Breast Imaging - Breast Ultrasound

Diagnostic Ultrasound is a common adjunct to digital mammography in the evaluation of breast disease.  Its most common indications include:

•    Determining the Nature of a Breast Abnormality
The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography.

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.

Doppler ultrasound is used to assess blood supply in breast lesions.

•    Supplemental Breast Cancer Screening
Mammography is the only screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of glandular tissue and less fat, many cancers can be hard to see on mammography.

Many studies have shown that ultrasound and magnetic resonance imaging (MRI) can help supplement mammography by detecting small breast cancers that may not be visible with mammography. This is usually only considered when the breast tissue is dense. It is hoped that by detecting such cancers, these other screening tests might help to further prevent deaths due to breast cancer beyond what is achieved with mammography alone. When ultrasound is used for screening, many abnormalities are seen which may require biopsy but are not cancer (false positives), and this limits its cost effectiveness.

Today, ultrasound is being investigated for use as a screening tool for women who:
•    have dense breasts
•    have silicone breast implants and very little tissue can be included on the mammogram
•    are pregnant or should not to be exposed to x-rays (which is necessary for a mammogram)
•    are at high risk for breast cancer based on family history, personal history of breast cancer, or prior atypical biopsy result.

•    Ultrasound-guided Breast Biopsy
When an ultrasound examination cannot characterize the nature of a breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures.

A breast biopsy involves removing some tissue—usually by a procedure involving a needle which can take small pieces of tissue under local anesthesia—from the suspicious area in the breast and examining it under a microscope to determine a diagnosis. Occasionally, a surgical biopsy is needed to make a diagnosis.

Ultrasound-guidance is used to assist physicians in obtaining tissue samples from the breast in three different biopsy procedures: a cyst aspiration, a fine needle aspiration (FNA) biopsy and a core needle (CN) biopsy. Most cysts do not require any procedure. FNA is most often performed to evaluate suspicious axillary lymph nodes (under the arm) in patients with known or suspected breast cancer. Most ultrasound-guided breast biopsies are performed using core or vacuum-assisted needle biopsy techniques.

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