A patient submitted outside study for review. Submitted for review are digital mammographic images (1/6/15), ultrasound images of right breast (1/6/15), images from stereotactic biopsy of right breast with specimen radiographs and post procedural right digital mammographic images (1/22/15) and breast MRI (1/22/15) performed at DuPage Medical Group. DIGITAL MAMMOGRAPHIC IMAGES (1/6/15):The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram. Highly suspicious pleomorphic type calcifications distribute segmentally in the lower outer quadrant of the right breast. These calcifications measure 55 x 34 x 37 mm (AP x LR x CC).No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT BREAST (1/6/15):There is an irregularly shaped hypoechoic area with internal multiple hypoechoic spots in the right breast at 7 o'clock position, corresponding to the mammographic findings. The sonographic images suggest intraductal lesion with calcifications.One abnormal lymph node with cortical thickening is present in the right axilla. Cortical thickness measures 4.4 mm.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPHS AND POST PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (1/22/15):Stereotactic core biopsy of the right breast calcifications was performed. Two sites of these calcifications were targeted; at posterior and anterior aspect. Specimen radiographs of both biopsies reveal multiple calcifications in the obtained cores.Post procedural right digital mammographic images show that a marker clip for the anterior biopsy site (dumbbell shaped) is displaced 2.5 cm medially. A marker clip for the posterior biopsy site (top hat) is at the posterior aspect within the group of calcifications.Per outside pathology report, the results for the posterior biopsy site were invasive ductal carcinoma, grade 3 associated with high-grade ductal carcinoma in situ, and the results for the anterior biopsy site were high-grade ductal carcinoma in situ.BREAST MRI (1/22/15):The study was performed with a protocol outlined in the outside radiology report.Segmental non mass enhancement is demonstrated at lower outer right breast at mid depth to posterior aspect, corresponding to the abnormal calcifications on the mammogram. This lesion measures 54 x 29 x 51 mm (AP x LR x CC). A marker clip is identified within the lesion at posterior aspect, located at 17 mm anterior from the posterior border. Another marker clip is identified at the central breast, mid-depth, displaced from the non-mass enhancement.An enlarged lymph node is present in the upper right axilla. It measures 15 mm in maximum diameter.No abnormal enhancing lesion in the left breast.
Biopsy proven invasive and in situ carcinoma in the right breast, with an enlarged right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.