A patient submitted outside study for review. Submitted for review are diagnostic mammogram (3/18/15), left breast ultrasound (3/18/15), images from ultrasound guided biopsy and post procedural unilateral left mammogram(3/18/15) performed at Memorial SB, and MRI (4/7/15) performed at Elkhart General Hospital. For comparison, mammograms dated 4/4/14 and 2/12/13 are available. MAMMOGRAM (3/18/15): Three standard views of both breasts, and a single spot compression view of the left breast, were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There has been interval development of a 3.4 cm mass in the upper inner left breast, which persists on spot compression imaging. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. ULTRASOUND (3/18/15): Images labeled "Left breast PALP" at the 9-10:00 position, 6-8 cm from the nipple demonstrate a lobulated hypoechoic mass with angular margins measuring 2.1 x 1.5 x 2.4 cm. IMAGES FROM US GUIDED LEFT BREAST BIOPSY and POST-PROCEDURAL MAMMOGRAM (3/18/15): Submitted images from ultrasound guided biopsy of the hypoechoic mass at the 10:00 position of the left breast demonstrate appropriate targeting. A clip was placed. Post-procedural mammogram demonstrates a twist-shaped clip along the posterior margin of the mass.MRI (4/7/15): MRI was performed without and with contrast as per outside hospital protocol. There is a unifocal enhancing mass at the 10:00 position of the left breast measuring 4.2 x 3.7 x 4.1 cm. No further areas of enhancement are appreciated in the left breast. A 0.5 cm benign focus of enhancement is present at the 6:00 position of the right breast. No further areas of enhancement are present in the right breast. No abnormal axillary lymph nodes are appreciated.PATHOLOGY: Per outside report, pathology at 10:00 Left breast reveals poorly-differentiated invasive ductal carcinoma.
Unifocal 4.2 cm mass at the 10:00 position of the left breast, corresponding to the patient's known invasive ductal carcinoma. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.