4-4

HISTORY: 56-year-old woman with a history of recently diagnosed right breast cancer. Evaluation of extent of disease. Summary of prior imaging: Mammography: Patient presented after recent abdominal CT demonstrated an enhancing mass in the lateral aspect of the right breast. Diagnostic mammogram demonstrated scattered fibroglandular densities with an irregular obscured mass in the right breast at 8:00 anterior depth. Ultrasound: Subsequent ultrasound demonstrated a correlating 31 x 30 x 19 mm irregular hypoechoic mass with posterior acoustic shadowing at 8:00 5 cm from the nipple. There was no axillary adenopathy identified. Breast MRI: NA

HISTORY: 29 year old woman with BRCA2 gene mutation presented for high risk screening. Summary of prior imaging: Mammography: Negative 1 year earlier Ultrasound: None Breast MRI: None

HISTORY: 44 year old woman with history of treated T2N1 right breast cancer status post lumpectomy, known ataxia telangiectasia-mutated (ATM) gene, and heterogeneously dense breasts presented for high risk screening. Summary of prior imaging: Mammography: Breast conserving therapy (BCT) changes right breast, postoperative changes in the right axilla and stable benign appearing 0.9 mass left breast 3:00 middle depth. Ultrasound: None applicable Breast MRI: No evidence of malignancy, BCT changes right breast and benign cysts with rim enhancement left breast

HISTORY: New diagnosis of invasive ductal carcinoma in left UOQ. Summary of prior imaging: Mammography: Palpable irregular isodense mass at 1:00. No calcifications Ultrasound: 1.5 cm hypoechoic microlobulated mass with internal perfusion and posterior shadowing at site of palpable mass. Breast MRI: None.

HISTORY: 44-year-old woman presenting with a palpable right breast mass. US guided biopsy of mass showed invasive ductal carcinoma ER+ PR+ Heu2+. Right axillary node biopsy was negative. Summary of prior imaging: Mammography: Extremely dense breasts with ill-defined 4cm mass RUOQ Ultrasound: 3.5 cm lobulated vascular hypoechoic mass 11:30 4cm FN. 2 cm right axillary node with thickened cortex. Breast MRI: NA

HISTORY: 37-year-old woman with a history of right breast enlargement and erythema. She has undergone multiple rounds of antibiotics with minimal decrease in the degree of erythema. Summary of prior imaging: Mammography: Heterogeneously dense breasts. There is diffuse asymmetric trabecular and skin thickening of the right breast. There is no discernable mass in the breast. There are several enlarged abnormal appearing axillary lymph nodes. Ultrasound: Targeted ultrasound was performed of the right axilla. Several enlarged lymph nodes with thickened cortices were identified corresponding to the mammographic abnormality. Subsequent biopsy of a lymph node revealed metastatic mammary carcinoma involving a lymph node. Breast MRI: NA

HISTORY: 65-year-old female presenting from an outside facility with recently biopsied left axillary mass and node demonstrating grade 3 invasive ductal carcinoma (ER+, PR-, HER2+). Evaluate extent of disease. Summary of prior imaging: Mammography: Incompletely visualized left axillary mass with circumscribed margins measuring at least 38 mm. Ultrasound: Targeted ultrasound of the left axilla demonstrates a markedly abnormal lymph node with cortical thickness of 12 mm, but a preserved fatty hilum. There is an adjacent oval mass with indistinct margins measuring up to 28 mm. Breast MRI: NA

HISTORY: 37 year old woman with a history of recently diagnosed left breast cancer. Evaluation for extent of disease. Summary of prior imaging: Mammography: Patient presents for diagnostic mammogram and US for a palpable abnormality in the upper outer left breast. Diagnostic mammogram demonstrates diffuse coarse heterogeneous and fine pleomorphic calcifications in the upper outer left breast. There is no definite underlying mass. Ultrasound: Targeted ultrasound of the left breast demonstrates a vague hypoechoic mass with indistinct margins in the left breast at 2 o’clock. In addition, there is mass or densely shadowing area in the left breast at 7 o’clock. An abnormal lymph node is also identified in the left axilla. Biopsies of all of these areas was subsequently performed with ultrasound guidance demonstrating invasive ductal carcinoma at each site in the breast, and metastatic carcinoma in a lymph node. The patient also underwent a biopsy of a mass in the right breast with benign results. Breast MRI: NA

HISTORY: 38-year-old woman undergoing high risk screening due to recent diagnosis of her sister age 34, with breast cancer. Summary of prior imaging: Mammography: Extremely dense breasts, no suspicious abnormalities Ultrasound: N/A Breast MRI: N/A

HISTORY: 65 year old female with recently diagnosed left breast invasive lobular carcinoma. Summary of prior imaging: Mammography: Diagnostic mammogram performed after recall for screening demonstrates an irregular mass in the left breast at 12 o’clock middle depth which measures approximately 2.7 cm (CC). There are associated fine pleomorphic calcifications. Ultrasound: Targeted ultrasound of the left breast at 12 o’clock 2 cm from the nipple demonstrates an irregular hypoechoic mass with indistinct margins which measures 2.4 cm. There are no abnormal lymph nodes in the left axilla Breast MRI: NA

