A patient submitted outside study for review. Submitted for review are bilateral screening/diagnostic mammography 3/4/2015, bilateral breast MRI and MRI guided biopsy 3/14/2015, and right diagnostic mammography 3/25/2015 performed at Northwestern Memorial Hospital. For comparison, bilateral screening mammography 4/14/2011 are available. 46 year old female per report referred to outside diagnostic mammography for left breast symptoms. Patient was reportedly breast feeding and suddenly stopped from the left breast. Family history of ovarian cancer in aunts and cousins. Patient believes she underwent genetic testing in the past with negative results. 3/4/2015 SCREENING/BILATERAL DIAGNOSTIC MAMMOGRAPHY AND POSTPROCEDURAL MAMMOGRAM Two standard views of both breasts, additional right ML and four spot magnification views were provided. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Cluster of calcifications in the right upper outer breast, posterior depth, have developed. On spot magnification, they are pleomorphic and measure 0.5 cm. Additional scattered benign calcifications are stable.These calcifications were biopsied reportedly under stereotactic guidance (no images available). Post-procedural orthogonal mammogram of the right breast demonstrate post biopsy change including foci of gas and X shaped clip in the previous location of the cluster of calcifications in the 9 o'clock position. No residual calcifications are visualized.3/14/2015 DIAGNOSTIC BILATERAL BREAST MRI AND 3/25/2015 MRI GUIDED BIOPSY:Exam is limited by motion artifact, more so on the right. A vitamin E marker was placed along the right upper outer breast. Postbiopsy hematoma is noted in the 9 o'clock position with only thin peripheral enhancement around the cavity. In the 11 o'clock position, there is non-mass enhancement measuring 2.3 x 1.4 x 1.8 cm, which was subsequently biopsied under MRI guidance. MRI images from the biopsy were not submitted, however the MRI biopsy clip placement on 3/24/2015 mammogram is accurate for the findings on MRI.3/24/2015 DIAGNOSTIC RIGHT MAMMOGRAM:Two standard views of the right breast were provided. X shaped biopsy clip from stereotactic guided biopsy of cluster of calcifications with reported pathology of DCIS is located in the 9 o'clock position posterior depth. Previously seen post biopsy change have resolved. No residual calcifications are noted. Trimark clip from MRI guided biopsy is located in the 11 o'clock position with reported benign results. Postbiopsy change including foci of gas and small hematoma are noted.
1.Right 9 o'clock 5 mm cluster of calcifications with reported biopsy results of DCIS after stereotactic guided biopsy. X-shaped clip with no residual calcifications are visualized on subsequent mammogram. 2.Right 11 o'clock non-mass enhancement with reported benign biopsy results after MRI guided biopsy. Trimark clip is visualized on subsequent mammogram. Benign pathology is concordant. 3.No mammographic or MRI abnormality in the left breast.4.No abnormal lymph nodes.5.Recommend submission of outside pathology materials and surgical consultation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.