A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram and left breast ultrasound dated 3/15/2016, left breast ultrasound-guided core biopsy with postprocedure mammogram dated 3/22/1960 performed at Porter regional Hospital Center for women's health, Valparaiso, Indiana. For comparison,none are available. Three standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . Triangular marker denoting palpable abnormality identified in the left upper-outer quadrant. Underneath the marker there is an irregular hyperdense focal asymmetry with few spiculations measuring 3 cm, with few associated faint calcifications. No dedicated spot compression or magnification views of this area obtained.A faint cluster of calcifications in the right breast 9:00 position measuring 12 mm needs further evaluation with spot magnification views. Few coarse benign morphology calcifications are seen elsewhere in the right breast. Benign right axillary lymph node is noted.Ultrasound demonstrates an irregular hypoechoic mass at 1:00 position approximately 5 cm from the nipple that measures 2.5 x 1.5 cm (on ultrasound dated 3/22/2016 which was on the day of the biopsy, this mass approximately measures 2.7 x 1.8 cm). In the left breast 1:00 position 2 cm from the nipple an oval benign morphology mixed echogenic mass is identified which could represent a benign intramammary lymph node although no definite blood flow is noted on ultrasound or definite focal asymmetry is noted on mammogram. It measures 5 x 7 x 3 mm and is located 1.5 cm anterior to the mass. Ultrasound-guided core biopsy of both these lesions was performed with clip placement. Good targeting noted of the larger of the 2 masses. 4 images have been submitted of the anterior smaller mass ultrasound-guided biopsy. Biopsy targeting appears suboptimal. Postprocedure mammogram demonstrated 2 clips in the left breast 1:00 position, distance between the clips is approximately 19 mm. Smaller of the 2 clips is within the center of the irregular spiculated mass. The longer of the 2 clips is within the anterior most likely benign morphology mass.Pathology results revealed left breast mass 1:00 2 cm from the nipple is fibrocystic change which appears concordant.Pathology results revealed left breast mass 1:00 position 5 cm from the nipple is IDC grade 2 which appears concordant.
Biopsy-proven IDC left breast 1:00 position posterior depth.12 mm cluster of indeterminate calcifications in the right breast need further evaluation with spot magnification views.4 images have been submitted of the ultrasound-guided core biopsy of the anterior smaller left breast mass. The results are benign and concordant however repeat ultrasound is recommended due to questionable targeting. Given the dense breast tissue, additional evaluation with breast MRI should be considered.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.