Ms. Wasik submitted outside study for review. Submitted for review are unilateral mammogram (1/14/2016 and 1/19/2016), ultrasound (1/14/2016 and 1/19/2016), MR (1/18/2016) performed at Little Company of Mary Hospital and Health Care Centers, Evergreen Park, Illinois. For comparison, prior mammograms dating back to 2013 are available. MAMMOGRAM 1/14/2016: Three standard and spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is increased mammographic density involving the superior portion of the right breast. In the superior central breast, there is an asymmetry with associated architectural distortion, spanning approximately 7 cm. Additionally, loosely scattered heterogeneous calcifications are seen throughout the right breast. Scattered benign calcifications are present on the left. ULTRASOUND 1/14/2016: Static images of the right breast and axilla were submitted. At the 12:00 position 7 cm from nipple, at the site of palpable abnormality there is a mixed echogenicity mass measures up to 2.8 cm with internal vascularity. Static images of the right axilla demonstrate a normal morphology lymph node measuring up to 2.2 cm.MRI 1/18/2016:Axial T1, fat suppressed T2 and fat-suppressed pre and postcontrast sequences were submitted and analyzed with Dyna CAD. There is moderate heterogeneous fibroglandular tissue and mild background parenchymal enhancement in both breasts.In the right breast, there is clumped non mass enhancement in a segmental distribution predominantly involving the upper inner quadrant. This correlates to the area of architectural distortion and calcifications seen on the mammogram. This area demonstrates rapid uptake with persistent enhancement on dynamic evaluation. The entire extent of abnormality measures 7.9 x 3.0 x 2.6 cm (AP x TV x CC). No suspicious enhancement elsewhere in the right breast.In the left breast, there enhancing foci are seen consistent with background enhancement. No suspicious mass or non mass enhancement. There are a few axillary lymph nodes seen bilaterally, none suspicious in appearance.ULTRASOUND/CORE BIOPSY AND POST BIOPSY MAMMOGRAM 1/19/2016:Static images submitted show ultrasound-guided core biopsy of an irregular mixed echogenicity mass in the 12-1:00 position of the right breast 4-7 cm from the nipple, measuring up to 3.9 cm. Internal vascularity is present. Targeting appears appropriate. A clip was placed as is seen on the post biopsy ultrasound and CC mammogram view. The clip may overly calcifications on the ML view. Per the report, preliminary pathology report demonstrated infiltrative ductal carcinoma.Static images of a normal morphology left breast 2:00-3:00 lymph node measuring up to 1.3 cm is shown on this day, correlating with MRI.
Extensive mammographic abnormality of the superior right breast correlating with a large area of clumped nonmass enhancement on MRI in the superior right breast measuring up to 7.9 cm. Per outside hospital radiology report, pathology revealed infiltrating ductal carcinoma, which is concordant with imaging.No evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.