A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram dated 9/12/2015Bilateral breast MRI dated 11/7/2015MR directed ultrasound dated 11/11/2015Bilateral breast MR guided biopsy dated 11/16/2015 with postprocedure mammogram performed at Midwest Center for Advanced Imaging. For comparison,mammogram 9/6/2014 are available. Patient has history of left breast DCIS with excision in 2008, diagnosed with Cowden syndrome 1. Bilateral diagnostic mammogram dated 9/12/2015: 2 standard views of both breasts were obtained. Tomo synthesis cannot be interpreted. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scar marker overlies the left lower inner quadrant. Multiple scattered benign calcifications seen in both breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over the left axillae.2. Bilateral breast MRI:Images were uploaded on Dyna CAD workstation for final interpretation.Linear area of non mass enhancement identified in the right breast 10:00 position approximately measuring 16 x 2 x 10 mm in the AP X ML x CC dimension.In the left breast 7:00 position there is a circumscribed oval mass is intensely enhancing that measures 8 x 5 x 7 mm (AP X ML x CC) with most likely benign morphology.Outside hospital report mentions an enhancing nodule measuring 8 x 7 x 5 mm at 12:00 position of the left breast which appears to represent parenchymal enhancementNo abnormality noted in the axillary region.3. MR directed ultrasound: No correlate was identified to the lesions identified in the outside hospital.4. Bilateral breast MRI biopsy: Right breast 10:00 and 2 sites in the left breast (7:00 and 12:00) were biopsied under MRI guidance. Targeting appears adequate. Clips were placed. A dumble-shaped clip is identified in the right upper-outer quadrant at appropriate location. A rod-shaped clip is identified in the left upper inner quadrant. A dumble-shaped clip is identified in the left lower inner quadrant.Pathology: Right breast 10:00 MR biopsy: DCIS high-grade, malignant and concordantLeft breast 7:00 MR biopsy: Benign breast tissue showing evidence of dense fibrosis suggestive of scarLeft breast 12:00 MRI guided biopsy: Benign breast tissue showing evidence of patchy fibrosis with duct ectasia and apocrine metaplasia with radiation type changes.Both left breast results are benign and concordant
MRI guided biopsy right breast 10:00 linear non mass enhancement shows DCIS.2 sites left breast MRI guided biopsy results are benign and concordant.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.