Ms.Georgy Ann Peluchiwski, 48 years old, submitted outside studies for review. She has a family history of breast cancer in her sister diagnosed at 43, cousin at 36, and grandmother at 60.Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 11/3/2015MRI breast 1/15/2016MRI guided biopsy imaging 1/21/2016Postprocedure mammogram 1/21/2016Images submitted for comparison:Mammogram 11/3/2014, 5/6/2013 MAMMOGRAM 11/3/2015:Two standard views with tomosynthesis were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Tomosynthesis imaging is not reviewable.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. MRI BREASTS 1/15/2016:Multisequence sagittal and axial MRI breast with and without contrast were performed as per outside MRI breast protocol. The breasts are composed of scattered fibroglandular tissue. There is mild background parenchymal enhancement. Kinetic analysis is not possible.Right breast:In the central right breast, far posterior depth, there is a clumped nonmass enhancement measuring 1.2 x 0.5 x 2.3 cm (AP x ML X SI). No additional suspicious enhancement is identified in the right breast.Left breast:No suspicious enhancement is identified in the left breast. Incidental note is made of the 7 mm enhancing mass with T2 high signal in the upper outer left breast, middle depth, which likely corresponds to the small intramammary lymph node seen on older mammograms.Visualized axilla is unremarkable.A 5 mm high T2 signal area in the liver without associated enhancement likely represents a benign process such as a cyst or hemangioma.MRI GUIDED BIOPSY OF RIGHT BREAST 1/21/2016: Previously identified nonmass enhancement in the right posterior breast is the target for the biopsy. The targeting appears appropriate.POST PROCEDURE MAMMOGRAM 1/21/2016: A clip is placed in the the central right breast posterior depth, expected position.PER OUTSIDE PATHOLOGY:A. Right upper outer breast clumped nonmass enhancement; MRI guided core needle biopsy:- Invasive ductal carcinoma, grade 2- Ductal carcinoma in situ, grade 3, solid type with lobular extension and prominent lymphocytic reaction.- Fragments of skeletal muscle.
MRI detected 2.3 cm biopsy proven malignancy in the central and posterior right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.