50 year old asymptomatic female recalled from screening mammogram 03/29/16 for segmentally distributed calcifications in the left lateral breast. An ML view and four 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 (BiRads Density Category C), unchanged in pattern and distribution. Again seen are segmentally distributed calcifications in the left breast, spanning approximately 16 cm in AP dimension. There are additional focal asymmetries within this region of calcification in the left upper outer breast. Again seen are an enlarged intramammary lymph node in the left upper outer breast as well as slight prominence of lymph nodes in the left axilla.ULTRASOUND
Redemonstration of segmentally distributed calcifications in the left upper outer breast corresponding to multiple hypoechoic lesions on ultrasound with indistinct margins and increased vascularity, highly suspicious for malignancy. Enlarged intramammary lymph node with markedly increased vascularity at the 2:00 position. Borderline enlarged left axillary lymph nodes. Further workup with bilateral breast MRI and ultrasound guided biopsies of the suspicious left breast lesions and abnormal intramammary lymph node is recommended. Findings and recommendations were discussed with the patient.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.