A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram and diagnotic bilateral ultrasound dated 1/30/2015, ultrasound guided left breast biopsy and mammogram dated 2/6/2015, bilateral mammogram dated 4/10/2015, and breast MRI dated 2/20/2015 performed at Franciscan Alliance. BILATERAL DIAGNOSTIC MAMMOGRAM (1/30/2015): Note that only left breast images were uploaded. Tomosynthesis was performed on the LLM view only. Dilated ducts and focal asymmetries are noted in the left breast extending from the nipple over a distance of 8.4 cm. There is a dilated duct in the retroareolar region with an associated 13 mm mass. In the left breast at the 12 o'clock position at mid-depth there is a lobulated oval mass measuring up to 2 cm. Area of asymmetry extends posterior to this oval mass. Scattered benign calcifications are noted. BILATERAL BREAST ULTRASOUND (1/30/2015): Targeted right breast ultrasound demonstrated normal fibroglandular tissue in the upper outer quadrant. Targeted left breast ultrasound demonstrated dilated ducts in the retroareolar region with internal echoes that could represent debris or an intraductal mass and a small amount of calcium. There is a hypoechoic mass at the 12 o'clock position that measures 10 x 7 x 13 mm. There are no abnormal lymph nodes in left axilla.LEFT BREAST ULTRASOUND GUIDED BIOPSY AND POST-BIOPSY MAMMOGRAM (2/6/2015): Masses in the 12 o'clock and retroareolar area were targeted for biopsy. Post-biopsy mammogram demonstrates percutaneously placed clips in the appropriate positions within the aforementioned masses, which are decreased in size compared to prior mammogram. The maximum distance between the two clips is 4.5 cm.SURGICAL PATHOLOGY: Left breast 12 o'clock position is atypical sclerosing papillary lesion. Left breast retroareolar region with DCIS grade 2, cribriform and micropapillary types as well as atypical sclerosing papillary lesion. Results are concordant.BREAST MRI (2/20/2015): Biopsy clip artifact seen in the retroareolar area and a posterior clip the 12:00 position at mid depth. There is clumped non-mass enhancement in the 2 o'clock position in a linear distribution extending upto the nipple. There is non-mass enhancement extending 2 cm posterior to the posterior biopsy clip. The extent of the enhancement measures 8.9 x 3.1 x 2.7 cm (AP x ML x CC). No abnormal lymph nodes in either axilla. No abnormal enhancement in the right breast.LEFT BREAST DIAGNOSTIC MAMMOGRAM (4/10/2015): Three standard views of the left breast and tomosynthesis were submitted. Again seen is a left retroareolar focal asymmetry containing a biopsy clip corresponding to known cancer. Additional clip in the 12 o'clock at mid depth is again noted. Dilated ductal process and focal asymmetry extends from the nipple to 2 cm posterior to the posterior clip, correlating with extensive enhancement seen on MRI.
1.Extensive non-mass enhancement in the left breast consistent with DCIS measures 8.9 cm in maximal dimension. If sampling of the posterior aspect of the non-mass enhancement is needed, an MR directed ultrasound and possible biopsy can be attempted.2.Right mammogram images from 1/30/2015 should be submitted for completion.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.