HISTORY: 39-year-old woman with a history of recently diagnosed locally advanced right breast cancer with skin invasion and axillary nodal metastases. Summary of prior imaging: Mammography: Patient presented with a palpable abnormality in the right breast and axilla. Diagnostic mammogram demonstrated a 57 x 42 x 67 mm oval mass with circumscribed margins and associated skin thickening at 11:00 anterior depth. Ultrasound: Subsequent ultrasound demonstrated a correlating 57 x 53 x 57 mm irregular, hypoechoic mass with angular margins at 11:00 5 cm from the nipple. The mass invades the dermis. Morphologically abnormal axillary lymph nodes are also identified. Previous Breast MRI: Extending from 9 to 12:00 in the upper outer right breast anterior to middle depth, there is a 6.3 cm (CC) irregular mass with irregular margins and rim internal enhancement. Worst curve kinetics are initial phase rapid and delayed phase washout. There is central decreased enhancement compatible with necrosis. The mass invades the adjacent dermis. There is focal susceptibility artifact at the superior lateral aspect of the mass compatible with a biopsy clip. There are two small adjacent masses or intramammary lymph nodes at the posterior superior aspect of the mass compatible with satellite lesions. There are multiple abnormal level I axillary lymph nodes, the largest of which contains focal susceptibility artifact compatible with a biopsy clip. Abnormal level II axillary adenopathy is also demonstrated.

HISTORY: 58 year old woman, high risk screening breast MRI, prior history of right breast invasive ductal cancer s/p right mastectomy and TRAM flap reconstruction 1 year prior to this MRI. Summary of prior imaging: Mammography: No right breast imaging after surgery. Left breast BI-RAD 1 Ultrasound: NA Breast MRI: NA

HISTORY: High risk screening MRI. LEFT LOQ breast cancer IDC excised 6 months prior to this exam. Preoperative MRI showed 2 foci of lateral enhancement in the RIGHT breast. Lesion 1 RIGHT breast was a fibroadenoma at US biopsy (UOQ). Lesion 2 was biopsied by MRI guidance and was LCIS (LOQ) which was then excised. Patient status post LEFT breast radiation treatment. Summary of prior imaging: Mammography: Post-surgical changes both breasts Ultrasound: NA Breast MRI: See above.

HISTORY: 80 year old woman status post bilateral mastectomies presented for implant assessment. Summary of prior imaging: Mammography: None post op Ultrasound: None post op Breast MRI: None

HISTORY: 35 year old high risk woman presented with calculated lifetime risk 31.9%. Summary of prior imaging: Mammography: Extremely dense breasts, negative Ultrasound: None Breast MRI: Normal

HISTORY: 55-year-old woman with a history of right breast lumpectomy and axillary surgery and left breast reduction presenting with a 6 month history of diffuse right breast swelling. Summary of prior imaging: Mammography: Recent diagnostic mammogram demonstrates postoperative findings in the right breast, and diffuse skin thickening. Ultrasound: Ultrasound of the right breast demonstrates skin thickening and no underlying abnormality. Breast MRI: NA

HISTORY: 32 year old female presents for high risk screening MRI. Summary of prior imaging Mammography: Scattered fibroglandular densities. Normal mammogram. Ultrasound: NA Breast MRI: NA

HISTORY: 51 year old woman, high risk screening, recently diagnosed as BRCA1 after her sister was diagnosed with breast cancer. No personal history of breast cancer. Summary of prior imaging Mammography: Normal Ultrasound: N/A Breast MRI: N/A

HISTORY: 49 year old woman presented with recently diagnosed invasive ductal carcinoma with micropapillary features grade 2 left breast cancer presented to evaluate extent of disease. Summary of prior imaging Mammography: In the setting of extremely dense breasts, there is global asymmetry in the upper outer quadrant of the left breast anterior and middle depths. There is an incompletely visualized enlarged left axillary lymph node. Ultrasound: Poorly delineated architectural distortion and hypoechoic masses with posterior acoustic shadowing is noted in the left breast from 10:00 to 3:00 1-7 cm from the nipple at the site of palpable mass. There are 2 enlarged left axillary lymph nodes. Breast MRI: None

HISTORY: 79 year old woman, history withheld. Summary of prior imaging Mammography: Normal Ultrasound: Normal Breast MRI: NA

HISTORY: 74-year-old woman with recently diagnosed right breast DCIS presenting for staging. Summary of prior imaging: Mammography: New focal asymmetry RUOQ identified on routine screening. Left breast normal. Ultrasound: 9mm lobulated hypoechoic mass 10:00 Right breast Breast MRI: N/A

HISTORY: 40 year old woman presented with palpable right breast mass. Summary of prior imaging: Mammography: Obscured 3.0 cm mass right breast 6:00 posterior depth Ultrasound: None Breast MRI: None

HISTORY: 47 year old woman with a large rapidly growing painless right breast mass over the last month with redness, US biopsy proven IDC with metaplastic features metastatic to nodes. Triple negative. Summary of prior imaging: Mammography: Left breast – extremely dense otherwise normal. Right breast could not be imaged. Ultrasound: Solid 8cm+ mass at palpable site outer right breast. Multiple enlarged right axillary nodes. Breast MRI: NA

HISTORY: 58 year old woman status post remote bilateral implants with newly diagnosed right breast DCIS and papillomas presented for extent of disease. Summary of prior imaging: Mammography: Bilateral silicone implants and developing asymmetry RLOQ Ultrasound: Ductal dilation and multifocal intraductal masses right breast middle depth RLOQ Breast MRI: None

HISTORY: 42-year-old woman presenting with a palpable mass in the RLOQ sent for breast MRI at outside institution following a BIRADS 5 US. (Note: This is not the recommended standard of practice, we would recommend US guided biopsy before MRI). Summary of prior imaging: Mammography: Focal asymmetry extreme lateral right breast Ultrasound: 1.5 cm hypoechoic spiculated mass at site of palpable mass Breast MRI: NA