A patient submitted outside study for review. Submitted for review are digital mammographic images (10/7/16, 10/14/16), ultrasound images of left breast (10/14/2016), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (10/18/2016), breast MRI (10/24/2016) performed at outside institution. For comparison, digital mammographic images (7/31/2015) are available. DIGITAL MAMMOGRAPHIC IMAGES (10/7/16, 10/14/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There is a new mass, measuring approximately 1 cm, at posterior 6:00 position in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (10/14/2016):A hypoechoic mass, measuring 7 x 5 mm, with shadowing is detected at 6:00 position in the left breast, corresponding to the mass seen on the mammogram. A normal-appearing lymph node is detected in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (10/18/2016):Ultrasound guided biopsy was performed for the mass at 6:00 position with an appropriate needle placement. Postprocedural mammographic images show a marker clip at the biopsy site.Per outside radiology report, the result was malignant; invasive ductal carcinoma grade 1 and focus of atypical ductal hyperplasia.BREAST MRI (10/24/2016):The study was performed per outside imaging protocol.A focal non-mass enhancement is present at posterior 6:00 position, measuring 16 x 14 x 12 mm (AP x LR x CC) in the left breast. This is the proven breast cancer. A marker clip is seen immediate medial to this lesion.In the right breast, there is a focal non-mass enhancement at posterior 10:00 position, measuring 17 x 12 x 10 mm.No abnormal lymph nodes are identified in either axillary region.
1. A biopsy proven unifocal left breast cancer2. A focal non-mass enhancement in the right breast at posterior 10:00 position on MRI. MR directed ultrasound study is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.3. No abnormal lymph nodes in either axillary region on MRIBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: U - Ultrasound Study Needed - No Letter.