Need help interpreting report, please !

Provided clinical information: 39-year-old female with 3 weeks of

right breast redness and thickening pain treated for mastitis with 2

rounds of antibiotics. Not improved. Positive family history in her

grandmother with a history of inflammatory breast cancer.

Procedure and materials: 2-D digital mammography in the CC and MLO

projection and 3-D digital breast tomosynthesis in the CC and MLO

projection were obtained of the breasts. Additional true lateral and

spot magnification views of the right breast were obtained. 2-D images

were analyzed by a CAD system.

Comparison studies: None.

Reason for examination: Right breast redness and thickening

Observations:

Breast composition: b. There are scattered areas of fibroglandular

density.

There are extensive coarse heterogeneous calcifications in a segmental

distribution somewhat in a linear configuration in the 2-4 o'clock

inner right breast with associated asymmetries over an area of 10 x 8

cm. Diffuse skin thickening is noted on the right. Targeted ultrasound

was performed. No suspicious mass, distortion, calcifications, or

other findings identified on the left.

ULTRASOUND:

Multiple real-time 2-D grayscale images of the 2-4 o'clock right

breast and right axilla were obtained. Color Doppler imaging was used

to evaluate vascularity. I personally rescanned the patient. Area of

concern is thickened and erythematous.

Scattered heterogeneous hypoechoic shadowing areas are noted

throughout the 2 to the 4:00 right breast, mid to posterior depth,

likely corresponding to the asymmetry/calcifications seen on

mammogram. Surrounding vascularity is noted. There is borderline right

axillary lymph node with cortex measuring approximately 3 to 4 mm.

Preserved fatty hilum. No other suspicious adenopathy.

IMPRESSION

Extensive suspicious coarse heterogeneous calcifications over 10 cm in

the 2-4 o'clock in her right breast with associated asymmetries and

skin thickening concerning for inflammatory breast cancer. Area of

concern corresponds with heterogeneous hypoechoic shadowing lesions

under ultrasound and tissue diagnosis with ultrasound-guided biopsy is

recommended for further evaluation. Borderline thickened right

axillary lymph node.

Findings were discussed with the patient and her mother. She will be

scheduled to return for her biopsy.

Recommendation: Ultrasound-guided biopsy right breast

BI-RADS Assessment: Category 5: Highly suggestive of malignancy -

Appropriate action should be taken.