BI-RADS Category 5 Left Breast Carcinoma with Suspicious Axillary Nodal Metastasis: A Case Report

Background: Breast cancer is the most common malignancy among women, and accurate imaging is essential for early diagnosis and appropriate management. We report the case of a 56-year-old postmenopausal woman who presented with a painless lump in the upper outer quadrant of the left breast for four months. Ultrasonography revealed a 2.4 × 1.6 cm heterogeneously hypoechoic irregular mass with non-circumscribed margins, punctate calcifications, posterior acoustic shadowing, and internal vascularity. Shear-wave elastography demonstrated markedly increased stiffness with a Tsukuba score of 5, elevated strain ratio, and high elasticity values, indicating a high likelihood of malignancy. Multiple enlarged ipsilateral axillary lymph nodes with cortical thickening, irregular margins, loss of fatty hilum, and increased vascularity were also identified, suggesting metastatic involvement. The lesion was categorized as BI-RADS Category 5, and ultrasound-guided core needle biopsy of the breast lesion with FNAC/core biopsy of the axillary lymph node was advised for histopathological confirmation. This case highlights the complementary role of conventional ultrasonography and elastography in improving diagnostic confidence, identifying nodal metastasis, and facilitating early diagnosis and timely management of breast carcinoma.

Keywords: Breast carcinoma; BI-RADS 5; Breast ultrasonography; Shear-wave elastography; Axillary lymph node metastasis; Case report.