A patient submitted outside study for review. Submitted for review are digital mammographic images (11/30/15), ultrasound images of right breast (11/30/2015), breast MRI (12/18/2015), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (12/24/2015) performed at Silver Cross Hospital. For comparison, digital right mammographic images (8/28/15), ultrasound images of right breast (8/28/15) are available. DIGITAL MAMMOGRAPHIC IMAGES (11/30/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A triangular marker is placed at upper outer quadrant of right breast, denoting the area of palpable concern. Increased trabecular pattern with architectural distortions are present at upper outer aspect of the right breast. This abnormal area measures at least 17 x 30 mm on MLO view. A low-lying right axillary lymph node is larger than one on the prior study.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT BREAST (11/30/2015):Ill-defined hypoechoic lesion with increased blood flow is visualized at 10:00 position, 5 cm from nipple. This lesion likely corresponds to the abnormal findings on the mammogram. No measurement is recorded on the images.BREAST MRI (12/18/2015):Breast MRI was performed with a protocol outlined in the outside radiology report.Diffuse abnormal non-mass enhancement is seen in the right breast measuring 71 x 84 x 110 mm (AP x LR x CC). The non-mass enhancement extends to the nipple. An enlarged lymph node is seen at right axillary tail measuring 19 x13 mm.No abnormal enhancement is seen in the left breast. No abnormal lymph node is seen in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (12/24/2015):Biopsy was performed for the area of palpable lump at 12:00 position in the right breast. The needle is placed anterior aspect of an ill-defined hypoechoic lesion. Another biopsy was performed for the enlarged lymph node at axillary tail. The needle is placed at inferior aspect of the target lymph node.Postprocedural mammographic images demonstrate a marker clip placed at anterior 12:00 position in the right breast.No marker clip was placed to the lymph node in the axillary tail.The pathology result for the right breast biopsy was malignant; microinvasive carcinoma, high nuclear grade, ductal carcinoma in situ intermediate to high nuclear grade. The pathology result of the right axilla was benign; fragment of fibroadipose tissue, no lymph node tissue.
Biopsy proven microinvasive carcinoma with DCIS in the right breast. MRI demonstrated extensive non-mass enhancement. Biopsy of the right axillary tail lymph node was benign, however; it is likely a mistargeting because there is no lymph node tissue within the specimen. Repeat biopsy of the lymph node can be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.