A patient submitted outside study for review. Submitted for review are diagnostic mammograms and ultrasounds (7/7/16) along with post procedural mammograms (7/13/16) performed at Northwestern Lake Forest Hospital. Three standard views of both breasts were obtained along with spot compression and spot magnification views of the bilateral breasts. Subsequent ultrasound was also performed. The breast parenchyma is heterogeneously dense.Right:Three areas of concern are described on the right:1. Loosely scattered calcifications are seen in the lower, inner quadrant. These calcifications span 3.4 cm on the MLO spot magnification view. Few benign coarse calcifications are noted within this cluster. On corresponding ultrasound, within the right lower, inner quadrant a corresponding 10 x 7 x 3 mm mass is demonstrated that was subsequently biopsied and consistent with benign fibroadenoma which is concordant. A coil shaped clip is present adjacent to the coarse and other loosely scattered calcifications. Specimen radiograph were not obtained to confirm calcifications but the post procedure mammogram shows that a few calcifications were removed at the time of biopsy. 6 month follow up mammogram is recommended of this area of calcifications to confirm stability. 2. A benign subcentimeter intramammary lymph node is identified in the right upper-outer quadrant with a correlate seen on ultrasound subsequently.Left:Four areas of concern are described on the left:1. Patient palpable mass at the 5:00 position does not show any abnormality on mammogram or targeted ultrasound.2. A cluster of calcifications within the left axillary tail measures up to 8 mm on mammogram. This area was biopsied, marked by a heart shaped clip that has been medially displaced about 3 cm. Pathology corresponds to focal ALH at this area. This is concordant. Specimen radiograph shows cores with calcifications. 3. A tight cluster of calcifications measuring 4 mm is seen at the 6:00 position. This area was subsequently biopsied marked by an x= shaped clip and was consistent with fibroadenoma with fibrocystic change. This is concordant. Specimen radiograph shows cores with calcifications. 4. Within the posterior depth at 12:00 position a 14 mm mass with associated calcifications is identified best on MLO views (partially visualized on CC view). This area was unable to be biopsied secondary to depth and overlying vasculature. A correlate was not found on ultrasound.
On the right, six-month follow-up is recommended for the loosely scattered calcifications adjacent to the coil clip with benign results. On the left, ultrasound is recommended to further characterize the mass within the posterior depth of the breast.Surgical consultation is recommended for the left axillary tail calcifications that showed focus of ALH. Heart shaped clip is medially displaced by 3 cm. No definite residual calcifications are seen. No abnormality noted corresponding to the palpable area of concern in the left breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.