45 year old female who was recalled from screening mammogram for bilateral asymmetries or masses on baseline study. MAMMOGRAM: Three standard views of both breasts with additional spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Asymmetries in the left retroareolar region and right lower outer breast, anterior depth are redemonstrated. These lesions become less conspicuous on compression imagingULTRASOUND: A targeted bilateral ultrasound was performed in the areas of mammographic abnormalities.In the left retroareolar region, at the 6:00 position, there is an anechoic, oval lesion with posterior acoustic enhancement measuring 5 x 4 x 3 mm. There is no internal vascularityIn the right lower outer breast, at the 9:00 position approximately 5 cm from the nipple there is an anechoic, oval lesion with posterior acoustic enhancement measuring 2 x 2 x 2 mm. There is no internal vascularity.In the right lower-outer breast at the 9:00 position approximately 4 cm from the nipple, there is an anechoic, oval lesion with posterior acoustic enhancement measuring 3 x 2 x 3 mm. There is no internal vascularity. Ultrasound of the remaining right lower outer breast demonstrates no other cysts and no solid masses.These lesions correlate with mammographic findings.
Tiny bilateral benign cysts as above. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.