A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as "area of pain/area of palp." There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.
Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.