76-year-old female with biopsy proven right breast cancer. The patient underwent right and left breast biopsy at outside institution, but no post-biopsy mammogram was submitted. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There are 2 hydromark clips at upper outer quadrant in the right breast, separating approximately 7 mm. These clips are placed at the malignant lesion (ILC) proven initially. There is another hydromark clip at upper inner quadrant in the right breast. This is the second malignant lesion (DCIS), proven subsequently. Distance between clips at upper outer quadrant and upper inner quadrant is approximately 6 cm.In the left breast, there is a 2 cm round mass at upper outer quadrant, likely a hematoma from recent biopsy. A hydromark clip is present at anterior inner aspect of this hematoma. A lesion on the MRI (11/23/16) which was supposed to be a target for this biopsy is located near 12:00 position . However, the marker clip and hematoma is located upper outer aspect. The biopsy results were ALH, stromal fibrosis. Linear marker overlies 12:00 position in the left breast, denoting the area of prior surgery which shows architectural distortions.
Marker clips are placed to the patient's biopsy sites; 2 clips at right upper outer quadrant for the original malignancy, one clip at right upper inner quadrant for the second malignancy, and one at left upper outer quadrant for the lesion showing non-malignant result. Distance between the 2 clips of original and second malignancy in the right breast is approximately 6 cm.A marker clip in the left breast is laterally located, however the target lesion was centrally located. Submission of biopsy images with report is recommended to determine whether the biopsy was appropriately performed. If there is evidence of mistargeting, repeat MRI guided biopsy may be needed. Final recommendation will be conveyed after all images and reports are reviewed. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.