54-year-old woman history of locally advanced multicentric left breast cancer with metastasis to lymph nodes on systemic chemotherapy presents for evaluation. MAMMOGRAM: Three standard views of the left breast 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. Overall, there is decreased density of the left breast. The biopsy-proven 4:00-6:00, 1:00 and retroareolar left breast cancers are not discretely visualized. Scattered microcalcifications are stable in distribution.Biopsy clip is noted anterior to a low-lying lymph node in the left axilla, slightly decreased in size and density, measuring 5 mm (previously 8 mm).ULTRASOUND:On physical exam, there is no visible or palpable abnormality.Targeted ultrasound of the left breast was performed for the mammographic areas of concern. In the left breast 6:00 position (8 cm from nipple) a few small ill-defined masses are seen with largest measuring 2.4 x 1.3 x 1.6 cm. The largest mass previously seen in this area measured 5.4 cm in largest dimension on ultrasound 4/15/2015. No discrete mass is seen in the left retroareolar breast. No discrete mass is seen in the left breast 1:00 position.In the left axilla near the 1:00 position there is a small lymph node measuring 0.8 x 0.5 x 0.6 cm with maximum cortical thickness of 0.3 cm, normal. A biopsy clip is not identified within this lymph node. It is unclear whether this is the previously biopsied lymph node which had a maximal cortex of 0.7cm.
Interval decrease in size 4:00-6:00 and left breast masses described. Resolution of left retroareolar and 1:00 breast mass. Normal morphology left axillary node, unclear whether this is the previously biopsied lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.