A patient submitted outside study for review. Submitted for review are digital mammographic images (4/3/15), breast MRI (10/17/15), ultrasound images of right breast (10/28/15), images from ultrasound guided biopsy of right breast with postprocedural right mammographic images (10/28/2015), images from MRI guided biopsy of right breast and postprocedural right mammographic images (11/3/2015) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (9/20/2013, 9/4/2013, 7/10/2012, 4/13/2010), ultrasound images (9/20/2013)are available. DIGITAL MAMMOGRAPHIC IMAGES (4/3/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Scattered benign calcifications are present in both breasts.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. BREAST MRI (10/17/15):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass measuring 13 x 14 x 15 mm (AP x LR x CC) at anterior 12:30 position in the right breast. There are a few satellites immediately inferior to this mass, and linear non-mass enhancement immediately medial to the mass. Overall measurement of these lesions is 16 x 20 x 20 mm. There is a benign-appearing enhancing focus at the central aspect in the right breast.There are multiple enhancing foci in the left breast, likely parenchymal enhancement.No abnormal lymph nodes are identified in either axillary region.ULTRASOUND IMAGES OF RIGHT BREAST (10/28/15):An ill-defined, irregularly-shaped hypoechoic mass measuring 13 x 9 x 15 mm at 12:00 position, 3 cm from nipple, is detected, corresponding to the enhancing mass on the MRI. There is an echogenic rim around this mass, suggesting malignancy.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/28/2015):Ultrasound guided biopsy for the right breast mass at 12:00 position was performed with an appropriate needle placement. A coil clip is placed at anterior 12:00 position on the postprocedural mammogram. Per outside radiology report, pathology was malignant, invasive carcinoma with mixed ductal and lobular features grade 1.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/3/2015):MRI guided biopsy was performed for the enhancing focus at the central aspect in the right breast. Targeting appears appropriate. Post procedural mammographic images show a rod shaped clip at posterior upper outer quadrant in the right breast. Per outside radiology report, the pathology result was benign.
1. Biopsy proven invasive carcinoma in the right breast at 12:00 - 12:30 position. Breast MRI demonstrated mass with a few satellites and a linear non-mass enhancement. 2. Biopsy-proven benign lesion at the central aspect in the right breast.3. No MRI or mammographic evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.