38-year-old female with multifocal left breast cancer and metastatic left axillary lymph node currently on neoadjuvant chemotherapy. A personal history of left retroareolar benign biopsy. Three standard views of both breasts were performed digitally, with additional CC and ML right spot compression views, and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Redemonstrated lock shaped clip in the left central posterior breast at the site of biopsy-proven index malignancy. Focal asymmetry previously seen at this site on mammogram of 7/7/2016 is no longer visualized.Redemonstrated hydromark clip also in the left central breast, slightly anterior to the index lesion, with no residual associated mass.A left retroareolar ribbon clip is redemonstrated, at site of previous benign biopsy.There is no mammographic correlate to the new right lower breast is unchanged right mass identified on same day MRI study.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breasts.BILATERAL BREAST ULTRASOUND:Targeted ultrasound of the left lower outer breast, 5:30 3 cm from the nipple redemonstrates a Hydromark clip at site of biopsy-proven malignant satellite lesion. There is no residual mass (previously, 0.7 cm mass).Targeted ultrasound of the left lower outer breast, 5:00 3 cm from the nipple redemonstrates a biopsy clip marker at site of index malignancy. Small residual hypoechoic mass measuring 0.7 x 0.4 x 1.0 cm, previously 1.7 x 1.1 x 1.7 cm. Targeted ultrasound of the left axilla redemonstrates biopsied lymph node measuring 2.1 x 0.7 x 2.1 cm, with decreased cortical thickening (0.5 cm, previously 0.7 cm). Please note, on previous ultrasound study of 11/7/2016, 2 lymph nodes were identified. On today's ultrasound evaluation, only the biopsied lymph node is identified. Please this regard images labeled "1" and "2".Targeted ultrasound of the right breast, 6:00 2 cm from the nipple, reveals a 0.7 x 0.2 x 0.5 cm heterogeneous ill-defined mass with peripheral vascularity. This finding correlates to the new enhancing mass on MRI.
1. New indeterminate right right lower breast mass. Although imaging characteristics could be due to benign etiology, recommend ultrasound-guided biopsy and clip placement is recommended to exclude malignancy. Alternatively, since the patient is scheduled for bilateral mastectomy later this month, single needle localization could be performed.2. Interim decrease in size of left index malignancy, and resolution of adjacent malignant satellite lesion.3. Slight decrease in size of biopsied abnormal left axillary lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.