A patient submitted outside study for review. Submitted for review are breast MRI (8/31/15), digital mammographic images (9/10/15), ultrasound images of both breasts (9/10/2015), images from ultrasound guided biopsy of right breast and right axilla with post procedural right mammographic images (9/10/2015) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (10/1/14, 10/1/13) are available. As per outside report, the patient is BRCA2 mutation carrier, and there is a strong family history of breast cancer. BREAST MRI (8/31/15):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 a slowly enhancing, oval shaped mass at the central aspect of right breast, measuring 8 x 5 x 5 mm (AP x LR x CC). An enlarged lymph node is present at low right axilla.In the left breast, there is an intramammary lymph node at posterior lower outer quadrant. No abnormal enhancement is seen in left breast.DIGITAL MAMMOGRAPHIC IMAGES (9/10/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Mildly enlarged lymph node is seen in the right low axilla.ULTRASOUND IMAGES OF BOTH BREASTS (9/10/2015):An oval hypoechoic mass with partially indistinct margins is detected at 10:00 position, 5 cm from nipple, in the right breast, likely corresponding to the mass seen on MRI.In the right lower axilla, there is a circumscribed oval mass with marked vascularity, likely an enlarged lymph node with effaced hilum.There is a possible normal intramammary lymph node at 3:00 position, 7 cm from nipple in the left breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND RIGHT AXILLA WITH POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (9/10/2015):Ultrasound guided biopsy of the mass in the right breast at 10:00 position, and the mass in the right axilla was performed with appropriate needle placement.Postprocedural mammograms demonstrates a coil clip at upper outer quadrant, and a wing clip in the left axillary mass.The pathology results are not available.
1. Status post ultrasound guided biopsy of the right breast mass and right axillary mass, both of which are initially detected on MRI. Pathology results are not available. Management should be determined based on the pathology results.2. No MRI or mammographic evidence for malignancy in left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.