Ms. Uppal submitted outside study for review. Submitted for review are:-Right breast ultrasound: 7/22/2016-Right breast ultrasound-guided biopsy: 7/29/2016-Bilateral breast MRI: 8/23/2016-Post stereotactic biopsy left breast mammogram: 8/26/2016The right breast ultrasound and right ultrasound-guided biopsy were performed at Advocate Good Samaritan Hospital. The bilateral breast MRI and post-stereotactic biopsy left breast mammogram examinations were performed at Northwestern Memorial HealthCare. RIGHT BREAST ULTRASOUND: Static ultrasound images are submitted for interpretation.At 10:00, 3 cm from the nipple, there is a 1.1 x 0.6 x 1.3 cm hypoechoic lesion with posterior acoustic enhancement, suggestive of a cyst.RIGHT BREAST ULTRASOUND-GUIDED BIOPSY: Static ultrasound images are submitted for interpretation.Previously described hypoechoic lesion in the left breast at 10:00 was targeted for biopsy. Targeting appears appropriate with clip placement.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is extreme fibroglandular tissue in both breasts. There is mild background parenchymal enhancement.LEFT BREAST:There are two vitamin E capsules overlying the outer posterior left breast. There is clumped nonmass enhancement in the central outer left breast that demonstrates mixed enhancement kinetics, spanning approximately 1.6 x 1.5 x 1 cm (TV x AP x CC). No additional areas of suspicious enhancement in the left breast. No left axillary or internal mammary lymphadenopathy.RIGHT BREAST:There are vitamin E capsules overlying the lower inner and upper outer quadrants of the right breast.In the central inner right breast, along the 3:00 radian, there is a 1.4 x 1.3 x 3.2 cm mass with T1 and T2 hyperintense signal and peripheral enhancement, suggestive of hematoma. Per outside pathology report, this area corresponds to the site of prior stereotactic biopsy. There is a focus of susceptibility artifact along the superior aspect of this mass (series 2, image 49), which may correspond to a biopsy marker clip.In the upper outer right breast, there is a focus of susceptibility artifact (series 2, image 53), which may correspond to a biopsy marker clip. Per outside report, this location corresponds to the site of prior ultrasound-guided biopsy.In the outer far posterior right breast, there is a focus of susceptibility artifact (series 2, image 43).In the low right axilla, there is a 5 mm reniform enhancing mass, suggestive of benign intramammary lymph node.POST STEREOTACTIC BIOPSY MAMMOGRAMS, LEFT BREAST: A CC, XCCL, and LM views of the left breast are submitted.There is heterogeneous fibroglandular tissue, which may obscure small masses. There is an hourglass-shaped biopsy clip in the upper outer quadrant of the left breast. There are residual calcifications in the upper outer left breast adjacent to this clip, spanning approximately 3.6 cm on the XCCL view. There are additional calcifications in the lower inner left breast.PER OUTSIDE PATHOLOGY:-Right breast, stereotactic core biopsies, 3:00: DCIS, grade 2, with necrosis and associated calcifications, involving two cores. The carcinoma extends to the edge of the core biopsy fragment.-Right breast, ultrasound guided core biopsies, 10:00: Histiocytic and chronic inflammatory cell reaction consistent with a ruptured duct/cyst. Moderate ductal hyperplasia, columnar cell change, and stromal fibrosis. Negative for malignancy.-Left breast, stereotactic core needle biopsy, upper outer quadrant: DCIS, solid type, nuclear grade 3
Biopsy-proven DCIS of both breasts. Surgical management is recommended for known malignancy. Submission of all mammograms would be of benefit to see if left lower breast calcifications are stable, document morphology of calcifications on magnification views and to document clip locations in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.