Ms.Joyce Short, 59 years old, submitted outside study for review. The outside documents including the radiology report for the imaging are incomplete. The history of the patient is unclear.Images performed at Northwest Community Health Care submitted for review: MRI breast 12/17/2015Ultrasound breast 1/12/2016Ultrasound-guided biopsy of the breast 1/12/2016Postprocedure mammogram 1/12/2016Images submitted for comparison:None MRI BREAST 12/17/2015:Multisequence MRI breast with and without IV contrast was performed as per outside hospital MRI breast protocol. The breasts are composed of scattered fibroglandular tissue. There is a mild background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. Left Breast:There is a 16 x 11 cm mass identified in the left breast, 9:00 o'clock position in the far posterior depth. Projecting anterolateral to the 9:00 mass are multiple irregular enhancing masses and foci. The total extent from the 9:00 mass to the multiple central masses are approximately 7.5 cm lateral to medial oblique. Additionally, there is a 5 mm enhancing mass near the medial aspect of the nipple, which has enhancement similar to the other enhancing masses and foci.Right breast:No suspicious enhancement is noted in the right breast. A few nonspecific enhancing foci likely representing the normal background parenchymal enhancement. There is also a normal sized lymph node in the lateral breast with a preserved fatty hilum. Visualized bilateral lymph nodes are unremarkable.TARGETED ULTRASOUND OF LEFT BREAST AND THE ULTRASOUND-GUIDED BIOPSY OF THE LEFT BREAST 1/12/2015:Static ultrasound images are submitted for interpretation. Multiple masses are noted in the left breast.1. Left Breast, 9:00 position, 8 cm from the nipple, there is a round hypoechoic mass measuring 1.3 x 1.1 x 1.5 cm. Immediately adjacent to this mass are another two hypoechoic masses, labeled as same position, measuring 0.7 x 0.4 x 0.5 cm and 0.5 x 0.4 x 0.5 cm, respectively.2. Left breast, labeled as 1 - 2:00 position, 2 cm from the nipple, there is a lobulated hypoechoic mass measuring 0.8 x 0.8 x 1 cm.3. Left breast, labeled as 1:00 position, 2 cm from the nipple, there is another hypoechoic mass measuring 0.6 x 0.3 x 0.6 cm.4. Left breast, 8:00 position, 4 cm from the nipple, there is a hypoechoic irregular mass measuring 0.7 x 0.3 x 0.5 cm.No suspicious finding identified on the images labeled as the left breast, 6:00, 7:00, 10:00, 11:00, and 12:00 positions.The 1.5 cm mass in the left breast, 9:00 position and the 1 cm mass left breast, labeled as 3:00 position (may correspond to the hypoechoic mass labeled as 1 to 2:00 position) are the targets for the biopsy. Targeting appears appropriate. Clips were placed at each biopsy site.POST PROCEDURE MAMMOGRAM 1/12/2016: A ribbon-shaped clip is placed in the the left breast 9:00 position.A dumbbell shaped clip is likely placed in the the left breast, 1 to 2:00 position (likely corresponding to the 3:00 biopsy site.) The two biopsy clips and biopsied masses are more than 8 cm apart. PER OUTSIDE PATHOLOGY:A. left breast mass, 3:00 position; ultrasound guided core needle biopsy:- DCIS, cribriform subtype with necrosis, grade 2- This result is concordant with the imaging findings.B. left breast mass, 9:00 position; ultrasound guided core needle biopsy:- Fragmented breast core with DCIS, cribriform subtype , grade 2- This result is concordant with the imaging findings.
Biopsy proven multicentric disease in the left breast with numerous suspicious enhancing masses and foci throughout the left breast and extending to the left nipple.Please note that no imaging before the MRI is submitted at the time of this dictation. It is expected that a bilateral mammogram and probably other exams were performed before the MRI. An addendum can be issued if the images become available later.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.