A patient submitted outside study for review. Submitted for review are digital mammographic images (11/5/14, 11/21/14), images from stereotactic core needle biopsy of the right breast and post procedural right digital mammographic images (12/3/14), images from needle localization of the right breast and specimen radiograph (1/6/15), breast MRI (1/28/15) performed at Edward Hospital. DIGITAL MAMMOGRAPHIC IMAGES (11/5/14, 11/21/14):The breast parenchyma is composed of scattered fibroglandular elements. There are pleomorphic calcifications at 6 o'clock position, at anterior - posterior depth. Distribution of calcifications measures 81 x 49 mm (AP x CC) on ML view, and 73 mm in transverse on CC view.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM STEREOTACTIC CORE NEEDLE BIOPSY OF THE RIGHT BREAST AND POST PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (12/3/14):Stereotactic biopsy of the right breast calcifications was performed. Specimen radiograph demonstrates target calcifications within the specimens. Post procedural right mammographic images show a marker clip placed at the posterior 7 o'clock position. Per outside radiology report, the pathology result was malignant.IMAGES FROM NEEDLE LOCALIZATION OF THE RIGHT BREAST AND SPECIMEN RADIOGRAPH (1/6/15):Double wire localization (bracketed with anterior and posterior wires) was performed for the right breast calcifications. Anterior wire is placed to the marker clip and posterior wire is placed approximately 2.5-cm posterior to the anterior wire. Both wires are placed by inferior approach. Specimen radiographs demonstrate multiple calcifications within the specimen, along with a marker clip and two localizing wires. Those calcifications appear extending toward the specimen margins.BREAST MRI (1/28/15):The study was performed with a protocol outlined in the outside radiology report. Images could not be processed with our DynaCAD workstation. Because the images cannot be reviewed on the dedicated MRI workstation, limited interpretation is made.An elongated seroma cavity is present at 6 o'clock position in the right breast from anterior toward the pectoralis muscle. There is focal non mass enhancement, measuring 22 x 20 mm (AP x LR), locating immediate lateral to the seroma cavity at middle depth, suggesting residual cancer vs. fat necrosis. No abnormal enhancement is seen in left breast. There are a few mildly enlarged lymph nodes in the right axilla. Considering post operative status, those lymph nodes may be reactive.No abnormal axillary lymph nodes are identified in left axillary region.
Status post lumpectomy for right breast malignancy. Suspicious non mass enhancement in the right breast, lateral to the seroma cavity.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. 