Patient with known malignancy of the left breast from outside hospital presents for a left unilateral diagnostic mammogram to confirm clip placement and repeat left breast ultrasound to evaluate additional SPECT relate mass identified on the mammogram. Mammogram: Three standard views of the left breast and 2 spot compression views 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), unchanged in pattern and distribution. Clip identified within the left upper-outer quadrant with a confluent hematoma measuring 3 cm around it. Spiculated mass measuring 14 mm is identified immediately posterior to it. Probably the clip has migrated anterolateral to the mass x 6 mm.A 15 mm focal asymmetry is identified in the left central posterior breast best seen on the ML view with a possible correlate in the lateral cc view. It is located 2.7 cm posterior to the previously biopsied mass. Multiple scattered oil cysts identified in the left breast.Ultrasound: Targeted left breast ultrasound was performed. Previously biopsied suspicious mass now with probably organizing hematoma adjacent to it measures 1.2 x 0.9 x 1.6 cm with peripheral blood flow. A clip is identified within a hematoma located slightly lateral to it. The hematoma approximately measures 1.6 x 1.8 cm.Sonographic correlate to the focal asymmetry seen on the mammogram is identified at 4:30 o'clock position, 9 cm from the nipple that measures 1.1 x 1.2 x 0.9 cm with apical blood flow. This appears suspicious and ultrasound-guided core biopsy is recommended.
Biopsy-proven cancer in the left breast 4:00 position with clip located within it hematoma adjacent to it.New spiculated mass identified on the mammogram and ultrasound of the left breast 4:30 o'clock position, 9 cm from the nipple that needs ultrasound-guided core biopsy.Given the multifocality of the mass, breast MRI can be considered for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.