A patient submitted outside study for review. Submitted for review are screening mammogram dated January 22, 2015, right breast diagnostic mammogram and ultrasound dated January 28, 2015, and breast MRI dated February 10, 2015 performed at Advocate Trinity Hospital. No studies are available for comparison. BILATERAL SCREENING MAMMOGRAM (1/22/2015): Two standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements. Asymmetry is present within the lateral right breast, with distortion noted along the anterior aspect of this asymmetry with overall measurement of about 7 x 5 cm. A tiny cluster of calcifications is noted along the medial aspect of the asymmetry. Elsewhere, scattered benign calcifications are present bilaterally. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Benign morphology lymph nodes are present in the right axilla.RIGHT DIAGNOSTIC MAMMOGRAM (1/28/2015): An ML view and two spot compression views of the right breast are submitted. There is persistent asymmetry and distortion within the anterior upper outer right breast. A tiny cluster of calcifications is noted along the medial aspect of the asymmetry. Elsewhere, scattered benign calcifications are present. RIGHT BREAST ULTRASOUND (1/28/2015): Images labeled right breast 11 o'clock, 4 cm from the nipple reveal an irregular, spiculated hypoechoic mass with posterior acoustic shadowing measuring 2.6 x 2.2 cm. Images labeled "right breast 11 o'clock 4 cm fn axl" which may represent axillary imaging demonstrate a normal morphology lymph node measuring 1.3 cm.ULTRASOUND GUIDED RIGHT BREAST BIOPSY AND POST-PROCEDURAL MAMMOGRAM (1/28/2015): Images from ultrasound guided biopsy of the right breast mass at 11 o'clock were submitted. Targeting appears appropriate. Postprocedural mammogram reveals a rectangular shaped clip within the area of asymmetry and distortion in the upper outer right breast.BILATERAL BREAST MRI (2/10/2015): MRI was performed per outside protocol. There is extensive non-mass enhancement involving the central and lateral aspects of the right breast spanning 8.9 x 6.2 x 4.0 cm. This demonstrates areas of rapid uptake with washout kinetics. Susceptibility artifact from a biopsy clip is noted along the anterior margin of this non-mass enhancement, and resides 2.6 cm posterior to the nipple. The non-mass enhancement extends to near the level of the pectoralis muscle, without evidence for pectoralis involvement. A normal sized probably intramammary lymph node is noted on the right. No suspicious left breast enhancement. A prominent lymph node is visualized within name low right axilla measuring 1.2 cm, and may correspond to the lymph node visualized on ultrasound examination.MRI-GUIDED RIGHT BREAST BIOPSY AND POST-PROCEDURAL MAMMOGRAM (2/10/15): Multiple sequences from reported MRI guided biopsies were submitted. Targeting cannot be evaluated as images currently submitted do not show needle placement. Right CC and MLO mammographic views labeled "post MRI biopsy" demonstrate cylinder shaped clips along the medial aspect of the anterior extent of asymmetry. A second cylinder shaped clip is noted directly posterior to this along the posterior nipple line, and is felt to be too medially located to correspond to biopsy of the posterior extent of non-mass enhancement on MRI. No accompanying procedural report from MRI guided biopsy was available at the time of this dictation. This clip may be displaced, or targeting may have been medial to the non-mass enhancement. PATHOLOGY as per outside hospital reports: -Right breast 11 o'clock 4 cm from nipple; right breast ultrasound guided breast biopsy:Proliferative fibrocystic change with multiple portions of papilloma in florid ductal hyperplasia.-Right breast, more anterior 11 o'clock; MRI guided core biopsy:Atypical ductal hyperplasia in association with a sclerosing intraductal papilloma (atypical papilloma). Florid proliferative fibrocystic changes.-Right breast more posterior 9 o'clock; MRI guided core biopsy:Complex sclerosing lesion (radial scar versus sclerosing papilloma) with florid proliferative fibrocystic changes. Recommend excision.
Extensive non-mass enhancement involving the central and lateral right breast with suspicious mammographic and sonographic findings also noted. Pathology slides should be reviewed at University of Chicago. Incompletely submitted imaging and reports from MRI guided biopsy. Targeting and clip placement/displacement cannot be adequately evaluated.Surgical consultation is advised. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.