A patient submitted outside study for review. Submitted for review are digital mammographic images (1/8/15, 1/16/15), ultrasound images of right breast (1/13/15), breast MRI (1/29/15) performed at Christie Clinic. DIGITAL MAMMOGRAPHIC IMAGES (1/8/15, 1/16/15):The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram. There is an architectural distortion at the upper outer quadrant in the right breast. A cluster of pleomorphic calcifications are present at posterior 9 o'clock position, posterior lateral from the architectural distortion in the right breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/13/15):An irregularly shaped, shadowing lesion, measuring 10 x 13 mm at 9:00 - 10:00 position in the right breast, likely corresponding to the architectural distortion on mammogram. Calcifications are present near this lesion. A lobulated hypoechoic mass, measuring 10 x 7 mm is detected at 8 o'clock position. At 1 o'clock position, there is a circumscribed hypoechoic mass, measuring 20 x 8 mm. A benign appearing lymph node is detected in the right axilla.BREAST MRI (1/29/15):Study was performed with a protocol outlined in the outside radiology report.RIGHT BREASTThere is an irregularly shaped mass measuring 25 x 15 x 23 mm (AP x LR x CC) at 9:00 - 10:00 position (anterior - middle), with internal marker clip artifact. This corresponds to the architectural distortion on mammogram. There is an enhancing mass with internal clip, measuring 8 x 8 x 8 mm at middle 7 o'clock position. These two lesion are likely post-biopsy because of the presence of cip. Per U of C pathology report, right 10:00 lesion was malignant; IDC 2, and right 8 o'clock lesion was benign; fibroadenoma. There are several enhancing masses around the 9:00 - 10:00 mass; the largest mass is located at middle 9:00 position, measuring 10 x 10 x 10 mm. This mass has dark internal septations, suggesting fibroadenoma. A round mass at middle 7 o'clock position, measuring 8 x 8 x 7 mm, is most distant from the 9:00 - 10:00 mass. Overall measurement of these masses is 46 x 28 x 66 mm.In addition, there is a circumscribed mass measuring 16 x 9 x 12 mm at posterior 2 o'clock position, corresponding to the mass soon on the ultrasound at 1 o'clock position. This mass is benign appearing, likely fibroadenoma. LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.
Biopsy proven carcinoma in the right breast at 9:00 - 10:00 position, and biopsy proven fibroadenoma at right 8 o'clock position. Multiple additional masses in the right breast. Recommend MR directed ultrasound for right 7 o'clock mass, middle 9 o'clock mass and possible biopsy.BIRADS:6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter. 