44-year-old female with known left breast cancer on neoadjuvant chemotherapy to assess response 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. Irregular multilobulated hyperdense mass corresponding to biopsy-proven cancer is identified in the left breast 10:00 position that measures 35 x 40 x 34 mm on the mammogram, previously measured 33 x 36 x 34 mm minimally increased in size in the superoinferior dimension. Clip from prior biopsy identified within the mass. The mass appears multilobulated and more dense on the current mammogram. A hydromark clip is identified 18 mm from the anteriormost margin of the mass. Multiple scattered calcifications seen in the left breast. A clip is identified within the left axillary lymph node which is reduced in size and now measures 12 mm.Ultrasound: Targeted ultrasound left breast and axilla performed. Index cancer now measures 30 x 30 x 27 mm, previously measured 28 x 23 x 24 mm, minimally increased in size mostly in the superior-inferior dimension. A hydromark clip is identified anteriorly by 1.4 cm. No mass is identified around the hydro mark clip. At least 3 lymph nodes were identified in the right axillary region, the previously biopsied lymph node now measures 7 x 10 x 8 mm, previously measured 14 x 12 x 16 mm. The second elongated lymph node now has eccentrically thickened cortex and measures 25 x 7 x 8 mm, previously measured 18 x 8 x 17 mm.
Mild interval increase in size of the left breast index cancer mostly in the superoinferior dimension with increased densityy on the mammogram.Interval decrease in the size of previously biopsied left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.