A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. This lesion needs additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.
1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for the asymmetry at posterior upper outer quadrant in the work-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.