A patient submitted outside studies for review. Submitted for review are a diagnostic mammogram and ultrasound (7/18/16), right diagnostic mammogram (8/13/2016), and left diagnostic mammogram (9/28/2016) performed at Presence Saint Joseph Hospital. In addition, a breast MRI (10/11/2016) was done at Advocate Illinois Masonic Hospital. For comparison, a prior mammogram is available dated 7/25/2014. On 7/18/16, a screening mammogram was done at Presence Saint Joseph Hospital. The CC views are limited due to inadequate compression. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There is a new cluster of calcifications spanning 2.2 cm within the right upper outer breast posterior depth, without a CC correlate secondary to technique. In addition, there are a few calcifications in the right breast noted 3.5 cm anteromedial to the cluster. In the left breast, a new faint cluster of calcifications is present in the upper outer quadrant. On 8/13/16, a right diagnostic mammogram with spot magnification and exaggerated CC views was done at Presence Saint Joseph Hospital. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There redemonstration of a cluster of indeterminate calcifications within the right upper outer breast at posterior depth, which span 2.2 cm and overlie the pectoralis muscle on MLO view. There is also redemonstration of a few faint calcifications 3.5 cm anteromedial to the cluster. A same day ultrasound was done, which did not demonstrate a correlate lesion.On 9/28/16, a left diagnostic mammogram with spot magnification views was done at Presence Saint Joseph Hospital for a suspicious cluster of calcifications within the left upper outer quadrant. Same day stereotactic biopsy was done with clip placement. Post-procedure mammogram demonstrates a clip in the appropriate location with a 10 mm hematoma along the anterior aspect. Specimen radiograph shows the majority of the calcifications within the specimen. Pathology returned DCIS grade 2, which is concordant with mammographic findings.On 10/11/16 a breast MRI was completed at Advocate Illinois Masonic Hospital.Exam was post processed by Dynacad. Exam is limited due to motion along the lateral aspects of both breasts. No definite biopsy clips identified. On postcontrast images, extensive parenchymal enhancement is seen bilaterally. There is asymmetric bandlike non-mass enhancement along the posterolateral aspect of the right breast at the 9:00 position, but it is difficult to determine if it is parenchymal enhancement or non mass enhancement associated with the calcifications.
Cluster of calcifications within the left upper outer quadrant with pathological diagnosis of DCIS grade 2. Clip in appropriate location. Additional cluster of suspicious calcifications within the right upper outer breast spanning 2.2 cm at posterior depth, with a couple of additional faint calcifications located more anteromedially. On MRI, there is question of asymmetric band-like non-mass enhancement along the posterolateral aspect of the right breast. However, extensive background parenchymal enhancement limits evaluation. Recommend repeat MRI during day 7-11 of the menstrual cycle for further evaluation.Stereotactic biopsy and post procedure mammogram of the right breast can be submitted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.