Ms. Casey submitted outside studies for review.Submitted for review are:-Bilateral breast MRI dated 7/12/2016 performed at Silver Cross Hospital-Bilateral mammogram dated 7/12/2016 performed at Silver Cross Hospital-Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure right breast mammogram performed at Silver Cross HospitalFor comparison, bilateral mammogram dated 8/15/2014, left breast ultrasound dated 2/6/2015, bilateral breast MRI dated 2/9/2015, and images from a left breast ultrasound-guided biopsy dated 2/17/2015 are available. Older exams from this institution are also available. BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is scattered fibroglandular tissue bilaterally. There is minimal background parenchymal enhancement.No abnormal enhancement in either breast. There are postsurgical changes in the upper outer posterior left breast with stable mild enhancement near the surgical site. Biopsy clip artifact is seen within the area of postsurgical changes. No abnormal enhancement in either breast. No axillary or internal mammary lymphadenopathy. Post surgical changes noted in the left axilla. BILATERAL MAMMOGRAM:Bilateral CC and MLO views and spot magnification views of the right breast are submitted.The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B).There is a suspicious 11 mm cluster of pleomorphic calcifications in the upper outer quadrant of the right breast at posterior depth. There is a smaller 3 mm cluster of calcifications 6 mm posterosuperior to this cluster. When measured together, the calcifications span approximately 1.2 x 1 x 1 cm (AP x TV x CC).There are expected postsurgical changes in the upper outer quadrant of the left breast at posterior depth. Biopsy clip is seen in the upper left breast at posterior depth on the MLO view. Scattered benign calcifications are present in the left breast. No new mass, suspicious microcalcifications, or nonsurgical architectural distortion in the left breast.STEREOTACTIC CORE BIOPSY, RIGHT BREAST:Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure CC and ML view mammograms of the right breast are submitted.A suspicious cluster of pleomorphic calcifications in the upper outer quadrant of the right breast are targeted for biopsy. Targeting appears appropriate. Specimen radiograph demonstrates calcifications within one of the cores. Postprocedure mammograms demonstrate a dumbbell-shaped clip in the upper outer quadrant of the right breast that is displaced inferiorly by 1.3 cm. There are residual calcifications 8 mm posterosuperior to the biopsy site.OUTSIDE PATHOLOGY (per report):The core specimens samples of the 10 o'clock RIGHT breast demonstrate ductal carcinoma in situ, cribriform type with necrosis and microcalcifications, nuclear grade 2.
1. Biopsy proven right breast DCIS. The biopsy clip is displaced 1.3 cm inferiorly. There are residual calcifications posterosuperior to the biopsy site. Continued surgical management is recommended.2. Expected postsurgical changes of the left breast are not changed. No mammographic or MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.