A patient submitted outside study for review. Submitted for review are digital mammographic images (9/24/15), ultrasound images of both breasts (9/24/15), images from ultrasound guided biopsy of left breast with specimen radiograph and postprocedural left mammographic images, and images from ultrasound guided right breast aspiration (9/24/15) performed at Rush University Medical Center. For comparison, digital mammographic images (9/11/14, 9/11/13, 3/1/10), ultrasound images (9/11/14, 1/27/14, 9/11/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple circumscribed masses are present in both breasts. Many of those masses are stable and benign. An oval mass at lower outer quadrant in the left breast shows interval increase in size. Multiple calcifications in both breast are unchanged. There are no suspicious findings in either breast on mammogram.ULTRASOUND IMAGES OF BOTH BREASTS (9/24/15):There are multiple simple cysts in the right breast. In the left breast, there is an irregularly shaped hypoechoic mass with angular margins at 6:30 position measuring 6 x 6 mm. A complicated cyst measuring 6 mm is seen at 4:00 position. In addition, there are multiple simple cysts in the left breast. A simple cyst at left 4:30 position likely corresponds to the developing circumscribed mass on left mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES, AND IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST ASPIRATION (9/24/15):An aspiration for the complicated cyst at 4:00 position in the right breast was performed. Complete resolution of the cyst was achieved. Core needle biopsy for the hypoechoic mass at 6:30 in the left breast was performed with appropriate needle placement. Radiograph of the specimen shows several pieces of solid tissue without calcifications. Postprocedural mammographic images show a marker clip located at lower inner quadrant in the left breast.Per outside pathology report, the result of the core biopsy of left breast was DCIS grade 3.
Biopsy proven DCIS in the left breast. The lesion was occult on mammogram and was detected on ultrasound. Given complicated appearance of mammogram and dense breast tissue, breast MRI would be helpful to rule out any other occult disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.