75-year-old female with history of right breast lumpectomy in 2014 for DCIS and ADH, and left lumpectomy for IDC and DCIS in 2011. Patient also has history of CLL. Patient was found to have mildly enlarged left neck lymph nodes on ultrasound evaluation, here for sonographic evaluation. No family history of breast cancer. Targeted ultrasound was performed for area of concern, corresponding to the location of left level IV cervical lymph nodes. Multiple cervical lymph nodes are reidentified measuring up to 1.9 cm in longest dimension, again demonstrating diffuse mild cortical thickening, stable in size as compared with sonographic evaluation of 6/2/2016. These are just lateral to the jugular vein. On prior neck MRI study of 12/2014, a few left level IV lymph nodes likely corresponding to these lymph nodes, suggesting chronicity of the finding, though the sonographic measurements this year are somewhat larger than the prior size on MRI.
Mildly prominent left level IV cervical lymph nodes, stable in appearance and size as compared with sonographic evaluation of 6/2/2016. If further imaging evaluation is clinically warranted, a PET scan could be considered. The patient will be seen in surgery clinic today. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.