A patient submitted outside study for review. Submitted for review are digital mammographic images (8/4/15, 8/6/15, 9/1/15), ultrasound images of left breast (8/4/15, 8/6/15, 9/1/15), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (9/1/2015), breast MRI (9/9/15) performed at Adventist Hinsdale Hospital. For comparison, digital mammographic images (4/9/14, 12/11/12), ultrasound images (4/9/14, 12/11/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (8/4/15, 8/6/15, 9/1/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at upper outer quadrant of left breast, denoting the area of palpable lump. There is a developing focal asymmetry with architectural distortions at the site of palpable lump, at the upper outer quadrant in the left breast, measuring approximately 4 cm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. 'ULTRASOUND IMAGES OF LEFT BREAST (8/4/15, 8/6/15, 9/1/15):An irregularly shaped hypoechoic mass is visualized at 1:30 position in the left breast measuring 17 x 10 mm. The lesion is unchanged in one month follow-up.A normal appearing lymph node is visualized in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/1/2015):Ultrasound guided biopsy was performed for the mass at 1:30 position in the left breast, with an appropriate needle placement. A marker clip is placed at anterior-medial aspect of the focal asymmetry with distortion at upper outer quadrant. Per outside radiology report, the biopsy result was malignant; invasive lobular carcinoma.BREAST MRI (9/9/15):Imaging protocol is outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a large irregularly shaped mass at upper outer quadrant measuring 47 x 43 x 44 mm (AP x LR x CC). This enhancing lesion corresponds to the proven carcinoma, but the size of the lesion appears larger in the MRI. No abnormal enhancing lesions in the right breast.No abnormal lymph nodes are identified in either axillary region.
Biopsy proven invasive lobular carcinoma in the left breast. Size of the tumor is larger on the MRI than on the conventional imaging.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.