82-year-old woman call back for right breast masses identified on screening mammogram. MAMMOGRAM: An ML view and spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Additional views demonstrate persistence of an irregular mass in upper outer quadrant. In the central right breast, inferior and medial to this mass is a nodular focal asymmetry which persists on additional views. Ultrasound is performed for further evaluation of both findings. The focal asymmetry in the medial right breast disperses on additional views and is consistent with normal fibroglandular tissue.ULTRASOUND: On physical exam, there is a palpable solid nonmobile mass in the lateral right breast.Targeted ultrasound was performed for the areas of mammographic and clinical concern. In the right breast 9:00 position, 3 cm from nipple, there is a hypoechoic mass with angular margins measuring 1.6 x 1.0 x 1.5 cm, highly suspicious for malignancy. Internal vascularity is present. This correlates with the irregular mass seen on mammogram in the upper outer quadrant and an ultrasound-guided biopsy is recommended further evaluation.In the 6:00 position 1 cm from nipple, there is a 3 x 4 x 3 mm nodular hypoechoic mass, indeterminate. Internal vascularity is not present. This correlates with the mass seen inferior and medial to the dominant mass in the lateral right breast and an ultrasound-guided biopsy is recommended for further evaluation.Incidental note is made of a 5 mm benign sebaceous cyst in the 5:00 position of the breast, 3 cm from nipple.
Suspicious mass in the lateral right breast measuring up to 1.6 cm for which ultrasound-guided biopsy is recommended. Additional indeterminate nodular mass measuring up to 3 mm in the inferior breast, 6:00 position for which ultrasound-guided biopsy is also recommended further evaluation. Findings and recommendations were discussed with patient at time of exam. The patient does take blood thinning medications and she will be asked to discontinue these medications 3-5 days prior to the biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.