Ms. Mary Shade is a 63 years old female with a palpable mass in the right breast. MAMMOGRAM: Three standard views and additional spot compression views of both breasts and the right axilla (a total of 14 images) 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). A partially visualized spiculated mass with few possible faint calcifications is identified in the upper inner right breast far posterior depth. This mass measures 3 cm anteroposteriorly on the ML view. A prominent 12 mm intramammary lymph node is identified in the right axillary tail. In addition, a 12 mm focal asymmetry is identified in the upper outer left breast which persists with spot compression.Prominent right axillary lymph node noted.ULTRASOUND:On physical examination, an fixed mass is palpated in the right upper inner breast.A targeted right ultrasound was performed for the mammographic and palpable area of concern. In the right breast, 2:00 position, 5 cm from the nipple, there is a heterogeneously hypoechoic mass with irregular margin which measures 2.6 x 2.1 x 2.3 cm. There is increased vascular flow to this mass. In addition, a 1.1 x 0.7 x 1 cm hypoechoic mass is identified in the right breast 11:00 position, 8 cm from the nipple, which correlates with the low lying intramammary lymph node on the mammogram. A lymph node is identified in the right axilla measuring 1.4 x 1.2 x 0.5 cm, which has diffuse cortical thickening (3 mm) and nonhilar flow.A targeted left ultrasound was performed for the mammographic area of concern. In the left breast, 2:00 position, 3 cm from the nipple, there is a 1.2 x 0.5 x 1.3 cm lobulated hypoechoic correlation mass, which corresponds to the mammographic finding. There is no definite vascular flow associated with this mass.
--2.6 cm palpable right breast mass concerning for malignancy. Ultrasound-guided biopsy or FNA is recommended.--1.1 cm suspicious right intramammary lymph node concerning for metastatic disease. Ultrasound-guided biopsy is recommended.--Borderline suspicion of right axillary lymph node.--1.3 cm lobulated mass in the left breast with low suspicion for malignancy, this could represent a benign fibroadenoma. Ultrasound-guided biopsy is recommended.Surgical consultation is recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.