55-year-old female with known right breast malignancy and bilateral axillary lymphadenopathy currently undergoing neoadjuvant chemotherapy. Evaluate treatment response. Family history of ovarian carcinoma in her sister at age 45 and cervical cancer in her daughter and maternal niece. A targeted right ultrasound was performed for the areas of concern. At the 11 o'clock position of the right breast, 3 cm from the nipple there is an irregular hypoechoic mass measuring 2.1 x 1.2 x 3.2 cm (previously 4.0 x 3.6 x 3.4 cm). Mild peripheral vascularity is appreciated.At the 7 o'clock position of the right breast, 2 cm from the nipple, there is a 2.1 x 1.0 x 2.9 cm irregular hypoechoic mass with mild peripheral vascularity (previously 3.7 x 2.5 x 3.6 cm).Targeted ultrasound of the right axilla was performed, without evidence for adenopathy. The previously identified abnormal lymph nodes are not visualized on today's examination.A targeted left axillary ultrasound was performed for the area of concern. Two prominent lymph nodes are present in the left axilla, both demonstrating a hyperechoic appearance, and decreased in size from prior examination suggesting treatment response. The largest lymph node measures 1.9 x 1.0 x 1.7 cm. The second lymph node measures 1.9 x 0.9 x 0.8 cm. No submitted vascularity is associated with either lymph node.
1. Decrease in size of two right breast masses, as above. 2. Nonvisualization of previously identified right axillary lymph nodes, suggesting response to therapy.3. Decrease in size of left axillary lymph nodes with treatment response. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.