Directed second look ultrasound of the right breast in patient with newly diagnosed right breast ILC at the 10 o'clock position. Staging MRI demonstrated two satellite lesions anterior to the index mass as well as a mildly atypical appearing subpectoral lymph node in the right axilla and an indeterminate focus of enhancement in the central aspect of the right breast. A targeted ultrasound of the right breast and right axilla was performed for the areas identified on the MRI. A 2.9-cm along right axillary lymph node is noted in the central inferior right axilla. The margins are slightly lobulated. The cortex measures 3 mm in thickness. There is hilar flow. This does not have morphologic features that are suspicious enough change the standard surgical approach to staging the axilla. The suspicious subpectoral lymph node seen on MRI could not be identified. The index mass is again identified at the 10 o'clock position approximate 7 cm from the nipple. Immediately adjacent to the lateral edge of the mass is a 4 x 2 mm hypoechoic nodule. This is either a focal protrusion from the index mass or an adjacent satellite. This is labeled number one.A satellite lesion is identified approximately the 5 mm anterior to the index mass corresponding to one of the two satellite lesions seen on MRI. This is labeled number two. This measures approximately 8 x 3 x 3 mm. There is apical blood flow on color Doppler imaging.A second satellite lesion measuring 8 x 3 x 8 mm and demonstrating apical blood flow is identified just anterior to lesion labeled number two. This is labeled number 3. The two satellite lesions together measure approximately 2 cm and therefore the more anterior lesion is approximately two half centimeters away from the index mass.No sonographic correlate was identified in the expected location of the additional MRI detected focus in the central medial right breast.
1. The two satellite lesions anterior to the mass that were suspected on MRI are seen on ultrasound. Measurements as documented above. A third satellite or focal projection was identified immediately adjacent to the lateral edge of the mass.2. The indeterminate subpectoral lymph node in the right axilla could not be identified. There were no lymph nodes with sonographic features that would alter the standard surgical approach to staging the axilla.3. No sonographic correlate corresponding to the additional central medial enhancing focus could be identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.