47-year-old woman with known right breast cancer presents for further evaluation of a satellite lesion and intramammary lymph nodes detected on MRI dated 3/29/2016. A targeted right ultrasound was performed areas of clinical concern.In the upper outer quadrant of the right breast, superior to the index malignancy, there are two intramammary lymph nodes identified, correlating to the MRI. Both lymph nodes are normal in size measuring 5 mm and 6 mm, respectively. Both lymph nodes demonstrate normal morphology with hilar flow. These have been stable dating back to mammogram 2/4/2014.The known index malignancy in the upper outer quadrant, posterior depth is revisualized, with biopsy clip seen centrally. Immediately inferior and slightly lateral to the index malignancy there is a 5 x 5 x 6 mm oval mass with mild peripheral vascularity, consistent with the satellite lesion seen on MRI. This is seen approximately 1.4 cm inferior to the index malignancy.
(1) Normal size and morphology right upper outer quadrant intramammary lymph nodes. (2) Approximately 1.4 cm inferior to the known index malignancy, an oval mass measuring up to 6 mm is identified correlating with the satellite lesion seen on MR. Management options for this lesion could include inclusion in a lumpectomy via ultrasound guided needle localization versus ultrasound guided biopsy and clip placement with subsequent localization of the biopsy clip at the time of surgery. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.