31-year-old female with history of left triple negative breast cancer with metastatic left axillary lymph nodes status post neoadjuvant chemotherapy presenting for assessment of treatment response. Patient had bilateral breast MRI on 10/10/2016 which revealed significant reduction in size of index tumor and satellites in the left breast. Family history is positive for breast cancer in aunts on both the maternal and paternal sides. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense (BiRADS Density Category D), which lowers the sensitivity of mammography, unchanged in pattern and distribution. Redemonstrated wing clip at the level of the axillary tail, where index malignancy was biopsied. A Hydromark biopsy clip marker is again seen in the outer central posterior breast, at site of biopsy-proven malignant satellite lesion. The index malignancy and biopsied satellite are not well visualized on the mammogram. Clips are approximately 7.2cm apart on the ML view.Ribbon and hydromark biopsy clip markers are reidentified at site of biopsy-proven metastatic left axillary lymph node, which appears slightly decreased in size currently measuring 1.7 cm in maximum dimension, previously 2.6 cm.No suspicious microcalcifications or areas of architectural distortion are noted in the left breast. LEFT BREAST AND AXILLARY ULTRASOUND:Targeted ultrasound of the left breast 3:00 position presents clip artifact with surrounding elongated anechoic mass likely reflecting gel capsule associated with the biopsy clip. No definite residual solid mass.Targeted ultrasound of the left axillary tail reveals a 0.8 x 0.6 cm elongated hypoechoic mass (previously measuring 1.9 x 1.0 x 3.9 cm on 8/8/2016) with peripheral vascularity and eccentric biopsy clip marker artifact, at site of index malignancy.Targeted ultrasound of the left axilla reveals a 1.1 x 0.5 x 1.0 cm lymph node (previously measuring 1.6 x 0.9 cm on breast MRI dated 10/10/2016) with artifact from 2 echogenic biopsy clip markers.
Interim decrease in size of index left axilla tail mass and metastatic left axillary lymph node, and sonographic resolution of malignant satellite lesion (located approximately 7.2 cm from the index malignancy). Patient is scheduled for bilateral breast MRI today and that will be separately reported.  BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.