Ms.Erica Izraeli, 42 years old, submitted outside study for review. She initially presented for follow-up of a probable benign right breast mass at 9:00 position on May 4, 2016 with diagnostic workup demonstrating 2 groups of indeterminate calcifications in the upper outer right breast. 2 site stereotactic biopsy on 5/9/2016 revealed IDC grade 1 in the posterior group and ALH in the anterior group. Ultrasound-guided biopsy of the right breast 9:00 mass revealed fibroadenoma. Patient has a strong family history of breast cancer in her to and ovarian cancer in her grandmother. Images performed at Northwestern Memorial Health Care submitted for review: Mammogram 5/4/2016Ultrasound of 5/4/2016Stereotactic guided biopsy two sites 5/9/2016Postprocedure right breast mammogram 5/9/2016MRI breast 5/20/2016Ultrasound guided biopsy of right breast 5/24 2016Images submitted for comparison:Mammogram 4/30/2015 and 4/23/2014 MAMMOGRAM 5/4/2016: Three standard views of both breasts and 2 additional spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. In the right breast upper outer quadrant, there are 2 clusters of amorphous calcifications and punctate calcifications with associated architectural distortion measuring 2.8 x 4.3 cm. Stable intramammary lymph node in the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND 5/4/2016 : Static ultrasound images are submitted for interpretation.Right breast targeted ultrasound demonstrated a circumscribed, iso to slightly hypoechoic mass measuring 0.6 x 0.5 x 0.2 cm the right breast 9:00 position, 3 cm from the nipple. No other solid or cystic masses are identified in the upper outer right breast.STEREOTACTIC GUIDED BIOPSY OF RIGHT BREAST 5/9/2016: The anterior and posterior aspect of the clustered calcifications in the right breast upper outer quadrant were the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on one of the specimen radiograph. POST PROCEDURE MAMMOGRAM 5/9/2016: A dumbbell shape clip is placed in the posterior aspect of the right upper outer breast. One x shaped clip is in the anterior aspect of the right upper outer breast. Biopsy clips are at the expected locations. Small amount of residual calcifications are also present.MRI breast 5/20/2016:Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is marked background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST: There is artifact from the biopsy clip in the posterior right upper outer breast, 11:00 position. An irregular enhancing mass mass surrounding the biopsy clip measures 2.2 x 1.7 x 2.2 cm (AP x LR X SI). This corresponds to the biopsy-proven malignancy in the posterior right upper outer breast. There is no suspicious enhancement in the pectoralis minor muscle.Another susceptibility artifact is identified anterior and inferior to the above enhancing mass. There is rim enhancement associated with the biopsy track. This likely represents the biopsy site in the middle right upper outer breast.There is a 0.5 cm enhancing mass in the right breast 9:00 position approximately 3 cm from the nipple. This corresponds to the stable mass demonstrated on the prior ultrasound.LEFT BREAST:No suspicious enhancement is identified in the left breast. An intramammary lymph node is noted in the upper outer left breast.Axillae:Multiple nonspecific lymph nodes are identified bilaterally.ULTRASOUND-GUIDED BIOPSY OF right breast 9:00 mass 5/24/2016: Previously identified stable mass in the right breast 9:00 position is the target for the biopsy. Targeting appears appropriate.PER OUTSIDE PATHOLOGY:A. Posterior aspect of the right upper outer calcifications; stereotactic guided core needle biopsy:- Invasive ductal carcinoma, grade 1, with tubular features. LCIS with no associated microcalcifications and ADHB. Anterior aspect of the right upper outer calcifications; stereotactically guided core needle biopsy:-Atypical lobular hyperplasiaC. Right breast 9:00 masses; ultrasound-guided core needle biopsy:-Fibroadenoma- These results are concordant with the imaging findings.
1. 2.2 cm unifocal malignancy in the posterior right upper outer breast.2. ALH in the middle right upper outer breast.3. No malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.