A patient submitted outside study for review. Submitted for review are:Ultrasound of the right breast dated 9/2/2016, ultrasound-guided core biopsy of the right breast dated 9/7/2016, performed at AMita health care institute. Bilateral breast MRI dated 9/19/2016 performed at Loyola hospital.For comparison,none are available. 1: Ultrasound of the right breast dated 9/2/2016:As per the report diagnostic mammogram was performed of both breast which are not submitted. Patient has history of a palpable mass in the right breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 2.4 x 2.9 x 3.6 cm with apical blood flow corresponding to the palpable abnormality at 11:00 position 11 cm from the nipple. Located at 12:00 position 3 cm from the nipple is another suspicious hypoechoic mass with irregular margins, taller than wide that measures 1.7 x 1.5 x 1.3 cm with apical blood flow. This mass also demonstrates some anterior intraductal extension with hyperechoic areas possibly calcifications within it, labeled at right breast 12:00 2 cm from the nipple with apical blood flow.2. Ultrasound of the right breast dated 9/7/2016:Patient underwent ultrasound-guided core biopsy of the index mass, palpable in the right breast 11:00 position 11 cm from the nipple. 5 cores were obtained. Targeting appears adequate, clip coil was placed as per the imaging. Second site at 12:00 position 2 cm from the nipple was biopsied, 5 cores were obtained, ribbon clip was placed. Postprocedure mammogram was obtained as per the biopsy report however not submitted for review. Specimen radiograph was obtained from the cores of the biopsy sites (which site is not specified) and calcifications were noted at the biopsy site.Final pathology indicates DCIS grade 3 solid type at both sites.3: Bilateral breast MRI dated 9/19/2016:MRI images were uploaded on to Dyna CAD for postprocessing and were interpreted on Dyna CAD.Heterogenous dense breast parenchyma noted bilaterally. Moderate parenchymal enhancement noted bilaterally.Right breast 11:00 position palpable mass corresponds to biopsy-proven DCIS. A clip artifact is noted within the mass. The mass is irregular in shape with heterogenous enhancement and irregular margins, measuring 33 x 29 x 41 mm (AP X ML X CC). Second biopsy-proven area of DCIS is located anteriorly, approximately 19 mm anterior and medial to the previously described index mass. It presents as an irregular heterogeneously enhancing mass with a clip artifact within it that measures 22 x 24 x 31 mm (AP X ML X CC) located at 12:00 position anterior depth.Multiple additional masses are identified in the right breast that are located medial, posterior and anterior to the index mass. The posterior-most mass is located 2.5 cm posterior to the index cancer and approximately measures 9 x 8 x 13 mm (AP X ML X CC), located at 12:00 position posterior depth. There is non mass enhancement adjacent to the masses seen extending anterior to the anteriormost biopsy-proven area of DCIS reaching up to the nipple.Total extent approximately measures 11.6 x 7.2 x 8.4 cm (AP X ML X CC).No abnormality noted within the left breast. No suspicious bilateral axillary lymph nodes noted.
1. Multicentric right breast cancer, with maximum extent measuring up to 11.6 cm on MRI. 2 sites biopsied at outside hospital with results consistent with DCIS. The palpable mass in the right breast 11:00 position is highly worrisome for invasive cancer and multiple additional masses also appear very some for invasive cancer.2. No abnormality noted within the left breast or bilateral axillary lymph nodes.3. Diagnostic mammogram or postprocedure mammograms have not been submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.