66-year-old female with biopsy-proven left breast invasive ductal carcinoma presents for MR guided ultrasound of bilateral breasts and left axilla. Recent MRI dated 10/11/2016 demonstrated enhancing masses at the 9:00 position posterior to the index mass in the left breast, at the 2:00 and 4:00 positions in the left breast, and in the subareolar region of bilateral breast. Abnormal morphology left lower axillary lymph nodes were also identified on MRI. On physical examination of both breasts, the patient has bilateral inverted nipples.A targeted LEFT breast ultrasound was performed for the areas of concern seen on MRI.In the left breast, 9:00, 4 cm from the nipple, again seen is the biopsied index mass measuring approximately 1.9 x 1.6 x 1.8 cm, corresponding to known malignancy.Immediately posteromedial and adjacent to the index mass in the left breast, 9:00, 3 cm from the nipple, there is a 7 x 4 x 7 mm oval circumscribed hypoechoic mass, corresponding to the enhancing oval mass seen on MRI.In the left breast, 2:00, 3 cm from the nipple, there is a 6 x 4 x 6 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding.In the left breast, 4:00, 3 cm from the nipple, there is no sonographic correlate for the MRI finding.In the left breast, subareolar region, there is no solid or cystic mass identified.In the left axilla, there is an abnormal left axillary lymph node with an area of focal cortical thickening measuring 1.3 x 0.6 x 1 cm.Targeted RIGHT breast ultrasound was performed in the area of concern seen on MRI.In the right breast, subareolar region, there is no solid or cystic mass identified.
1. Known biopsied malignancy in the left breast at the 9:00 position, measuring up to 1.9 cm.2. Abnormal left axillary lymph node, for which ultrasound-guided biopsy is recommended.3. In the left breast, 9:00 position, adjacent to the index mass, there is a probably benign 7 x 4 x 7 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding. Six month follow-up bilateral breast MRI is recommended to evaluate for stability.4. In the left breast, 2:00 position, there is a probably benign 6 mm oval circumscribed hypoechoic mass, corresponding to the MRI finding. Six month follow-up bilateral breast MRI is recommended to evaluate for stability.5. No sonographic correlate for the left breast 4:00 lesion seen on MRI. This can be reevaluated on six-month follow-up bilateral breast MRI.6. No sonographic findings in the subareolar region in both breasts. Bilateral subareolar enhancement seen on MRI is compatible with inverted nipples.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.