43 year old with known left breast cancer. Evaluation of left axilla and left breast findings from MRI is requested. A targeted left ultrasound was performed for the areas of concern. Three suspicious left axillary nodes are seen. The largest of these measures 1.3 x 1.3 cm. One of the nodes retains a fatty hilum, but it has some non-hilar blood flow. In the left outer breast there are numerous simple and complicated cysts, however no suspicious morphology mass to correlate to the enhancement on MRI in the outer breast is present. In the left upper inner breast anterior to the index mass (which is well seen with internal biopsy clip artifact), there is a small 6 mm hypoechoic lesion located 1.3 cm anterior to the index mass that could be a correlate to the anterior satellite on MRI. Please note that the presence of innumerable cysts throughout the breast is somewhat of a limitation of this study.
1. Suspicious left axillary lymph nodes would be amenable to ultrasound guided biopsy.2. No suspicious morphology mass seen sonographically in the left outer breast to correlate to the enhancement on MRI. 3. Subtle potential correlate to the small satellite seen on MRI in the left inner breast anterior to the index lesion. If breast conservation is planned, then the following is suggested:A. Presuming a left axillary ultrasound guided biopsy will be done, also perform an ultrasound guided biopsy for the anterior satellite lesion.B. Subsequently, perform MRI biopsy for the left outer breast area of enhancement and at that time ensure that the biopsy clip from the satellite lesion correlates positionally to the finding on MRI. If it does not correlate, then perform an additional MR guided biopsy for the satellite. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.