66 year old female with a personal history of palpable left breast lump. Three standard views of both breasts with repeat left CC and MLO views and additional spot compression right CC, superior left CC, superior right MLO, and superior left ML views 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). There is a marker overlying the left breast immediately inferior to the nipple, corresponding to the palpable area of concern. In this region is a lobulated, obscured mass which measures approximately 2.0 x 1.8 cm. There is a focal asymmetry in the left upper outer breast, relatively low suspicion on full field views. An additional focal asymmetry is present in the right upper outer quadrant at posterior depth, most likely a lymph node. Additional focal asymmetry in the right upper outer breast at mid depth is only evaluated with on the CC compression and partially disperses. An additional asymmetry in the right ML view is low suspicion. Patient declined the completion of spot compression views, which is a limitation, though all areas of asymmetry were evaluated on ultrasound. ULTRASOUND
1.Lobulated mass in the left breast corresponding to the palpable area of concern, suspicious for malignancy. Ultrasound-guided biopsy is recommended. Mammogram and ultrasound findings as well as recommendation for ultrasound-guided biopsy were discussed with the patient and the patient's son, who both verbalized understanding. Written and verbal instructions were provided to the patient to hold her daily aspirin for 5 days prior to biopsy.2.Other typically benign findings as described above. A 6 month follow up bilateral mammogram is suggested to ensure stability of these typically benign findings.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.