Ms. Riley is a 46 year old female presenting with recent biopsy-proven intraductal papillary proliferation and focal ADH. There is scattered fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of this exam for the evaluation of subtle abnormalities.In the right medial breast, there is a segmental distribution of clumped non-mass-enhancment, spanning approximately 13.2 cm (AP) x 3.7 cm (transverse) x 5.4 cm (CC). The enhancement extends anteriorly up to the nipple base without demonstrable nipple involvement. This abnormality corresponds in appearance and distribution to the screen-detected abnormalities that were subsequently sampled under ultrasound guidance. The Hydromark clip is seen at the posterior-most extent of this enhancement. There is no additional abnormal enhancement seen elsewhere in the right breast or in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.
13 cm span of abnormal segmentally-distributed clumped non-mass-enhancement of the right breast, corresponding to the mammographically detected abnormalities. Given the extensive span of this enhancement and the pathology results from recent biopsy, additional tissue sampling is recommended to exclude underlying malignancy. An US-guided vacuum assisted biopsy of a mid-depth and anterior-depth correlate can be performed if clinically desired. Alternatively, an excisional biopsy around the biopsy marker clip can be performed for additional tissue evaluation. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.