Ms. Kendall submitted outside studies for review.Submitted for review are:-Screening mammogram dated 8/27/2016 performed at Palos Diagnostic and Women's Health Center-Left breast diagnostic mammogram dated 9/12/2016 performed at Palos Diagnostic and Women's Health Center-Post procedure left breast mammograms and specimen radiograph dated 9/15/2016 performed at Palos Diagnostic and Women's Health Center-Bilateral breast MRI dated 9/26/2016 performed at Palos Diagnostic and Women's Health Center-Right breast ultrasound dated 9/28/2016 performed at Palos Diagnostic and Women's Health CenterFor comparison, diagnostic right breast mammogram and images from ultrasound-guided right breast cyst aspiration dated 9/8/2015 are available. SCREENING MAMMOGRAM:Bilateral CC and MLO views, CC view of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses.There are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth. No dominant mass, suspicious microcalcifications, or architectural distortion in the right breast. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST DIAGNOSTIC MAMMOGRAMAn ML and two spot magnification views of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. Again seen are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth, spanning approximately 2.1 x 1.6 cm (AP x TV). No new mass or architectural distortion in the left breast.LEFT BREAST POSTPROCEDURE MAMMOGRAM AND SPECIMEN RADIOGRAPH:Postprocedure CC and MLO views of the left breast and specimen radiograph are submitted.Radiograph of the specimen cores demonstrates calcifications. Postprocedure mammograms demonstrate a lock-shaped clip in the central lower left breast at mid depth. There are residual calcifications extending 2.4 cm anterior to the biopsy marking clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement bilaterally.There are postbiopsy changes in the central lower left breast at mid depth. There is focal nonmass enhancement along the anterior aspect of the biopsy cavity, measuring approximately 2.5 x 1.4 x 0.8 cm, likely corresponding to residual calcifications seen on mammogram. There are additional scattered enhancing foci in the left breast, compatible with background parenchymal enhancement.There is an indeterminate 8 x 5 x 10 mm enhancing mass in the retroareolar right breast. No additional enhancing foci or masses in the right breast.No axillary or internal mammary lymphadenopathy.RIGHT BREAST ULTRASOUND:Images from MR guided right breast ultrasound are submitted.Targeted right breast ultrasound images at the 12:00 position and retroareolar region demonstrate no sonographic correlate for the previously described MR finding in the right breast.OUTSIDE PATHOLOGY (per report):1. Left breast needle biopsy with calcifications:-Ductal carcinoma in situ, solid type with necrosis (comedocarcinoma) high nuclear grade.Estrogen receptor: Positive moderate nuclear staining 66%Progesterone receptor: Negative2. Left breast needle biopsy without calcifications: Negative for tumor.
1. Biopsy proven left breast DCIS. There is nonmass enhancement anterior to the biopsy site on MRI, corresponding to residual calcifications seen on mammogram. If breast conservation is desired, bracketed wire localization of the clip and residual calcifications can be performed. Continued surgical management is recommended.2. Indeterminate 10 mm enhancing mass in the retroareolar right breast. Repeat MR-directed right breast ultrasound is recommended. If no ultrasound correlate is identified, follow-up bilateral breast MRI in 6 months is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.