A patient submitted outside study for review. Submitted for review are digital mammographic images (9/29/2016), ultrasound images of left breast (9/29/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (9/30/2016), ultrasound images of left axilla (10/4/2016), breast MRI (10/5/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (9/29/2016):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A triangular marker is placed at upper inner quadrant of left breast, denoting the area of palpable lump. There is an ill-defined mass at posterior lower inner quadrant in the left breast, posterior to the palpable marker. On the secondary captured tomo images, the mass appears partially circumscribed measuring 17 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (9/29/2016):There is a microlobulated hypoechoic mass measuring 22 x 18 mm at 8:00 position, 6-cm from the nipple, in the left breast. Blood flow of this mass is confirmed with Doppler study.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/30/2016):Ultrasound guided biopsy for the left 8:00 mass was performed. Targeting appears good, and a marker clip is placed into the mass. Postprocedural mammograms show that a marker clip is located within the mass at inferior central aspect.The biopsy result was malignant as per outside radiology report.ULTRASOUND IMAGES OF LEFT AXILLA (10/4/2016):There are 2 adjacent hypoechoic masses in the left axilla, consistent with enlarged lymph nodes with effaced hila. The larger lymph node nature is 41 x 28 x 29 mm and the smaller lymph node measures 26 x 18 x 20 mm. Ultrasound guided needle biopsy was performed for the larger lymph node. A biopsy needle appears appropriately placed. A sonographically visible clip was placed into the target lymph node.Pathology results are not available to us.BREAST MRI (10/5/2016):Dynamic contrast enhanced breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple small cysts in both breasts.A large irregularly-shaped enhancing mass, which is a proven malignancy, is present at 5:00 - 7:00 position, measuring 37 x 39 x 30 mm (AP x LR x CC) in the left breast. The mass extends near the skin at the anterior lower portion. In the left axilla, several enlarged lymph nodes are seen; the largest lymph node contains a marker clip measuring 30 x 37 mm (AP x LR) on axial plane. An enlarged internal mammary lymph node, measuring 7 mm, is seen in the left parasternal region.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.
1. A biopsy proven malignant tumor in the left breast with multiple highly suspicious abnormal lymph nodes in the left axilla and a suspicious left internal mammary lymph node. Pathology slides should be reviewed at the University of Chicago. 2. No MRI evidence of malignancy in the right breast or right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.