What it says

• Left breast: an irregular solid-appearing lesion measuring 20 x 29 mm at the 4 to 6 o'clock position.
• It is classified BI-RADS 4C, which means a high suspicion for cancer, but it is not a diagnosis. BI-RADS 4C lesions have an estimated cancer likelihood of more than 50% but less than 95% and require tissue diagnosis by biopsy. BI-RADS category explanation
• Left armpit (axilla): a few enlarged lymph nodes are described, with loss of the normal fatty hilum. This can be suspicious for involvement by disease, but ultrasound cannot confirm metastasis. The nodes also need sampling if the specialist considers it appropriate.
• Other breast tissue, nipple/areolar area, pectoral muscle, and absence of calcifications are described as normal. These findings do not rule out cancer in the identified mass.

What should happen next

1. Arrange an appointment with a breast surgeon/surgical oncologist urgently, ideally within days.
2. The usual next diagnostic step is an image-guided core needle biopsy of the breast lesion. BI-RADS 4 lesions are indications for core biopsy. Current Surgical Therapy, 14e, Box I, lines 1193-1219.
3. The clinician may also arrange:
   • Diagnostic mammography of both breasts, if not already done
   • Ultrasound-guided biopsy or needle sampling of a suspicious axillary lymph node
   • Further scans only after biopsy results, if needed

Important