83 year old female status post right lumpectomy and complete axillary dissection in 2006 for IDC and DCIS, presents with palpable abnormality with the left axilla noted on physical examination. Patient received radiation, chemotherapy, and Arimidex. No current breast complaints. No family history of breast cancer. On physical examination, there is a 1.0 cm mobile circumscribed mass in the low left axilla. A targeted left axillary ultrasound was performed for the palpable area of concern. At the area of palpable abnormality, there are two adjacent lymph nodes. The first measures 0.7 x 0.7 x 0.7 cm, with cortical thickening measuring up to 0.5 cm, and effacement of the fatty hilum. No significant abnormal vascularity is identified within this node. The second measures 0.7 x 0.5 x 1.0 cm with complete effacement of the fatty hilum, and no appreciable vascularity on Doppler imaging.
Two indeterminant adjacent lymph nodes within the low left axilla, at the site of palpable abnormality. Ultrasound guided biopsy of these lymph nodes is recommended for definitive histologic diagnosis. These findings were discussed with the patient, and Joly Jose, APN, at the time of the examination.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.