A patient submitted outside study for review. Submitted for review are digital mammographic images (2/26/16, 7/19/16), ultrasound images of right breast (7/19/16), breast MRI (8/3/16), MRI guided biopsy of right breast and post-procedural mammogram (8/11/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (2/26/16, 7/19/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A marker clip from prior biopsy is present at posterior upper outer quadrant in the right breast.A focal asymmetry with possible architectural distortions is seen at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/19/16):A few irregularly shaped hypoechoic lesions are detected within the upper outer quadrant in the right breast.BREAST MRI (8/3/16):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing mass measuring 7 x 8 x 10 mm (AP x LR x CC) at 12:00 position in the right breast.Segmental non-mass enhancement, measuring 27 x 41 x 50 mm is present in the right upper outer quadrant, surrounding the mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.MRI GUIDED BIOPSY OF RIGHT BREAST AND POST-PROCEDURAL MAMMOGRAM (8/11/16):MRI guided biopsy was performed for 2 sites; the enhancing mass at 12:00 position (site #1), and non-mass enhancement at 10:00 position (site #2). A needle placement appears appropriate. A hematoma is present at 12:00 position after biopsy. Postprocedural mammogram demonstrates a coil clip at posterior 12:00 position, and a Hydromark clip at anterior 10:00 position.Per pathology report, the result of site #1 was malignant; invasive ductal carcinoma grade 1 with lobular features, ductal carcinoma in situ low-grade, and the result of site #2 was benign.
1. Biopsy proven carcinoma at posterior 12:00 position in the right breast.2. MR guided biopsy for non-mass enhancement in the right breast at upper outer quadrant was benign but discordant.If breast conservation surgery is planned, a needle localization for site #1 for lumpectomy, and site #2 for excisional biopsy is recommended.3. No mammographic or MR evidence of malignancy in the left breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.