A patient submitted outside study for review. Submitted for review are: 1. Diagnostic mammogram of both breast with tomo synthesis and right breast ultrasound dated 7/18/20162. Right breast biopsy with postprocedure mammogram dated 7/25/2016 performed at Christ Center for breast care, Oak lawn . For comparison,none are available. History of right lumpectomy 1996 for breast cancer. 1. Diagnostic mammogram of both breast with tomo synthesis and right breast ultrasound dated 7/18/2016: 2 standard views of both breasts and additional exaggerated CC lateral view of the left breast and spot magnification views of the left breast were submitted for review. Tomo synthesis images could not be uploaded for interpretation. The breast parenchyma is heterogeneously dense, distributes fairly symmetrically in both breasts. Postsurgical changes in the form of architectural distortion and scarring identified in the posterior central aspect of the right breast best seen on the CC view and exaggerated CC lateral view.There is a 15 mm partially visualized spiculated mass with highly suspicious calcifications with linear distribution in the right breast 10 to 11:00 position posterior depth best seen on the exaggerated CC lateral view. Suspicious calcifications are seen extending anteriorly in a discontinuous fashion approximately measuring 6 cm. This is best seen on the ML spot magnification view. Further evaluation with MRI would be helpful to assess extent of disease.Few hyalinizing fibroadenomas and benign calcifications are seen in the anterior depth. Focal asymmetry in the right retroareolar region is incompletely evaluated, this could represent asymmetric normal glandular tissue however special attention should be given to this area on MRI.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 1.4 x 1 x 1.5 cm with calcifications within it. This is located in the right breast 10:00 position, 11 cm from the nipple.Subsequent biopsy of the right breast was performed on 7/25/2016 and a clip was placed. Clip is identified within the mass on the exaggerated CC lateral view.Pathology revealed IDC grade 3 with DCIS which appears concordant.
Biopsy-proven IDC grade 3 with DCIS in the right breast 10:00 position with clip placement.Extensive calcifications extend anteriorly from the mass approximately 6 cm. Further evaluation with MRI would be helpful to assess extent of disease. Focal asymmetry in the right retroareolar region appears indeterminate and can be evaluated on MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.