Patient is a 55-year-old woman with strong family history of breast cancer. The patient submitted outside studies for review. Submitted for review are the following:-Bilateral screening mammogram 4/15/2015-MR 11/17/2015-MR guided Second Look ultrasound 11/30/2015.All of the studies were performed at Franciscan Alliance/St. Anthony Medical Center, Crown Point Indiana. For comparison,standard mammogram (2/21/2014, 3/15/2013, 12/29/2011) are available. BILATERAL SCREENING MAMMOGRAM 4/15/2015: Three standard views of both breasts and additional bilateral exaggerated CCL views were submitted. The breast parenchyma is extremely dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. A few bilateral microcalcifications are stable.Benign appearing lymph nodes are projected over the left axillae.BILATERAL SCREENING BREAST MRI 11/17/2015:There is large amount of dense heterogeneous fibroglandular tissue bilaterally. Mild amount of background parenchymal enhancement is present bilaterally. There are scattered subcentimeter rounded enhancing foci seen in both breasts, nonspecific and likely secondary to background parenchymal enhancement. This includes a 4 mm circumscribed rounded focus of enhancement seen in the right retroareolar region (series 10, image 50). This focus has typically benign kinetics on temporal evaluation.Normal size and morphology lymph nodes are seen in bilateral axilla, demonstrating fatty hilum.MRI GUIDED SECOND LOOK ULTRASOUND 11/30/2015:Targeted ultrasound was performed of the right retroareolar region further evaluate the foci of enhancement seen on MR. Unremarkable dense fibrotic tissue seen. No discrete suspicious solid or cystic masses are identified.Targeted ultrasound of the left axilla were also performed which demonstrate normal size and morphology lymph node with fatty hilum, similar to the mammogram and MRI.
Probably benign 4 mm circumscribed focus of enhancement in the slightly medial right retroareolar region, with typically benign kinetics. No correlate found on second look ultrasound. A 6 month follow-up MRI is recommended to assess stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.