A patient submitted outside study for review. Submitted for review are mammographic wire localization (6/8/2016); specimen radiograph (6/8/2016) and breast MRI (8/8/ 2016) performed at Advocate South Suburban Hospital . For comparison, breast mammogram 10/27/2015; ultrasound 10/27/2015 and MRI 10/20/2015 are available. Stereotactic wire localization (6/8/16): Mammogram demonstrates a left retroareolar, central area of architectural distortion/mass measuring approximately 5 cm with clip located centrally. Compared to mammogram 10/27/15 this lesion appears slightly less dense, but mostly unchanged in size. This mass was initially identified on breast ultrasound 9/22/2015. An irregular suspicious hypoechoic mass was noted in the left breast 3:00 position that measured 3.3 x 2.7 x 4.3 cm. An MRI performed 10/20/2015, confirmed an oval heterogenously enhancing mass within the left central breast, retroareolar location measuring approximately 4.0 x 4.0 x 4.2 cm (AP X ML X CC). Ultrasound-guided biopsy of this mass was performed on 10/27/2015, with post biopsy mammogram demonstrating clip in appropriate position within the central mass. Pathology result is not available.Mammogram 6/8/2016, also demonstrates a second clip within the left upper breast, at site of prior lymph node biopsy. This lymph node was first identified on breast MRI 10/20/2015, within the left upper breast measuring 1 cm. This lymph node was confirmed on second look ultrasound performed 10/27/2016, which demonstrated an abnormal intramammary lymph node with thickened cortex within the left breast, 10:00 location, 7cm from the nipple. Subsequent ultrasound-guided biopsy was performed on 10/27/2015, with postbiopsy mammogram demonstrating the biopsy clip in appropriate position. Pathology result is not available.Mammographic guidance needle localization images 6/8/2016 demonstrate the left breast placed in an alphanumeric grid using lateral to medial approach. 2 wires were placed, with one wire targeting the clip within the central left breast mass and the second wire targeting the left intramammary lymph node biopsy clip, in appropriate position.Specimen radiograph 6/8/2016: Specimen radiograph of the mass demonstrates a clip within the breast mass with wire within it. The mass extends to the specimen margin at 3B, 4C, 4D and 6B. Second specimen radiograph shows the clip within the lymph node and the lymph node and wire to be within the specimen. Final pathology has not been submitted. Breast MRI 8/8/2016 post processed on DYNACAD: There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Within the left central breast at site of prior lumpectomy, a seroma cavity measures 2.5 x 1.4 x 1.1 cm (AP X ML X CC). There is an enhancing spiculated mass, located at 12:00, abutting the superolateral seroma cavity margin, measuring 1.0 x 1.0 x 0.8 cm (AP X ML X CC). Two additional enhancing foci are identified anterior to this mass, and measures 5 mm. The total extent of disease measures 2.8 cm.There is postsurgical changes within the left lateral breast, at site of intramammary lymph node excision and enhancement within the skin along the left lateral breast, probably postsurgical change.No abnormal enhancement is identified within the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.
Status post left breast lumpectomy at 2 sites, with post lumpectomy MRI showing residual disease abutting the seroma cavity. No abnormality in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.