Ms.JILL CHAVIN, 55 years old, submitted outside study for review. An enhancing focus was noted in the left breast on screening MRI, which was subsequently biopsied.Images performed at Northwestern Memorial Hospital submitted for review: MR directed breast biopsy 12/24/2015, postprocedural mammogram 12/24/2015, diagnostic breast MR 12/18/2015, diagnostic mammogram 4/15/2015, and screening mammogram 4/9/2015.Images submitted for comparison:Screening mammogram 4/9/2014, screening mammogram 4/16/2013, screening MR breast 10/28/2013. SCREENING MAMMOGRAM 4/9/2015: Two standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Patient was recalled for focal asymmetries in the right breast at outside hospital.Right unilateral diagnostic MAMMOGRAM 4/17/2015: Two standard views as well as spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. SCREENING BREAST MRI 12/18/2015: Outside hospital MRI with contrast was uploaded on Dyna CAD for further interpretation. There is a new enhancing focus in the left breast at the 5:00 position, mid to anterior depth, measuring approximately 4 mm in maximal diameter. No additional abnormal enhancement is evident in either breast. Stable bilateral small enhancing foci elsewhere noted. No axillary or internal mammary lymphadenopathy is seen.MR BIOPSY OF THE LEFT BREAST BREAST 12/24/2015: Previously identified enhancing focus in the left breast 5:00 position, anterior to mid depth is the target for the biopsy. Targeting appears appropriate.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (10/19/2015): A cylindrical clip is placed in the left breast at the 5:00 position, anterior to mid depth.PER OUTSIDE PATHOLOGY:A. the left breast breast lesion, 5:00 position; MR guided core needle biopsy:- Breast tissue with focal atypical ductal hyperplasia, usual ductal hyperplasia, columnar cell change, sclerosing adenosis, fibroadenomatous changes, and rare microcalcifications.
Enhancing focus in the left breast at the 5:00 position compatible with biopsy proven atypical ductal hyperplasia.Clip in appropriate location.Surgical consultation and pathology review is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.