74 year old female who was recalled from screening mammogram for a developing mass in the left breast at anterior upper outer aspect. Mammogram: An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Spiculated 10-mm mass persist on spot compression views. No associated calcifications within the mass. Few loosely scattered calcifications posterior to the mass are mostly unchanged dating back to 2007.Ultrasound: Targeted left upper outer quadrant Ultrasound is performed. Irregular hypoechoic mass with blood flow measures 1.1 x 0.6 x 0.8 cm corresponding to the mammographic abnormality at 2 to 2:30 o'clock position. Located 2 cm posterior and slightly superior is a second taller than wide hypoechoic small lesion with micro-lobulations that measures 4 x 3 mm which probably corresponds to a oval asymmetry, slightly superior and posterior to the spiculated mass in the ML full-field view.
Two suspicious masses in the left breast two o'clock position, need further evaluation with ultrasound guided core biopsy. Findings and recommendations were discussed with the patient in detail.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.