Ms.Sue Barauski, 69 years old, submitted outside study for review. Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 12/2/2015Ultrasound 12/2/2015MRI breasts 12/24 2015Images submitted for comparison:None Mammogram 12/2/2015: Of note, outside screening mammogram is not available. 6 diagnostic views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is a dense mass with spiculated margin identified in the far posterior lateral right upper outer breast measuring 1.4 cm in superior-inferior dimension. Two adjacent clustered calcifications (each measuring 5 mm), spanning approximately 2.2 cm, are noted in the mid and posterior aspect of the right upper outer breast. The total distance from the anterior calcification to the posterior mass is approximately 7.7 cm on the cc view.Right Breast Ultrasound 12/2/2015 : Static ultrasound images are submitted for interpretation.In the right breast, 10:00 position, 8 cm from the nipple, labeled as palpable, is a 1.2 x 1 x 1.3 cm hypoechoic mass with angular margin. There is associated peripheral flow. No definite mass or cystic lesion identified ton the provided images marked 7 to 11:00 position, 6 cm from the nipple. Ultrasound of the right axilla demonstrate a few normal-appearing lymph nodes.Ultrasound-Guided and a stereotactic guided Biopsy Of the right breast Breast 12/2/2015: Previously identified mass in the the right breast breast 10:00 position 8 cm from the nipple is the target for the ultrasound biopsy. Targeting appears appropriate. Stereotactic guided biopsy imaging of the posterior calcification in the right breast also showed appropriate targeting.Post Procedure Mammogram (10/19/2015): A coil -shaped clip is placed in the right breast posteriorly at site of ultrasound-guided biopsy. A central bow tie shaped clip is placed in the right breast anteriorly at site of stereotactic guided biopsy. Residual anterior calcifications are noted in the right upper outer quadrant.Distance between the 2 clips is 5.5 cm.PER OUTSIDE PATHOLOGY:A. The right breast, 10:00 position, 8 cm from the nipple; ultrasound guided core needle biopsy:- Invasive carcinoma with mixed ductal and lobular feature, grade 1 and associated microcalcifications.B. the right breast calcification, upper Outer quadrant; stereotactic guided core needle biopsy:- ductal carcinoma in situ, grade 2MR breast 12/24/2015:Multisequence axial MRI of both breasts was performed with and without IV contrast as per outside facility breast MRI protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement.Right breast:In the right breast, 10:00 position, approximately 10 cm from the nipple, there is a 1.4 x 1.4 x 1.4 cm (AP X ML X SI) enhancing mass with irregular margin which demonstrates suspicious enhancing kinetics. This is compatible with the biopsy proven invasive carcinoma. The biopsy clip is centered in the mass.Anterior to the index mass is the susceptibility artifact from the stereotactic guided biopsy clip. There is 9 mm nonmass enhancement adjacent to this clip. Additionally, there is asymmetric nonmass enhancement and enhancing foci in segmental distribution in the right breast extending anteriorly, medially and inferiorly from the enhancing index mass. The total extent of this enhancement and the index mass measures 7 x 5 x 6 cm (AP x ML x SI). The anterior most of this enhancement is approximately 12 mm from the nipple base.Left breast:A few enhancing foci are noted in the left breast, which is nonspecific. No suspicious enhancement in the left breast.Bilateral axillary lymph nodes are unremarkable.
7 x 5 x 6 cm index mass with adjacent asymmetric segmental nonmass enhancement in the right breast, more extensive than mammographic measurement. Distance between the 2 clips is 5.5 cm. If additional tissue sampling is considered, stereotactic guided biopsy of the anterior most calcification can be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.