65-year-old female. Callback from 5/6/2015 screening mammogram for adjacent masses in the lateral aspect of the right breast. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: A standard ML view and three 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, unchanged in pattern and distribution. Again seen are two adjacent masses in the right breast upper outer quadrant that persist on spot compression views. The larger of the two masses is on the 9:00 radian, measures 1.5 cm in diameter and has microlobulated margins. The second mass is anterior and inferior to the first. The second mass has partially smooth margins. An asymmetry at the superficial margin of the fibroglandular tissue that was superior to both masses on the MLO view dispersed into normal fibroglandular tissue on the spot compression views. RIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast upper outer quadrant demonstrated an irregular 1.5 x 1.2 x 1.7 cm hypoechoic mass at 9 o'clock 4 cm from the nipple, corresponding to the larger of the two masses seen on the mammogram. The mass has microlobulated margins, an echogenic halo, and mild internal flow on color Doppler imaging.A second mass is seen at the 8 o'clock periareolar position, approximately 1.5 cm anteroinferior to the first mass. The second mass is a parallel hypoechoic circumscribed mass measuring 0.8 x 0.4 x 1 cm, corresponding to the second mass visualized on mammography. There is no definite internal flow on color Doppler imaging.
1. Right breast 9 o'clock mass with suspicious features. Ultrasound guided percutaneous biopsy is recommended. 2. Right breast 8 o'clock mass, approximately 1.5 cm away from the first mass, which has benign features, but which is non-specific. Ultrasound guided percutaneous biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.