A patient submitted outside studies for review. Submitted for review are diagnostic mammogram and ultrasound dated 6/1/2015, ductogram and ultrasound-guided biopsy with postprocedural mammogram dated 6/2/2015, and breast MRI dated 6/4/2015, performed at Franciscan alliance. For comparison, screening mammogram and ultrasound performed at St. Margaret Mercy North dated 5/2/2007 and breast MRI dated 4/2/2007 performed at University of Chicago, are available. Family history of breast cancer diagnosed in mother at age 59. Diagnostic mammogram dated 6/1/2015 performed for the complaint of right nipple discharge for 4 days: Two standard views of both breasts, right ML view and 3 spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple subcentimeter partially circumscribed masses present in both breasts are minimally increased from prior exams, previously documented to be cysts . No suspicious microcalcifications or areas of architectural distortion are noted in either breast. Right breast Ultrasound dated 6/1/2015: In the subareolar right breast at 9:00 there is a 7 x 7 mm hypoechoic mass. In the 3:00 subareolar area there is a focal dilated duct with low internal echoes which may represent mass or debris. A biopsy of both lesions was recommended at this time.Right breast ductogram dated 6/2/2015: 3 images are provided. A single duct was cannulated with mild areas of focal ectasia but no mass or filling defect.Right breast ultrasound-guided biopsy and postprocedural mammogram dated 6/2/2015: Biopsy of the 9 o'clock right breast mass demonstrated atypical intraductal papilloma, concordant with imaging findings. Biopsy of the 3:00 right breast mass demonstrated ductal ectasia with usual ductal hyperplasia and inflammatory changes, also concordant with imaging findings. Postprocedural mammogram demonstrated a ribbon clip placed at the 9:00 site and a wing clip was placed at the 3:00 side.Bilateral breast MRI dated 6/4/2015: Images were reviewed primarily on PACS and DynaCAD.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple bilateral T2 bright T1 low signal masses in both breasts are consistent with cysts, some with peripheral rim enhancement. Retroareolar susceptibility artifact is consistent with clip placement. In the right breast at 12:00 there is a focus of enhancement with associated high T2 signal likely representing a cyst or fibroadenoma. At 8:30 in the right breast a small enhancing focus seen on the prior exam compatible with lymph node or fibroadenoma, unchanged. There is no suspicious or uniquely enhancing lesion corresponding to the known intraductal papilloma or otherwise within either breast. No abnormal lymph nodes are identified in either axillary region.
1. Right breast atypical intraductal papilloma (ribbon clip at 9:00) for which surgical consultation is recommended. No additional suspicious lesions are noted in either breast.2. Multiple bilateral benign-appearing breast cysts and mild ductal ectasia in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.