BREAST-ULTRASOUND
Breast Ultrasound is a well established and effective diagnostic modality for evaluation of breast diseases.
Ultrasound breast is the primary imaging modality for younger women less than 30 years of age.
It is an important adjunct tool to mammography especially for women with dense breasts.
Technological advances and newer applications like Elastography and Automated Breast Volume Scanner (ABVS) have made ultrasound even more exciting and interesting.
Indication Of Breast-Ultrasound
Ultrasound breast is used as the initial imaging evaluation tool for palpable masses in younger women (less than 35 years of age) at average risk of developing breast cancer.
Breast Pain
Breast pain can be cyclical pain or non-cyclical pain.
Focal pain in the breast which is noncyclical can be because of multiple reasons such as focal mastitis, fat necrosis, breast abscess, haemorrhage in a cyst. Most of these conditions can be diagnosed and followed up on ultrasound.
Nipple discharge
Evaluation of women with serous or sanguineous nipple discharge with
high resolution ultrasound gives direct visualization of dilated ducts and their contents.
Colour Doppler helps in differentiating between inspissated secretions and intraductal masses such as papillomas.
Pregnant and lactating women
Ultrasound of breast is done in pregnancy and lactating women to avoid mammography related radiation. It is also an excellent tool for lactating women who are more likely to demonstrate dense breasts on mammography.
USG as an adjunct imaging modality
It is used as an adjunct imaging modality for further assessment of suspected or apparent abnormalities which are detected on mammography.
Ultrasound is very useful to differentiate a palpable solid mass from a benign cyst. In malignant masses it effectively demonstrates ductal extension of masses and is very useful to identify multifocal and multicentric disease in dense breasts.
Second-look ultrasound after MRI (Magnetic Resonance Imaging)
This allows identification of about 68% of abnormalities seen only at MR imaging. For example screening MRI for women at high risk for breast cancer or preoperative breast MRI performed to assess multicentricity in known breast cancer patients may demonstrate MR abnormalities that were not demonstrated on
mammography or ultrasound performed prior to MRI breast. Second-look ultrasound
studies are highly recommended in such situations.
Ultrasound
Breast-Screening
Ultrasound breast is to be used as an adjunct to screening mammography for women with dense breasts and is deemed useful in the detection of mammographically occult cancers. Ultrasound replaces MRI for screening of women in the high risk category if they are not suitable candidates for MRI or have no availability of MRI. However
ultrasound is not established as a primary screening modality for general populations and should not to be used as a standalone breast cancer screening tool.
Follow-up of breast lesions:
Sonographically well visualised BIRADS 3 lesions are best followed up in six months’ time on ultrasound as there is no risk of radiation. However if the lesion is not visualised on ultrasound mammographic follow up becomes necessary.
Imaging of Axilla
Ultrasound is the modality of choice to image the axilla as well as to perform image guided procedures in the axilla such as biopsy of axillary lymph nodes.
Developing breast: Ultrasound is excellent for evaluation of developing breasts in young
girls. Asymmetric breast development in this age group can be reassuringly differentiated
from other pathologies by ultrasound in this age group.
Male breast
Ultrasound evaluation of the male breast helps differentiate gynaecomastia from breast masses like breast carcinoma and breast abscess. It is also the modality of choice for guided procedures in the male breast.
Breast Implant
It is the primary imaging modality for evaluation of breast implant
associated problems.
Sonographic assessment of implant morphology, contour, content and assessment of peri-implant tissues help evaluate implant related complications such as infection, hematoma, capsular contracture and rupture of implant.
Investigation of an unknown primary
Ultrasound of the breast along with mammography is advised for investigation of patients presenting with metastases from an unknown primary.
ELASTOGRAPHY
Elastography is the sonographic method for imaging the elasticity of compliant tissues and provides information about stiffness of the lesion under evaluation.
It is known that in general malignant breast masses tend to be harder due to their desmoplastic reaction when compared to the adjoining normal breast parenchyma and most benign lesions.
The evaluation of breast masses to differentiate benign lesion from malignant is one of the most important applications of ultrasound elastography.
It can help the radiologist to better characterise BIRADS 3 and 4A masses, thus reducing unnecessary breast biopsies.