A patient submitted outside study for review. Submitted for review are digital mammographic images (6/15/16), ultrasound images of left breast (9/1/15), breast MRI (2/26/15) performed at outside institution. For comparison, digital mammographic images (12/15/14), ultrasound images of left breast (12/15/14), images from stereotactic biopsy with specimen radiograph and postprocedural left mammographic images (1/6/15), images from ultrasound guided biopsy of left breast (1/6/15) are available. DIGITAL MAMMOGRAPHIC IMAGES (6/15/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). An irregularly mass with extensive pleomorphic calcifications are present in the lower inner quadrant in the left breast. The mass measures approximately 4 cm and the calcifications extends anteroposteriorly approximately 7.5 cm. Calcifications are more extensive than those in the prior study (12/15/14). A marker clip is present within the mass. Pathology result from prior ultrasound guided biopsy of the mass was DCIS.Another marker clip is present at middle upper outer quadrant in the left breast, from prior stereotactic biopsy, resulting in DCIS. There are scattered calcifications around the clip, spanning approximately 4 cm posteriorly and laterally. THere are no significant changes in these calcifications.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (9/1/15):There is an irregularly shaped mass at 7-8:00 position in the left breast measuring 37 x 21 mm (previously 29 x 13 mm on 12/15/14), corresponding to biopsy-proven DCIS. There is ductal extension from the mass.BREAST MRI (2/26/15):There is non-mass enhancement at lower inner quadrant measuring 78 x 24 mm (AP x LR) in the left breast. Non-mass enhancement extends to the nipple. A clip artifact is seen at the middle portion of the non-mass enhancement. There are biopsy changes including signal void and area of high single intensity on STIR images at upper outer quadrant in the left breast, corresponding to the area of prior stereotactic biopsy. No abnormal enhancement is seen around this area.There are scattered enhancing foci in the right breast, likely background parenchymal enhancement.An enlarged lymph node, measuring 13 mm, is present in the left axilla.
1. Known left breast malignancy; increase in size of the mass with progression of extensive calcifications in the left lower inner quadrant, no change in the calcifications in the upper outer quadrant in the left breast.2. Enlarged lymph node in the left axilla3.No mammographic or MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.