Ms.Joo Lee, 44 years old, submitted outside studies for review. Images performed at Edward Hospital submitted for review: Screening mammogram 12/19/2015Diagnostic mammogram of left breast 12/30/2015Stereotactic guided biopsy imaging and postprocedure mammogram 1/6/2016MRI breast 1/14/2016Images submitted for comparison:None MAMMOGRAM 12/19/2015 and 12/30/2015: Standard views of both breasts and 3 additional views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements. 3 adjacent clustered microcalcifications are present in the left upper outer breast together measuring 3 x 4.4 cm. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast or elsewhere in the left breast. STEREOTACTIC GUIDED BIOPSY OF THE LEFT BREAST 1/6/2016: Previously identified calcifications in the left upper outer breast at 2:00 and 1:00 position are the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on both specimen radiograph. POST PROCEDURE MAMMOGRAM 1/6/2016: A bow tie shaped clip is placed in the the left breast breast 2:00 position.A U shaped clip is placed in the the left breast breast 1:00 position. The distances between the 2 clips is at least 3.6 cm. A few residual calcifications are best seen on the ML view.MRI breast 1/14/2016:Multiplanar and multisequence MR breast with and without contrast was performed as per outside MRI protocol. The breasts are composed of scattered fibroglandular tissue. There are mild background parenchymal enhancement in both breasts. Images are reviewed without the benefit of kinetic data, a limitation. Left breast:Susceptibility artifact from the 2 biopsy clips are noted in the left breast 2:00 and 1:00 position, respectively. There are nonmass enhancement surrounding 2 clips with a total span of 4.0 x 3.7 x 3.0 cm (AP x ML X SI). The anterior most of this enhancement is approximately 2.3 cm from the nipple base. Small area of enhancement in the far posterior central breast likely represents the background enhancement as symmetric enhancement is also present in the contralateral breast.Right breast:No suspicious enhancement is noted.Axillary lymph nodes:Two prominent lymph nodes are noted in the high left axilla measuring up to 14 and 15 mm, respectively. One of the lymph node is immediately lateral to the pectoralis muscle.The right axillary lymph nodes are unremarkable.PER OUTSIDE PATHOLOGY:A. left breast lesion, 2:00 position; stereotactic guided core needle biopsy:- DCIS, grade 2, cribriform type with the associated dystrophic calcifications.B. left breast lesion, 1:00 position; stereotactic guided core needle biopsy:- DCIS with focal apocrine feature and lobular cancerization, grade 2.
Biopsy proven DCIS in the left upper-outer breast corresponding to the 4.4 cm calcifications on the mammogram and 4 cm non mass enhancement on MRI. Prominent lymph nodes in the left axilla could be reactive and related to her biopsies.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.