A patient submitted outside study for review. Submitted for review are digital mammographic images (11/24/15, 6/10/16), ultrasound images of right breast (11/24/2015, 6/10/2016), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (6/21/2016), breast MRI (6/23/2016) performed at outside institution. For comparison, digital mammographic images (11/24/2014), ultrasound images (11/24/2014) are available. DIGITAL MAMMOGRAPHIC IMAGES OF BOTH BREASTS AND ULTRASOUND IMAGES OF RIGHT BREAST (11/24/15):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump. There is a partially circumscribed mass at the site of the BB marker. This mass is confirmed to be a simple cyst on ultrasound at 10:00 position in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST AND ULTRASOUND IMAGES OF RIGHT BREAST (6/10/2016):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at 12 o'clock position of right breast, denoting the area of palpable lump. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted at the area of palpable concern or elsewhere in right breast.On ultrasound, there is an ill-defined hypoechoic mass measuring 27 x 13 mm at 10:00 position in the right breast. Increased blood flow is observed in this area. Interval decrease of the simple cyst at 10:00 position in the right breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (6/21/2016):Ultrasound guided biopsy was performed for the abnormal hypoechoic masses at 12:00 position and 9:00 position of the right breast. The masses in the right breast appear more discontiguous than that seen in the prior study. The mass at 12:00 position was sampled by use of 11-gauge vacuum assisted needle, and the mass at 9:00 position was sampled with 14-gauge biopsy needle, with appropriate needle placement. Postprocedural right mammographic images show a marker clips at 12:00 position, and upper outer quadrant in the right breast, respectively. Distance between 2 clips is 32 mm on CC view. Per outside radiology report, pathology result for both sites was malignant.BREAST MRI (6/23/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Diffuse suspicious non-mass enhancement is seen at upper outer and upper inner quadrant in the right breast measuring 65 x 54 x 65 mm (AP x LR x CC). Simple cyst is seen at 10:00 position in the right breast.There are scattered enhancing foci, but no abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.
1. Biopsy proven malignancy in the right breast at 2 sites (12:00 and 9:00 position). Breast MRI demonstrated diffuse suspicious non-mass enhancement within upper outer and upper inner quadrant in the right breast, suggesting diffuse disease.2. No MRI evidence of malignancy in the left breast or either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.