A patient submitted outside study for review. Submitted for review are two view post procedure left mammogram (08/25/16); procedure ultrasound of the left breast (08/25/16); MRI breast (08/17/16); 2 view post procedure right mammogram (08/04/16); procedural ultrasound of the right breast (08/04/16) were performed at Advocate Good Samaritan Hospital. For comparison, standard mammogram images (11/25/13) are available. Left breast procedural ultrasound (08/25/16): An indeterminate oval, circumscribed lesion in the left breast at the 10:00 position, approximately 7 cm from the nipple measures 7 x 7 x 3 mm, which was targeted for biopsy; the targeting appears appropriate. Additional subcentimeter cysts were seen in the 12:00 position, 2 cm from the nipple as well as the 2:00 position, 6 cm from the nipple.Postprocedural left mammogram (08/25/16): Two standard views of the left breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution from the prior study dated 11/25/13. A clip is seen within the left upper inner breast, at the 10:00 position, at the site of previous biopsy.Breast MRI (08/17/16): Bilateral breast MRI was performed per outside protocol. There is a heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Right breast: Clip artifact is seen in the right breast at the 12:00 position, well-situated within an irregular, enhancing mass, which measures 2.5 x 4.0 x 2.9 cm (AP X ML X CC). Extensive nonmass enhancement extends in all directions, but predominantly posterior and medial to this mass, in total extent measuring 6.9 x 5.4 x 5.4 cm (AP X ML X CC). Nonmass enhancement extends anteriorly within one centimeter of the nipple. Mass and nonmass enhancement correlates to patient's known right breast malignancy. No abnormal axillary lymph nodes are identified in the axillary region.Left breast: There are multiple small enhancing foci in the left breast. The most prominent area is within the left upper inner breast, at approximately the 10:00 position, with dark internal septations, measuring approximately 5 x 7 x 6 mm(AP X ML X CC) and could represent a benign fibroadenoma. No abnormal axillary lymph nodes are identified in the axillary region. Right breast procedural ultrasound (08/04/16): There is an irregular, poorly defined hypoechoic mass in the right breast at the 12:00 position, approximately 1 cm from the nipple, which was targeted for biopsy. Targeting appears appropriate.Postprocedural right mammogram (08/04/16): Two standard views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution from the prior study dated 11/25/13. A clip is seen within the right superior breast at mid depth, within the spiculated mass at the 12:00 position, at the site of previous biopsy. There is postbiopsy change with surrounding architectural distortion correlating to the site of patient's known malignancy.
1.Recommend submission of recent bilateral diagnostic mammograms.2.Awaiting pathology of the left breast biopsy. If malignant, appropriate action should be taken. If benign, however, a six-month follow-up with MRI is recommended.3.Recommend continued surgical management of the known right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.