic enhancement compatible with simple cyst.At the 1:30 position 2 cm from the nipple and oval parallel circumscribed 0.9 x 0.4 x 0.7 cm homogenous isoechoic mass is identified, benign in appearance and stable since ultrasound of 2015. Immediately adjacent to it is another 1.8 x 1.3 x 1.3 cm oval mass with lobulated margin and slightly heterogeneous internal echotexture. This latter finding also appears stable in volume and appearance as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 2:00 position 2.5 cm from the nipple reveals an oval parallel nearly anechoic mass with posterior acoustic enhancement measuring 1.0 x 0.6 x 1.0 cm, likely a complicated cyst. At 2:30 4cm from the nipple, there is an oval parallel circumscribed hypoechoic mass measuring 1.0 x 0.4 x 0.7 cm, benign in appearance. Immediately adjacent to it is a circumscribed parallel anechoic 2.4 x 0.7 x 1.4 cm mass compatible with simple cyst. These findings appears stable as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 4:00 position 4 cm from the nipple reveals another oval parallel circumscribed anechoic mass measuring 0.8 x 0.5 x 1.2 cm, with posterior acoustic enhancement compatible with simple cyst.STEREOTACTIC BIOPSY RIGHT BREAST DATED AND POSTPROCEDURE MAMMOGRAM 10/25/2016:Images from a stereotactic right breast biopsy were provided demonstrating adequate targeting. Calcifications were present on 2 out of 4 samples.A Hydromark biopsy clip marker was deployed.Postprocedure mammogram reveals a Hydromark clip in the expected location in the right outer breast, mid depth. Extensive residual microcalcifications and a small hematoma are noted.BILATERAL BREAST MRI DATED 10/31/2016:Bilateral breast MRI without and with IV contrast was performed according to outside protocol. Images were reviewed using Dyna CAD software.There is heterogeneous fibroglandular tissue, associated with moderate/marked background parenchymal enhancement slightly limiting the sensitivity and specificity of this study.Scattered cysts are identified in both breasts. Multiple similar benign appearing masses are present in both breasts, largest measuring 1.4 x 1.2 cm in the left outer mid breast. This mass was identified on prior ultrasound studies and has been stable sonographically. RIGHT BREAST: Within the right outer breast, there is a segmental area of clumped nonmass enhancement measuring 6.7 x 3.8 x 5.2 cm (AP x transverse x IS), with extension into the subareolar region (approximately 1.4 cm from the nipple), at the central aspect of which, focal susceptibility artifact from a biopsy clip marker is present from prior stereotactic biopsy. Intrinsic high T1 signal from blood products is present along the biopsy clip tract. This area of nonmass enhancement correlates to the mammographically detected right outer segmentally distributed microcalcifications.LEFT BREAST:There is no suspicious mass, or non mass enhancement in the left breast. See above discussion of multiple benign masses. No axillary or internal mammary lymphadenopathy.RIGHT MRI BIOPSY AND POSTPROCEDURE MAMMOGRAM DATED 11/8/2016:Images from a right breast MRI guided biopsy are provided.The inferior aspect of the right breast nonmass enhancement was targeted.Postprocedure mammogram reveals a new biopsy clip marker within the right inferior central anterior breast. Distance between the two clips is 4.1 cm on the ML view.PATHOLOGY:Pathology slides were reviewed at the University of Chicago.Results for the biopsies are as follows:Right breast upper outer with calcs (stereotactic biopsy dated 10/25/2016): Lobular carcinoma in situ.Right breast lower outer (MRI biopsy dated 11/8/2016): focal atypical ductal hyperplasia.
1. Extensive right outer breast calcifications extending into the periareolar region, correlating with extensive NME on prior MRI guided biopsy, corresponding to biopsy proven ADH. 2. Multiple bilateral benign-appearing masses, largest measuring 1.4 cm in the left breast. No MRI evidence of left breast malignancy.3. No axillary or internal mammary lymphadenopathy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.