A patient submitted the following outside studies for review.1. Bilateral digital screening mammogram 11/18/20142. Left unilateral digital diagnostic mammogram 12/4/20143. Left breast ultrasound 12/4/20144. Ultrasound guided left breast biopsy 12/11/20145. Post procedure left unilateral digital diagnostic mammogram 12/11/20146. Bilateral breast MRI 12/19/20147. Bilateral digital screening mammogram 10/26/20138. Bilateral digital screening mammogram 10/17/20129. Bilateral digital screening mammogram 10/10/201110. Bilateral digital screening mammogram 9/20/2010 Submitted studies were performed at Palos Community Hospital in Palos Heights Illinois. BILATERAL DIGITAL SCREENING MAMMOGRAM (11/18/2014): Two standard digital views of bothbreasts were obtained and compared to prior studies of 10/26/2013, 10/17/2012, 10/10/2011and 9/20/2010. The breast parenchyma is heterogeneously dense, unchanged in pattern anddistribution. In the posterior depth of the left inferior and slightly medial breast, a 2cm area of architectural distortion with faint calcifications is present. No new masses, suspicious microcalcifications or areas of architectural distortion arenoted in the right breast. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM (12/4/2014): Digital left ML view and twoopen field spot compression views confirm an area of architectural distortion in theposterior depth of the left medial inferior breast.LEFT BREAST ULTRASOUND (12/4/2014): Static images from a left breast ultrasound weresubmitted. Labeled left breast 6 o'clock 4 cm from nipple, a 1.4 x 1.1 x 0.9 cmhypoechoic mass is present with angular margins and internal vascularity. Images of theleft axilla are unremarkable.ULTRASOUND GUIDED LEFT BREAST BIOPSY (12/11/2014): Static images of a left breastultrasound guided core needle biopsy reveal adequate targeting of the mass at the 6o'clock position of the left breast. Percutaneous clip was placed.POST PROCEDURE LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM (12/11/2014): Left MLO and CCviews were performed after the biopsy. A clip is present at the anterior aspect of thearea of architectural distortion in the left breast. No complication from the procedureis present.BILATERAL BREAST MRI (12/19/2014): Bilateral breast MRI was performed without and withcontrast as per the protocol submitted on the outside report. Heterogeneous fibroglandulardensities are present bilaterally. Minimal parenchymal enhancement is present. A 1.5-cmcyst is present in the right lobe of the liver.Left breast: In the posterior depth of the inferior central left breast, a 1.4 x 2.6 x 1.3cm (all measurements AP x LR x CC) area of heterogeneous enhancement with ill-definedborders is present. Susceptibility artifact is present along the superior and anterioraspect of the mass. Linear enhancement extends from the lateral portion of the mass to theskin surface, most likely related to biopsy changes. Washout kinetics are present. Noadditional abnormal enhancement is present in the left breast. No abnormal left axillarylymph nodes are noted.Right breast: In the mid depth of the superior central right breast, a 2.0 X 1.1 x 1.4 cmarea of linear non-mass enhancement with persistent kinetics is present. No additionalabnormal areas of enhancement are present in the right breast. No abnormal right axillarylymph nodes are present.PATHOLOGY: Pathology slides from Palos Community Hospital dated 12/11/2014 were reviewedat University of Chicago on 12/29/2014. Final pathologic diagnosis of the left breast 6o'clock core needle biopsy is invasive ductal carcinoma grade 2 with DCIS.
Biopsy proven left breast cancer. Non-mass enhancement in the superior rightbreast for which a MR directed ultrasound is recommended. If no ultrasound correlate ispresent, MRI guided biopsy will be needed. Surgical consultation is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.