A patient submitted outside study for review. Patient has a strong family history of breast cancer. Submitted for review are mammograms and targeted bilateral breast ultrasound dated 6/7/2016, bilateral ultrasound-guided breast core biopsies dated 7/5/2016, and breast MRI dated 7/20/2016 performed at St. Margaret Mercy . BILATERAL DIAGNOSTIC MAMMOGRAMS DATED 6/7/2016: Three standard views of both breasts, with additional left CC and MLO spot compression views, were obtained. The breast parenchyma is composed of scattered fibroglandular elements.Triangular marker overlying the left upper outer quadrant indicates location of palpable concern. There is an underlying isodense noncalcified mass with posteriorly indistinct margin measuring up to 3.9 cm.Within the right upper outer at posterior depth, there is a gently lobulated mainly circumscribed isodense mass measuring up to 2.5 cm. Additional smaller benign appearing masses are present in both breasts.No suspicious microcalcification or architectural distortion. Axillary lymph nodes appear normal bilaterally.BILATERAL BREAST ULTRASOUND DATED 6/7/2016:Targeted ultrasound of the left breast at the 1:00 position 8 cm from the nipple, in the area of palpable concern, reveals an oval heterogeneous predominantly hypoechoic mass measuring 4.8 x 1.6 x 4.6 cm. This mass presents mild-to-moderate internal vascularity.Additional smaller similar-appearing masses are present in the left breast, at 12:00, 2:00, 2:30, 3:00, and 9:00.Targeted ultrasound of the right breast at the 11:30 o'clock position 12 cm from the nipple presents a lobulated heterogeneous predominantly hypoechoic mass measuring 2.3 x 1.4 x 2.2 cm with internal vascularity.Additional smaller similar appearing masses are present in the right breast, specifically at 5:00, 12:00, and 11:00.BILATERAL US GUIDED CORE NEEDLE BIOPSIES DATED 7/5/2016:Ultrasound-guided biopsy of the largest mass within the right breast, at 11:30 12 cm from the nipple was performed with subsequent clip placement.Ultrasound-guided biopsy of the largest mass within the left breast, at the 1:00 position 8 cm from the nipple was performed with subsequent clip placement.Postprocedure mammogram demonstrates appropriate targeting. Percutaneously placed hydromark clip is located along the posterosuperior aspect of the biopsy cavity on the right side. Surgical pathology revealed complex fibroepithelial lesion, completed excision was recommended.Percutaneously placed butterfly clip is located along the superolateral biopsy cavity in the left side. Surgical pathology revealed fibrocystic changes including fibrosis and duct ectasia. This latter result was considered discordant with imaging findings, mainly due to presence of fibrosis, and surgical excision was recommended.BREAST MRI DATED 7/20/2016.A breast MRI was recommended prior to surgery to determine if any of the other masses detected on imaging should undergo biopsy. Heterogenous breast parenchyma noted in both breasts. There is moderate background parenchymal enhancement bilaterally.Within the right upper outer breast, at the 11:30 position approximately 9 cm from the nipple, there is a heterogeneously enhancing mass measuring 1.8 x 1.6 x 2.1 cm , with adjacent susceptibility artifact from postbiopsy clip along the posterior aspect of the mass. This finding corresponds to the site of biopsy-proven complex fibroepithelial lesion for which surgical excision was recommended.Within the right upper inner quadrant, there is a 0.7 cm oval enhancing mass with dark internal septations compatible with fibroadenoma. Smaller enhancing foci are identified throughout the right breast, demonstrating persistent kinetics.Within the left upper outer quadrant at the 1:00 position, approximately 5 cm from the nipple, there is a heterogeneously enhancing mass measuring 3.9 x 3.2 x 3.5 cm associated with susceptibility artifact from percutaneously placed biopsy clip along the lateral aspect of the mass. This finding corresponds to biopsy-proven fibrocystic changes, with fibrosis and duct ectasia for which surgical excision was recommended due to the past discordance. Other smaller benign appearing masses are visualized within the left breast with persistent kinetics, some with mammographic correlate.No suspicious lymphadenopathy.
1. Left 1:00 mass measuring up to 3.9 cm, for which surgical excision was recommended at outside hospital due to presence of fibrosis and consequent rad-path discordance. Histopathologic slides will be reviewed at the University of Chicago, and recommendations will be made once results are available.2. Right 11:30 mass measuring up to 2.1 cm, corresponding to complex fibroepithelial lesion for which surgical excision was recommended at outside hospital. Histopathologic slides will be reviewed at the University of Chicago, and recommendations will be made once results are available.3. Multiple bilateral circumscribed masses with persistent kinetics, are likely benign.4. Initial report suggested presence of nonmass enhancement in the left lower outer quadrant, for which MRI guided biopsy was recommended. On review of the study, findings are felt to most likely represent benign breast parenchyma. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.