The role of ultrasound in breast imaging

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The role of ultrasound in breast imaging
Dr Francien Malan Drs Van Wageningen Vennote 31
October 2007
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How does ultrasound work?

• High frequency sound wave
• Crystal probe serves as both transmitter and
  detector of sound waves
• Different tissue types
• Signal coming back translated into real time
  black and white picture by computer software
  

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Uses of ultrasound in breast imaging

• Palpable masses
• Mammographically detected masses
• Dense breasts
• Young patients
• Pregnant/ lactating woman
• Breast implants
• Guided aspiration/ biopsy/ localisation

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Palpable abnormality

• Ultrasound especially useful if mammogram shows
  no obvious abnormality
• /- mammo shows abnormality
• Young patients
• Benefits of ultrasound

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• Cystic or solid?

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Simple cyst
Typical fibroadenoma
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cancer
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Dense/whitebreasts
Fatty/ dark breasts
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• Dense breasts means a relatively large percentage
  of fibroglandular tissue and little fat
• 50 of patients lt30yrs
• 1/3 of patients gt 50yrs
• Cant see through
• Ultrasound useful!!!

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• Young patients (lt30/ lt35yrs)
• Should be first investigation mammogram only if
  ultrasound equivocal
• Palpable lesions in young woman most commonly
  cysts or fibroadenomas

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• Most common problem in lactating woman is
  mastitis / breast abcesses
• US guided drainage of abcess

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Implants
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• Indications the same as for women without
  implants
• Also for evaluation of implant complications
  such as rupture

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Ultrasound guided cyst aspiration/ biopsy

• Aspiration of cysts are done when cyst has
  atypical features, pain relief, relief of
  anxiety, cosmetic reasons
• Biopsy done when after clinical evaluation/
  mammography and ultrasound the nature of lesion
  is still uncertain

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What happens?

• Outpatient
• Sterilised, anaethetised
• Needle is guided into cyst under direct
  ultrasound vision
• Cells obtained to path lab for evaluation

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Ultrasound guided localisation

• Localisation is done prior to surgical resection
  of lesion to guide surgeon to the lesion, can be
  done with u/s or mammogram
• Inpatient, fasting, sterile conditions, local
  anaesthetic, localisation needle guided into
  lesion, wire strapped to arm, patient goes to
  theatre.

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Why ultrasound for localisation?

• Lesion visible on ultrasound, not clinically
  palpable may or may not be visible on mammogram
• Benefits of real time guidance of wire into
  lesion 3D perspective relatively quick

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Why mammogram for localisation?

• Microcalcifications
• Small lesion deeply seated in large breasts
• Area of suspicion on mammogram not visible on
  ultrasound

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Complications

• Unsuccessful
• Hematoma
• Minor discomfort
• Infection

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Limitations of breast ultrasound

• Many cancers are not visible on ultrasound
• Microcalcifications
• Inderteminate gt biopsy

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• CANNOT REPLACE REGULAR SELF EXAMINATION AND
  MAMMOGRAPHY AS PRIMARY SCREENING TOOL FOR BREAST
  CANCER!!!!