Ms.ROSEMARY GRIFFIN, 61 years old, submitted outside study for review. Images performed at Advocate Christ Medical Center submitted for review: Screening mammogram with tomosynthesis 2/3/2015, targeted ultrasound of the right breast 12/15/2015, ultrasound guided biopsy of the right breast 12/15/2015, and contrast-enhanced MRI of the right breast 12/29/2015. MAMMOGRAM 2/3/2015: Two standard views of both breasts were obtained with tomosynthesis. The breast parenchyma is heterogeneously dense. There is a 26 x 36 mm focal asymmetry with associated architectural distortion in the central right breast, anterior to mid depth. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. The distortion is best seen only on the tomo synthesis images, especially on the CC view.RIGHT BREAST TARGETED ULTRASOUND 12/15/2015 : Static ultrasound images are submitted for interpretation.There is a 2.3 x 1.3 x 3.0 cm heterogeneously hypoechoic mass with indistinct margins, labeled as residing in the 11:00 position 3 cm from the nipple.In certain images the irregular mixed echogenic area appears to be larger than the provided measurement, approximately measuring 3.7 x 1.5 cm.ULTRASOUND-GUIDED BIOPSY OF RIGHT BREAST 12/15/2015: Previously identified mass in the right breast at the 11:00 position is the target for the biopsy. Targeting appears appropriate.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (10/19/2015): A clip is placed in the right breast 11:00 position anterior to mid depth, in the area of previously noted architectural distortion and asymmetry.PER OUTSIDE PATHOLOGY:A. The right breast breast lesion, 11:00 position anterior to mid depth; ultrasound guided core needle biopsy:- Ductal carcinoma in situ, cribriform type, nuclear grade 2. ER/PR positive.- Extensive sclerosing adenosis associated with microcalcifications.Bilateral Breast MRI 12/29/2015: Outside hospital MRI with contrast was post processed with Dyna CAD.Right breast: There is marked heterogeneous background enhancement which limits sensitivity of examination. There is a 4.6 x 3.0 x 2.9 (AP x ML x CC) area of clumped non mass enhancement in the 10:00 to 11:00 position in the anterior to mid depth right breast. The most anterior focus of this contrast enhancement resides approximately 1.0 cm from the nipple. Susceptibility artifact from the biopsy clip is noted in the central portion of this enhancement. No axillary lymphadenopathy is evident.Left breast: Marked heterogeneous background enhancement within the left breast which limits sensitivity of this exam. No abnormal enhancement is evident within the left breast. No axillary lymphadenopathy is evident.
Pathologically proven DCIS, only seen on tomography, which on the MR demonstrates clumped non mass enhancement, (larger than the corresponding tomographic and sonographic abnormality). If breast conserving therapy is considered, repeat ultrasound to evaluate the anterior extent of the non mass enhancement is recommended, as MR guided biopsy would be technically difficult given the location of the anteriormost focus behind the nipple.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.