A patient submitted outside study for review. Submitted for review are digital mammographic images (10/1/15, 10/7/15), images from stereotactic biopsy of right breast and postprocedural right mammographic images (10/16/15), breast MRI (10/26/15), images from MRI guided biopsy of left breast and postprocedural left mammographic images (11/13/15), images from needle localization of right and left breast (11/24/15), digital mammographic images of right breast (12/4/15) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (9/25/14, 9/16/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (10/1/15, 10/7/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. There is a cluster of pleomorphic calcifications at 6:00 position in the right breast measuring 12 x 10 mm (AP x LR). No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. Benign appearing lymph nodes are projected both axillae.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/16/15):Stereotactic biopsy was performed for the cluster of calcifications in the right breast at 6:00 position. Postprocedural mammograms demonstrate a marker clip at 6:00 position, slightly inferior to the site of cluster of calcifications. There are no definite residual calcifications. Per outside radiology report, the pathology result was malignant; DCIS, grade 3.BREAST MRI (10/26/15):Breast MRI was performed with a protocol outlined in the outside radiology report.There is a regional non-mass enhancement, measuring 40 x 17 x 26 mm (AP x LR x CC) at 6:00 position in the right breast, corresponding to the site of biopsy-proven DCIS. Enhancement extends to the skin. A marker clip is identified near the skin, at the anterior aspect of the non-mass enhancement. There is a small lobulated mass measuring 8 x 7 x 8 mm at anterior 4:00 position in the left breast.IMAGES FROM MRI GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/13/15):MRI guided biopsy was performed for the enhancing mass in the left breast. Targeting appears appropriate. Post procedural mammographic images show a marker clip at anterior 4:00 position. Pathology result was benign and concordant; fragments of intraductal papilloma with apocrine metaplasia and microcalcifications.IMAGES FROM NEEDLE LOCALIZATION OF RIGHT AND LEFT BREAST (11/24/15):Single wire localization was performed for right and left breast. For the right breast, a wire was placed by inferior-superior approach. The wire placed immediately posterior to the clip and through the site of cluster of calcifications. For the left breast, a wire was placed by lateral-medial approach, immediately posterior to the clip. No specimen radiograph of either breast has been submitted. Per outside pathology report, DCIS present within 1 mm of the inferior, anterior, and medial margins.DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (12/4/15):Postsurgical seroma with a few surgical clips are seen at 6:00 position in the right breast. There are no residual suspicious calcifications at the site of surgery.
Status post lumpectomy of right breast for DCIS, and left breast for papilloma. No mammographic evidence for residual suspicious calcifications in the right breast on the postsurgical mammographic images (12/4/15).BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.