A patient submitted outside study for review. Submitted for review are digital mammographic images (4/10/15), ultrasound images of right breast and right axilla (4/10/2015), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (4/16/2015), images from ultrasound guided biopsy of right axilla (4/16/2015), breast MRI (4/28/2015), images from MRI guided biopsy of both breasts and postprocedural bilateral mammographic images (5/7/2015), breast MRI (8/25/2015) performed at Silver Cross Hospital. DIGITAL MAMMOGRAPHIC IMAGES (4/10/15):The breast parenchyma is composed of scattered fibroglandular elements. A triangular marker is placed at right retroareolar region, denoting the area of palpable abnormality. There is an ill-defined, irregularly-shaped mass measuring 51 x 43 mm at right retroareolar region, associated with architectural distortions, nipple retraction and skin thickening.There are diffuse benign calcifications in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (4/10/2015):An irregularly shaped hypoechoic mass is present at 11:00 position in the right breast, measuring 53 mm, corresponding to the mass on the mammogram. There is a lymph node with partially thickened cortex in the right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (4/16/2015), IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT AXILLA (4/16/2015):Ultrasound guided biopsy of the right breast mass and right axillary lymph node was performed with appropriate needle placement. A marker clip is placed at anterior aspect of the right breast mass. Postprocedural right mammographic images show a marker clip at superior lateral aspect of the mass.Per outside radiology report, biopsy result of the right breast mass and right axillary lymph node was malignant, infiltrating lobular carcinoma grade 3, lobular carcinoma in situ. Right axillary lymph node was metastatic carcinoma.BREAST MRI (4/28/2015):Imaging protocol is outlined in the outside radiology report.In the right breast, there is a large irregularly shaped mass measuring 65 x 48 x 80 mm (AP x LR x CC) at anterior-middle superior breast. A marker clip is present at lateral aspect in this mass lesion. There is a suspicious enhancing focus is present at posterior 12:00 position. AP distance of this abnormal findings including this enhancing focus is 84 mm. There is a suspicious enhancing mass measuring 10 x 5 x 8 mm at anterior 7:00 position.In the left breast, there is an enhancing mass measuring 6 x 5 x 7 mm at 1:00 position.A marker clip is present within a right axillary lymph node with borderline cortical thickening. Other than this lymph node, there are no abnormal lymph nodes in either axilla.IMAGES FROM MRI GUIDED BIOPSY OF BOTH BREASTS AND POSTPROCEDURAL BILATERAL MAMMOGRAPHIC IMAGES (5/7/2015):MRI guided biopsy was performed for the enhancing mass in the right breast at anterior 7:00 position, and the enhancing mass at 1:00 position in the left breast. A marker clip for each biopsy site is present at expected location on the postprocedural mammogram. Pathology results were followings;A. RIGHT BREAST TISSUE; MRI GUIDED BIOPSY:– INFILTRATING LOBULAR CARCINOMA, NUCLEAR GRADE 3– E-CADHERIN STAIN EXAMINED AND SUPPORTS.B. LEFT BREAST; MRI GUIDED BIOPSY: – SMALL BENIGN INTRADUCTAL PAPILLOMAS, SCLEROSING ADENOSIS WITH MICROCALCIFICATIONS AND COLUMNAR CELL AND FIBROCYSTIC CHANGES– ATYPICAL LOBULAR HYPERPLASIABREAST MRI (8/25/2015):Imaging protocol is outlined in the outside radiology report.The patient presumably received neoadjuvant chemotherapy.Right breast mass becomes smaller, measuring 56 x 33 x 16 mm (previously 65 x 48 x 80 mm). An enhancing mass at posterior 12:00 position is no longer visualized in the right breast.No abnormal enhancing lesions in left breast.Biopsied right axillary lymph node becomes normal appearing.
Interval imaging response of the right breast cancer with metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.