A patient submitted outside study for review. Submitted for review are ultrasound images of right breast, including images from ultrasound guided biopsy of right breast (7/25/14), breast MRI (8/4/14), images from ultrasound guided biopsy of right axilla and post-procedural right mammographic images (8/7/14) performed at Northwestern Memorial Hospital. ULTRASOUND IMAGES OF RIGHT BREAST, INCLUDING IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST (7/25/14):Following lesions are visualized;1. A lobulated mass with increased blood flow at 11:30 position (33 x 22 x 26 mm)2. A circumscribed, oval mass at 11:30 position, 1 cm posterior to the #1 mass (10 x 5 x 10 mm)3. A hypo/anechoic lesion at 12:30 position, likely cyst (6 x 4 x 5 mm)4. At least two abnormal lymph nodes in the right axilla; irregularly shaped lymph node (37 x 15 mm) and a lymph node with thickened cortex (18 mm)A needle biopsy was performed for the main mass (#1) and the circumscribed mass (#2). Pathology of #1 was malignant. Pathology for #2 is not available.BREAST MRI (8/4/14):Breast MRI is performed with a protocol outlined in the outside report.A heterogeneously enhancing, lobulated mass, which is a proven carcinoma, is visualized at anterior upper outer aspect in the right breast. It measures 32 x 33 x 35 mm (AP x LR x CC). Just posterior and superior to the main mass, there is an enhancing focus (5 mm), likely a satellite. There is another enhancing focus (5 mm) at posterior 8 o'clock position in the right breast.Enlarged lymph node (32 mm) is present in the right axilla at level 1. There are smaller, but abnormal lymph nodes with effaced hila are seen in the right axilla at level 2 and 3. One abnormal internal mammary node is seen.No abnormal enhancing lesion in the left breast. No abnormal lymph node in left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT AXILLA AND POST-PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (8/7/14):Ultrasound guided biopsy with clip placement was performed for the large lymph node in the right axilla. Pathology result of this biopsy was malignant.Post-procedural mammographic images show Hydromark clip within the main mass, and s-shaped clip at posterior upper aspect in the right breast. A coil clip is present in the right axillary lymph node.
Biopsy proven right breast cancer with metastatic right axillary lymph nodeBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.