57-year-old woman called back for mass in the right upper-outer breast. MAMMOGRAM: An ML view and two 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. The macrolobulated mass in the right upper-outer breast persists on additional views. An ultrasound is recommended for further evaluation.ULTRASOUND:On physical exam, there is no palpable abnormality.Targeted grayscale and color Doppler ultrasound of the right breast was performed for the mammographic area of concern. In the right breast 11:00 position 7 cm from the nipple, there is an indeterminant 1.6 x 1.0 x 1.1 cm lobulated hypoechoic mass, corresponding to finding on mammogram. There is mild internal vascularity and posterior acoustic shadowing. An ultrasound-guided biopsy is recommended.Additionally, in the right breast at the 10:00 position 7 cm from nipple, there is a lobulated mass measuring 6 x 6 x 4 mm with internal vascularity, also indeterminate and could represent a lymph node. Ultrasound-guided biopsy is recommended.Also in the right breast 10:00 position 7 cm from nipple, superficial depth there is a well-circumscribed oval hyperechoic mass measuring 4 x 4 mm with internal vascularity, consistent with fat necrosis.
Two suspicious masses in the right upper outer breast as described measuring up to 1.6 cm for which ultrasound-guided biopsy is recommended. The findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.