A patient submitted outside studies for review. Submitted for review are diagnostic mammogram and ultrasound(6/24/15), stereotactic biopsy and specimen radiographs (6/26/15), and MRI breast (7/1/15)performed at Community Health Care System. For comparison,standard mammogram (9/19/13) are available. Diagnostic mammogram: Three standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Bilateral subpectoral breast implants are present.In the left upper outer breast, there is a 1.8 cm spiculated mass containing minimal calcifications. This lesion extends to the level of the pectoralis muscle.Slightly inferiorly/medially to the aforementioned lesion, there is an additional asymmetry measuring 5 mm.Ultrasound: In the 3:00 position of the left breast, a targeted ultrasound was performed. There is a microlobulated hypoechoic mass with irregular margins arranged in an anti-parallel manner measuring 1.3 x 0.8 x 1.3 cm. There is no increased vascularity. This lesion correlated with mammographic findings.Please note that initially this lesion was labeled as located in the 9 o'clock position, however, a limited ultrasound performed later in the day confirmed that this lesion was in fact located at the 3 o'clock position. This was also reported on a submitted document.Stereotactic biopsy and specimen radiographs: A stereotactic biopsy was performed on the targeted left breast lesion at the 3 o'clock position. Multiple cores were obtained. A biopsy clip was attempted to be placed.Post procedure mammogram demonstrates no biopsy clip. The clip appeared to have flowed out during residual bleeding.Specimen radiographs demonstrated multiple cores, some of which may demonstrate faint calcifications.MRI breast: At the 3 o'clock position of the left breast, the known spiculated mass pathologically proven to represent ILC grade 2 is again appreciated. The lesions measures 19 x 16 x 7 mm (AP X ML X CC). The posterior aspect of this lesion extends to the underlying pectoralis muscle. There is no abnormal enhancement of the muscle to suggest involvement. The anterolateral aspect of the lesion is 7 mm from the skin surface. There are adjacent post biopsy changes noted along the lateral aspect of the lesion. Clip artifact is not well visualized. 4 mm inferior to this lesion there is a second round focus of abnormal enhancement with linear anterior extension measuring 10 x 5 x 5 mm. The total extent of both of these lesions is 29 x 15 mm in the CC x AP dimension. The right breast is unremarkable.No abnormal appearing lymph nodes are seen.
1. Multifocal left breast mass with inferior extension as seen on mammogram and MRI with total extent of 29 x 15 mm. This mass has been biopsy proven to represent ILC grade 2.2. A biopsy clip was deployed, but absent from the post biopsy films. The clip may have flowed out during the residual bleeding from the procedure. New clip placement is recommended.3. The right breast was subsequently biopsied x 3 with benign pathology.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.