Ms. Lichtenstein submitted outside studies for review.Submitted for review are:-Bilateral mammogram dated 9/13/2016 performed at Northwest Memorial Healthcare-Right breast ultrasound dated 9/13/2016 performed at Northwestern Memorial Healthcare.-Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure mammogram dated 9/14/2016 performed at Northwestern Memorial Healthcare.-Bilateral breast MRI dated 9/27/2016 performed at Rush University Medical Center.For comparison, bilateral diagnostic mammogram dated 10/24/2014 and right breast ultrasound dated 3/18/2015 are available. BILATERAL MAMMOGRAM:Bilateral CC and MLO views; ML, MLO, and spot magnification views of the right breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C).There is a linear marker overlying a scar on the right breast. There are postsurgical changes from right lumpectomy, noting architectural distortion, increased density, and surgical clips in the upper inner right breast at posterior depth. There is a 12 mm cluster of calcifications along the anterolateral aspect of the lumpectomy site. There is a partially obscured mass in the upper outer right breast at posterior depth, similar to prior mammogram dated 10/24/2014. There is a partially obscured mass in the upper outer right breast at mid depth, similar to prior mammogram dated 10/24/2014.There are stable postsurgical changes of the left breast, noting architectural distortion, increased density, and surgical clips in the upper outer quadrant. No new mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in the left breast. Scattered benign calcifications are present.Benign appearing lymph nodes are projected over both axillae. There are surgical clips in the right axilla.RIGHT BREAST ULTRASOUND:Static images from targeted right breast ultrasound are submitted.In the right breast, 10:00, 6 cm from the nipple, there is a 0.8 x 0.6 x 0.7 cm hypoechoic mass, previously 0.7 x 0.8 x 0.7 cm on prior ultrasound dated 3/18/2015.In the right breast, 11:00, subareolar region, there is a 0.7 x 0.5 x 0.7 cm hypoechoic mass, previously 0.8 x 0.7 x 0.8 cm on prior ultrasound dated 3/18/2015.In the right breast, 12:30, 4 cm from the nipple, there is a 0.4 x 0.3 x 0.4 cm hypoechoic mass, previously 0.5 x 0.3 x 0.5 cm on prior ultrasound dated 3/18/2015.STEREOTACTIC CORE BIOPSY, RIGHT BREAST:Pre- and postfire images from stereotactic core biopsy of the right breast, specimen radiographs, and post procedure CC and LM views of the right breast were submitted.Calcifications in the upper inner quadrant of the right breast were targeted for biopsy. Targeting appears appropriate. Specimen radiographs demonstrate calcifications within the cores. Postprocedure mammograms demonstrate a dumbbell-shaped clip along the anterolateral aspect of the lumpectomy site. There are residual calcifications 7 mm posterior to the clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement.There are postsurgical changes in the upper inner quadrant of the right breast. There is a seroma in the right breast lumpectomy site, measuring 3.7 x 1.5 x 2.6 cm. Susceptibility artifact from surgical clips is seen along the anterior and posterior aspect of the seroma cavity. There is no abnormal enhancement around the seroma cavity or elsewhere in the right breast. There are scattered complicated cysts in the right breast, corresponding to the right breast masses seen on ultrasound. No right axillary or internal mammary lymphadenopathy.There are postsurgical changes in the upper outer quadrant of the left breast with susceptibility artifact from surgical clips. No abnormal enhancement in the left breast. Numerous scattered benign enhancing foci are present, but no focus is uniquely suspicious. No left axillary or internal mammary lymphadenopathy. There is a 2.6 x 2.2 x 2.5 cm hepatic cyst.OUTSIDE PATHOLOGY (per report):A. Right breast, upper inner, with calcifications, stereotactic needle core biopsy (BI-RADS 4A):Ductal carcinoma in situ (DCIS), nuclear grades 2 and 3, cribriform and solid types with apocrine features and focal necrosisLobular carcinoma in situ (LCIS), classic typeB. Right breast, upper inner, without calcifications, stereotactic needle core biopsy (BI-RADS 4A):Focal ductal carcinoma in situ (DCIS), nuclear grade 2, solid type
1. Biopsy-proven right breast DCIS along the anterolateral aspect of the lumpectomy site, for which no suspicious MR enhancement is seen. Continued surgical management is recommended.2. Previously described right breast sonographic masses are stable from 3/18/2015 and correspond to complicated cysts on the MRI.3. Stable postsurgical changes of the left breast. No mammographic or MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.