A patient submitted outside study for review. Submitted for review are right breast mammogram 9/9/2015, ultrasound of the right breast 9/8/2015, ultrasound guided biopsy imaging 9/9/2015, right breast mammogram 9/8/2015, MRI breasts 9/4/2015, mammogram of the left breast 8/10/2015 and ultrasound of left breast 8/11/2015 performed at Center for breast care at River Forest, IL. For comparison,mammogram 9/15/2014, ultrasound of the left breast 9/15/2014 are available. Patient initially presented to outside hospital for follow-up of the multiple cysts in the left breast. Mammogram of the left breast on 8/10/2015 demonstrated interval decrease in size of the masses in the medial aspect of the left breast. In addition, there is a focal asymmetry in the far posterior left breast only seen MLO view without a definite sonographic correlate for which breast MRI was recommended. On ultrasound 8/11/2015, there is interval decrease in size of the multiple cysts with the largest cyst at 8:00 in the left breast measuring 9 mm vs 12 mm on the prior. Additionally, there is an another 9 mm indeterminate periareolar hypoechoic mass at the 2:30 o'clock of left breast. MRI was recommended to follow up with the focal asymmetry in the far posterior left breast on the mammogram and the 9 mm indeterminate hypoechoic mass at the 2:30 o'clock left breast. This most likely represents a complicated cyst. MRI BREAST 9/4/2015MR breast was performed as per outside MRI imaging protocol. The breasts are composed of dense fibroglandular tissue bilaterally. There is mild background parenchymal enhancement. A 10 x 11 x 18 mm (LR x AP X SI) mass is present in the posterior right breast, 1:00 location. This mass is abutting the pectoralis muscle without enhancement in the muscle. No additional suspicious mass or nonmass enhancement is noted in either breast. Multiple cysts are noted on the T2-weighted imaging, most prominent on the left breast. Bilateral axillary lymph nodes are unremarkable.DIAGNOSTIC MAMMOGRAM OF THE RIGHT BREAST 9/8/2015:The breast is composed of heterogeneously dense fibroglandular tissue. A small 10 mm partially visualized focal asymmetry is noted in the posterior upper inner right breast, corresponding to the MRI finding.DIAGNOSTIC ULTRASOUND OF THE RIGHT BREAST 9/8/2015:At 1:00 radian, 8 cm from the nipple, there is a 10 x 7 x 9 mm hypoechoic irregular mass, which also corresponds to the MRI and mammogram finding.ULTRASOUND GUIDED BIOPSY 9/9/2015 :Biopsy needle pierces through the hypoechoic mass at the 1:00 location of the right breast. 4 core biopsies were performed as per the provided imaging.POSTPROCEDURE MAMMOGRAM 9/9/2015:CC, ML and exaggerated CC views of the right breast demonstrated a long X shaped clip in the posterior, upper outer right breast, at the site of the biopsied mass.Pathology showed IDC grade 3
Biopsy-proven malignancy in the posterior upper inner right breast. Biopsy clip in the appropriate location. No additional imaging evidence of malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.