Ms.Laura Valle, 39 years old, submitted outside study for review. Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 12/10/2015 and 12/21/2015Breast ultrasound 12/21/2015Stereotactic guided biopsy imaging 12/30/2015Postprocedure mammogram 12/30/2015MRI breast 1/13/2015Images submitted for comparison:None SCREENING MAMMOGRAM 12/10/2015 AND DIAGNOSTIC MAMMOGRAM 12/21/2015: Multiple MLO, CC views, spot compression views of both breasts and magnification views of the left breast. The breast parenchyma is heterogeneously dense, which may obscure small masses. Numerous pleomorphic calcifications are noted in the left inner breast which extends close to the skin and the nipple base, measuring up to 9.5 cm in maximum AP dimension. No dominant mass or areas of architectural distortion are noted in either breast. Questionable focal asymmetries in both breasts efface with spot compression.BILATERAL BREAST ULTRASOUND 12/21/2015 : Static ultrasound images are submitted for interpretation.Bilateral whole breast ultrasound was performed. No sonographic abnormality was seen in the area of mammogram detected calcifications. There is a 4 x 2 x 5 mm mm benign-appearing cyst noted in the right breast, 7:00 location, 5 cm from the nipple. There is another 7 x 2 x 6 mm benign appearing cyst in the left breast, 1:00 position, 2 cm from the nipple. No additional suspicious finding is identified.STEREOTACTIC BIOPSY OF THE LEFT BREAST 12/30/2015: Previously identified anteriorly and posteriorly located calcifications in the left breast central inner region are the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on the specimen radiograph.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (12/30/2015): A dumbbell clip is placed in the left breast anteriorly. Another X shaped clip is placed in the left breast posteriorly. The 2 clips are separated by 2.4 cm. Residual calcifications are noted in the left inner central breast.MRI BREAST 1/13/2016:Multiplanar and multisequence of breast MRI with and without IV contrast were performed as per outside facility protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is extremely marked background parenchymal enhancement in both breasts, which limits the sensitivity and specificity of this examination. Additionally, image could not be reviewed on DynaCad, but are reviewed on PACS. Susceptibility artifact from 2 biopsy clips are noted in the medial aspect of the left breast. There is faint but extensive nonmass enhancement surrounding the 2 biopsy clips, in segmental distribution, spanning left central inner breast and extending into the left upper breast. The total extent of the non mass enhancement measures approximately 7.4 x 3.6 x 4.6 cm (AP x ML X SI). This is difficult to differentiate from background enhancement level. The anterior and medial aspect of the enhancement is very close to the skin. The anterior most extent of this enhancement is approximately 1.3 cm from the nipple base.There is no focal suspicious enhancement is noted in the right breast.Bilateral axillary lymph nodes are unremarkable.PER OUTSIDE PATHOLOGY:A. left breast calcifications, central inner posterior; stereotactic guided core needle biopsy:- DCIS, grade 3B. left breast calcifications, central inner anterior; stereotactic guided core needle biopsy:- DCIS, grade 3
Biopsy proven extensive multicentric DCIS predominantly in the inner and upper left breast likely correlates with the 7.4 cm nonmass enhancement on the MRI and 9.5 cm suspicious calcifications on the mammogram. Given her extensive background enhancement on MRI, the calcifications should be the target of any necessary localization procedure, such as marking of calcifications near the skin prior to surgery. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.