A patient submitted outside study for review. Submitted for review are screening mammogram dated 4/2/2014, and left diagnostic mammogram dated 10/15/2014, performed at High Tech Medical Park in Palos Heights, IL as well as screening MRI dated 12/2/2014 and images from MRI guided left breast biopsy dated 12/19/2014 performed at Silver Cross Hospital. For comparison, bilateral screening mammogram dated 2/28/2013 and left diagnostic mammogram dated 3/23/2013 are available. MAMMOGRAMS (4/2/2014 and 10/15/2014): Two standard views of both breasts, and spot magnification views of the left breast were obtained on 4/2/2014. Additional left MLO, CC and magnification was performed in October. The breast parenchyma is extremely dense, limiting mammographic sensitivity, unchanged in pattern and distribution.Scattered benign calcifications are present bilaterally. A loosely grouped cluster of calcifications is present within the upper central, slightly inner left breast. Some of these calcifications demonstrate a layered appearance on magnification views, suggesting milk of calcium. The calcifications in the left upper central breast are stable in the short term. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. BILATERAL SCREENING MRI (12/2/2014): MRI was performed without and with gadolinium as per outside hospital protocol. There is extremely dense fibroglandular tissue bilaterally, with moderate background parenchymal enhancement, which may decrease the sensitivity of the examination. Multiple cysts are present bilaterally. At the approximate 12:00 position of the left breast, there is a circumscribed, enhancing mass measuring 0.7 x 0.7 x 0.9 cm which demonstrates hyperintense signal on T2 imaging. Dark internal septations are noted. The mass may represent a fibroadenoma. No additional enhancing masses are present in either breast. IMAGES FROM MRI GUIDED LEFT BREAST BIOPSY (12/19/2014): Images from an attempted left breast MRI-guided biopsy were submitted. There is redemonstration of a circumscribed, enhancing mass at the approximate 12:00 position of the left breast. Per report, biopsy was not performed at the time of imaging due to difficulties in accessing the target site.
Enhancing, circumscribed mass at the 12:00 position of the left breast. While this may represent a fibroadenoma, follow up MRI, and possible MRI-guided left ultrasound, should be performed. Additionally, the patient is due for bilateral annual mammogram at this time. It is suggested that the MRI be performed before mammography/ultrasound so that any work-up needed due to the MRI can be performed at the time of the diagnostic mammogram. BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter.