Ms. Sanchez is a 47-year-old woman with biopsy-proven invasive ductal carcinoma of the right breast metastatic to right axillary lymph node. She presents today for an MR-directed ultrasound for additional lesions seen bilaterally on same day MRI. LEFT BREAST: A targeted grayscale and color Doppler left breast ultrasound was performed for the area of concern as directed by MRI in the left upper outer breast. In the left breast 1:00 position, approximately 2 cm from the nipple, there is an oval hypoechoic mass measuring 0.4 x 0.3 x 0.8 cm (CC by AP by TV). A vessel is seen draping over the mass. Internal vascularity is present. This correlates in location and appearance with the MR-detected finding. An ultrasound guided biopsy is recommended.RIGHT BREAST AND AXILLA: A targeted grayscale and color Doppler right breast ultrasound was performed for the area of concern as directed by MRI in the right upper outer breast. In the right breast 10:00 position, approximately 3 cm from the nipple, (located inferior to the index biopsy-proven cancer) there is a 0.4 x 0.3 x 0.5 cm hypoechoic mass with indistinct margins. This correlates in location and appearance with the MR detected finding. An ultrasound guided biopsy is recommended.Targeted grayscale and color Doppler of the right axilla was also performed. There is an abnormal morphology lymph node in the right axilla measuring approximately 3.3 x 0.9 x 2.3 cm, correlating with findings on outside ultrasound 7/27/2015 and consistent with the biopsy-proven metastatic lymph node.
(1) Bilateral suspicious breast masses identified on ultrasound, corresponding to the MR-detected findings. An ultrasound-guided biopsy is recommended for both lesions for further evaluation.(2) Known biopsy-proven metastatic lymph node in the right axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.