A patient submitted outside study for review. Submitted for review are screening and diagnostic mammogram (7/15/2015, 7/21/2015), ultrasound ( 7/21/2015), ultrasound-guided biopsy (7/27/2015), post biopsy mammogram (7/27/2015) and MRI (8/11/2015) performed at Palos Community Hospital, Indiana. For comparison,standard mammogram (6/11/2014 and 3/11/2013) are available. MAMMOGRAMS(7/15/2015, 7/21/2015): Two standard views of both breasts were obtained with tomosynthesis. Additional exaggerated CC lateral views of both breasts were also submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is very subtle architectural distortion in the right central breast middle depth near 12:00 position, spanning approximately 10 mm. These are likely more evident on the dynamic tomosynthesis views which are not available.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND (7/21/2015): Standard images from targeted ultrasound of the right breast shows a 6 x 7 x 3 mm lobulated hypoechoic mass in the right breast 12:00 position 4 cm from the nipple, without internal vascularity. Also in the right breast 4:00 position 6 cm from nipple there is a 7 x 8 x 4 mm anechoic lesion, consistent with a simple cyst.US Bx (7/27/2015): Static images from ultrasound-guided right breast core biopsy show appropriate targeting of the right breast mass 12:00 position 4 cm from the nipple with clip placement. Per the radiology report, pathology results showed invasive ductal carcinoma and DCIS.POST BIOPSY MAMMOGRAM (7/27/2015):Postbiopsy MLO and CC views of the right breast show a percutaneously placed biopsy clip within the medial upper quadrant of the right breast near the 12-1:00 position.MRI (8/11/2015):There is mild background parenchymal enhancement, right greater than left. Within the right breast upper inner quadrant there is a 10 x 12 mm enhancing mass (AP x TV) with clip artifact seen centrally and washout kinetics consistent with biopsy-proven cancer. Post biopsy changes are present adjacent to this mass. There are scattered nonspecific enhancing foci bilaterally, which demonstrate persistent enhancement kinetics and are most consistent with background enhancement. To confirm the stability of those foci, follow up MRI in 6 months is recommended.No additional areas of enhancement in the either breast or axilla to suggest malignancy.Incidental note of right hepatic dome cyst.
Concordant biopsy proven right breast 12:00 position invasive ductal carcinoma and DCIS measuring 10 x 12 mm on MRI. Multiple foci in both breasts on MRI, right greater than left, likely parenchymal enhancement. To confirm the stability of those foci, follow up MRI in 6 months is recommended. Per the outside hospital radiology report, pathology results showed invasive ductal carcinoma and DCIS. No additional suspicious foci of enhancement in either breast or axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.