A patient submitted outside study for review. Submitted for review are digital mammographic images (2/24/15), ultrasound images of right breast and right axilla (2/24/15), images from ultrasound guided biopsy and postprocedural right mammographic images (2/24/15), breast MRI (3/3/15), images from MRI guided biopsy of right breast with post procedural right mammographic images (3/11/15) performed at Midwest Center for Advanced Imaging. DIGITAL MAMMOGRAPHIC IMAGES (2/24/15):The breast parenchyma is composed of scattered fibroglandular elements. A triangular marker is placed at lower outer quadrant of right breast, denoting the palpable lump.There are four round masses aligned anteroposteriorly in the right lower inner quadrant, with total measurement 40 x 18 mm. Immediately posterior to these masses, there is a focal asymmetry measuring 20 x 16 mm. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (2/24/15):Multiple masses abutting each other are present at 3:30 to 4:00 position in the right breast. Total measurement is reported as 38 x 21 x 15 mm. A few normal appearing lymph nodes are seen in the right breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (2/24/15):Core biopsy was performed under ultrasound guidance with appropriate needle placement. Postprocedural right mammographic images show a marker clip placed at the posterior portion of the multiple masses in the right lower inner quadrant.Per outside radiology report, the pathology results were solid papillary, possible invasive carcinoma.BREAST MRI (3/3/15):Breast MRI was performed with a protocol outlined in the outside radiology report. Multiple enhancing masses are seen at lower inner quadrant, middle to posterior depth in the right breast, consistent with proven carcinoma. There is a posteriorly extending non-mass enhancement from these masses. Total measurement of these lesions is 68 x 22 x 27 mm (AP x LR x CC). No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST WITH POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (3/11/15): MR guided biopsy was performed for the area of non-mass enhancement at posterior lower inner quadrant in the right breast. Postprocedural mammographic images show a marker clip placed at far posterior lower inner quadrant in the right breast, approximately 43 mm posterior from the marker clip placed at ultrasound-guided biopsy.Per outside radiology report, the pathology results showed invasive ductal carcinoma and ductal carcinoma in situ.
Biopsy proven carcinoma in the lower inner quadrant in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.