A patient submitted outside study for review. Submitted for review are 2 view mammograms of the bilateral breasts, 2 spot compression views of the right breast, and right grayscale ultrasonographic images dated 7/14/2016 and bilateral breast MRI dated 8/9/2016 performed at Saint Alexius Medical Center. Mammogram 7/14/16:Focal lobulated asymmetry is visualized within the retroareolar region of the right breast measuring approximately 5.2 x 4.9 cm extending towards the nipple that persists on spot compression views. No significant associated calcification is visualized. This asymmetry likely corresponds to patient's area of palpable abnormality.Ultrasound 7/14/16:Targeted grayscale ultrasound of the right breast at 12:00 about 3 cm from the nipple demonstrates a largely hypoechoic heterogeneous appearing lesion without significant posterior shadowing measuring 3.4 x 2.1 cm. Further, questionable satellite lesions are also visualized. No color images were obtained, as such vascularity was not assessed.In the interim between Ultrasound and Breast MRI FNA was performed for lack of correlate ultrasound findings when compared to the mammogram.Breast MRI 8/9/2016:There is abnormal non-mass contrast enhancement with many lateral and inferior satellite lesions within the central and superior right breast that reaches anteriorly to the nipple. The total extent of the pathologic enhancement measures 6.0 cm in the medial to lateral dimension, 7.7 cm in the AP dimension, and 5.5 cm in the superior to inferior dimension. Further, two axillary lymph nodes are pathologically enlarged, the largest of which measures 18 x 9 mm.
Abnormal non-mass enhancement on breast MRI dated 8/9/2016 as specifically outlined above (more disease seen on MRI than mammogram) dated 7/14/2016 and is compatible with malignancy. Further, two pathologically enlarged right axillary lymph nodes are visualized. Ultrasound of the right axilla can be performed.Kindly submit the pathology report of the right breast biopsy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.