A patient submitted outside study for review. Submitted for review are digital mammographic images (9/23/15), ultrasound images (9/23/15), breast MRI (2/29/16) performed at Northwestern Memorial Hospital. For comparison, breast MRI (6/26/15), digital mammographic images (9/29/14, 9/19/14, 9/11/14, 9/9/13), ultrasound images (9/29/14, 9/19/14) are available. History of benign right ultrasound guided biopsy at 6:00 position, and benign left stereotactic biopsy at upper outer quadrant. DIGITAL MAMMOGRAPHIC IMAGES (9/23/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Stable circumscribed oval mass is present at 6:00 position in the right breast, with a marker clip from prior benign biopsy.A percutaneously placed clip is identified at middle upper outer quadrant in the left breast, from prior benign biopsy. There are new amorphous calcifications at upper outer quadrant in the left breast, located posterior and superior to the marker clip. Area of calcifications measures approximately 4 x 2 cm on ML view (AP x CC).No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES (9/23/15):There are stable benign appearing hypoechoic masses at 10:00 position (9 x 5 mm, previously 8 x 5 mm), and at 11:00 position (5 x 3 mm, previously 5 x 3 mm) in the right breast. A biopsy proven benign mass at 6:00 position in the right breast measuring 19 x 5 mm (previously 24 x 6 mm).BREAST MRI (2/29/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a regional non-mass enhancement at 2:00 position in the left breast measuring 45 x 22 x 21 mm (AP x LR x CC). This non-mass enhancement likely corresponds to the area of developing calcifications on the mammogram.Multiple small masses and foci are present in both breasts, without significant changes from prior study.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.
Developing amorphous calcifications at upper outer quadrant in the left breast, with MRI correlate. Stereotactic core needle biopsy for these calcifications is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.