41 year old female who was recalled from screening mammogram for multiple focal asymmetries, some with calcifications, in both breast presents for additional workup. Mammogram: 2 ML view and 8 spot magnification views of both breasts 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. 2 cm partially circumscribed mass in the left retroareolar region with multiple pleomorphic calcifications need further evaluation with ultrasound. A subcentimeter partially circumscribed mass is also identified in the left central slightly lateral breast.Another partially circumscribed mass with few calcifications is noted in the right upper outer quadrant approximately measuring 18 mm. These calcifications have coarse morphology.Few other benign morphology masses identified within the right breast.Ultrasound:A parallel oriented hypoechoic mass measuring 1.6 x 1.1 cm with few calcifications within it is identified in the right breast 11:00 position 2 cm from the nipple. Located slightly superior to it is another solid hypoechoic mass that measures 0.8 x 0.5 cm. Both these masses most likely correspond to the masses seen on mammogram.In the left breast 12:00 position there is an oval hypoechoic mass with multiple hyperechoic areas consistent with calcifications that measures 2.2 x 1 x 2.1 cm. This lesion demonstrates peripheral and central blood flow and most likely corresponds to the largest mass with indeterminate calcifications as seen on mammogram. Another small most likely benign morphology mass is identified at 3:00 position that measures 1.3 x 0.6 cm.
The largest mass in the left breast 12:00 position with multiple pleomorphic calcifications needs further evaluation with ultrasound-guided core biopsy. Specimen radiograph should be obtained to confirm suspicious calcifications within them.Multiple other most likely benign morphology masses in both breast. If the above-mentioned biopsies benign, annual diagnostic mammogram is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.