Breast Ultrasound

Breast ultrasound—or ultrasonography of the breast—is the use of ultrasonic waves (sound waves that cannot be heard by humans) to produce an image of breast tissue. Breast ultrasonography may be used with mammography or by itself.

Ultrasonography may be used to detect and classify breast lesions in the following types of women:

• Women with dense breasts.
• Women with fibrocystic breast disease.
• Women with a lesion that cannot be well-classified with mammography alone.
• Young women with masses.
• Pregnant women with masses.
• Women with breast implants.

Normally, the breast tissue will appear uniform and without masses. Distinctive patterns (abnormal results) may indicate:

• Fluid-filled cysts.
• Benign lesions.
• Malignant lesions (breast cancer).

Core biopsy

Mammography is an excellent way to detect breast abnormalities, but in many cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. To make this determination, it is necessary to obtain a tissue sample for microscopic examination. As an alternative to open surgical biopsy, which removes a larger specimen for microscopic analysis, a hollow needle may be passed through the skin into the suspicious lesion with the help of special breast x-rays. The sample of breast tissue obtained in this way can show whether the lesion is malignant or benign, and the procedure is much less invasive than the surgical approach.

A core biopsy procedure may be performed by using ultrasound guidance or mammography. A special computerized mammography machine uses intersecting coordinates to pinpoint the area of tissue change. This method is called stereotactic biopsy, or x-ray-guided biopsy. A pathologist examines the removed specimen and makes a final diagnosis so that treatment planning can begin.

A stereotactic breast biopsy is most helpful when mammography shows a mass, a cluster of microcalcifications (tiny calcium deposits that are closely grouped together), or an area of abnormal tissue change but no lump can be felt on careful breast examination.

An x-ray-guided biopsy often is done when:

• A woman has a mammogram showing a suspicious solid mass that cannot be demonstrated by ultrasound.
• A woman has a mammogram showing a suspicious cluster of small calcium deposits.
• The structure of the breast tissue is distorted.
• A new mass or area of calcium deposits is present at a previous surgery site.
• The patient or physician strongly prefers a nonsurgical method of assessment.

An ultrasound-guided biopsy often is done when:

• A woman has a mammogram and ultrasound showing a suspicious solid mass.
• The patient or physician strongly prefers a nonsurgical method of assessment.

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