A patient submitted outside study for review. Submitted for review are standard mammogram (07/03/2015 and 7/16/2015), ultrasound (07/03/2015 and 7/16/2015), and breast MRI (7/29/2015) performed at Advocate Trinity Hospital. For comparison,mammogram (11/07/2012, 7/16/2013, and 7/18/2014) are available. MAMMOGRAM (7/3/2015): Two standard views of both breasts were submitted. An exaggerated CC lateral and spot compression views of the right breast were also submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . A BB denotes the site of the palpable abnormality in the right breast. Deep to the BB is a high density mass with obscured margins measuring 32 x 35 mm. A few right axillary lymph nodes are also seen with the largest seen posteriorly on MLO view measuring 23 mm. Of note, these lymph nodes have not significantly increased in size when compared to the prior mammogram dating back to 11/7/2012.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND (07/03/2015): Static images from ultrasound of the right breast at the 10:00 position 7 cm from the nipple at the site of palpable abnormality demonstrates a 3.9 x 1.5 x 3.1 cm hypoechoic mass with lobulated margins and marked internal vascularity, highly suspicious for malignancy. Static images from ultrasound right axilla show a few indeterminate lymph nodes with mild cortical thickening, one of which is measured at 1.0 x 1.1 cm.ULTRASOUND-GUIDED BIOPSY AND POSTBIOPSY MAMMOGRAM (7/16/2015): Static images from ultrasound guided core biopsy of the right breast at the 10:00 position 7 cm show appropriate target of the hypoechoic mass and of one right axillary lymph node. Postbiopsy mammogram show a buckle clip within the central aspect of the right breast mass and a tophat clip within the right axilla node. Post biopsy changes are present.PATHOLOGY REPORT: Pathology report from outside hospital reads "right breast mass 10:00 7 cm from nipple (invasive poorly differentiated ductal carcinoma)" and "right axillary lymph node (lymph node without histologic evidence of metastasis. cytokeratin stain is performed)."MRI (7/9/2015): There is mild background parenchymal enhancement.Right Breast: There is a lobulated enhancing mass in the right breast upper outer quadrant 10:00 position measuring 3.3 x 2.9 x 2.6 cm (CC x AP x TV), with clip artifact seen in the medial/central mass, consistent with biopsy-proven palpable index cancer. Medial to this is a 1.1 cm enhancing mass, highly suspicious for malignancy. Additionally, there is a large area of non-mass enhancement extending from the mass to the nipple measuring 5.3 x 7.0 x 4.5 cm (CC x AP x TV) with multiple enhancing foci also highly suspicious for malignancy.Left Breast: There are no areas of abnormal enhancement in the left breast.Axilla: Nonspecific fairly symmetric bilateral axillary lymph nodes. Clip artifact is noted in one of the previously biopsied right axillary nodes(negative for malignancy per report).
Concordant biopsy proven right breast cancer 10:00 position measuring 3.3 x 2.9 x 2.6 cm on MR. Additional enhancing mass (measuring 1.1 cm) medial to the index cancer and large area of non mass enhancement extending from the mass to the nipple measuring 5.3 x 7.0 x 4.5 cm seen on MR are highly suspicious for malignancy.No suspicious findings in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. 