year old female who was recalled from screening mammogram for area of pleomorphic microcalcifications in segmental distribution in the left lower central breast with few focal asymmetries. Mammogram: An ML view and two spot magnification 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. There are pleomorphic grouped microcalcifications in segmental distribution with associated focal asymmetries in the left lower outer quadrant approximately spanning 7 cm on the cc view, reaching up to the nipple. A small 4 mm cluster of calcification in the left upper-outer quadrant also has similar morphology on spot magnification views.Ultrasound: Targeted left lower outer quadrant ultrasound and axillary ultrasound was performed.Multiple irregular hypoechoic areas with calcifications identified in the left breast 4 to 6:00 position spanning approximately 3.3 cm in maximum contiguous fashion. Located posteriorly, 5 cm from the nipple is a hypoechoic area with few calcifications that measures 6 x 5 x 8 mm. Located anteriorly close to the nipple is a similar hypoechoic area with calcifications that measures 6 x 4 x 8 mm. All these areas demonstrate increased vascularity. In the left upper-outer quadrant a normal morphology intramammary lymph node is identified measuring 1.1 x 0.4 cm. No definite correlate is identified to the small cluster of calcifications in the left upper outer quadrant. Normal morphology left axillary lymph nodes were identified.
Pleomorphic grouped segmental distribution of calcifications in the left breast 4 to 6:00 position with sonographic correlate needs further evaluation with ultrasound-guided core biopsy (of 2 sites preferably at the anterior and posterior most site).Normal morphology left axillary and intramammary lymph node.4 mm cluster of calcifications in the left upper outer quadrant can be biopsied if additional tissue sampling is needed. This will be based on the pathology results of the ultrasound guided biopsy of the left lower outer quadrant.Findings were conveyed to the patient and her orthopedic surgeon Dr. Arvind Athiviraham, pager 6082 at the time of dictation. Patient was scheduled for an elective knee replacement surgery on 10/2/2015 which has been rescheduled until further notice after discussion with Dr. Arvind Athiviraham, BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.