Breast ultrasound and ultrasound-guided breast biopsy

1
Breast ultrasound and ultrasound-guided breast
biopsy

• A practical guide
• Jill Donnelly
• Breast and General Surgeon

2
Clarifications The Triple Assessment
Rule Core biopsy and needle aspiration
3
This presentation applies to Women who
have Breast symptoms of pain /or
lump Localised to one breast quadrant

4
This presentation does not apply to Women
having breast screening Women with Nipple
symptoms Diffuse symptoms
5
For women with symptoms of pain /or a lump
localised to one quadrant Ultrasound and
ultrasound-guided core biopsy are the
investigations of choice. Mammography has no
initial role. 90 of patients are in this
group.
6
After history, assessment steps Step
1. Examination lump yes or no? Step 2.
Ultrasound symptomatic quadrant. Discrete
lesion yes or no? Step 3. If the answer is
yes to Step 2 or 3 core biopsy or needle
aspiration is required. Step 4. Lesion
solid on ultrasound biopsy Lesion cystic on
ultrasound aspirate
7
Common breast lumps Fibroadenoma Benign
breast change (lumpiness) Cyst Cancer
8
(No Transcript)
9
(No Transcript)
10
Benign breast change No discrete
abnormality seen on ultrasound Requires biopsy
because lump present on palpation (Triple
Assessment rule)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
Ultrasound features of benign
lumps Respect tissue plains Long axis
horizontal Wall clearly-defined Posterior
brightness (cysts) Ultrasound features of
malignant lumps Interrupt tissue plains Long
axis vertical Wall irregular, poorly-defined Pos
terior shadowing
21
Summary If you feel a discrete
lump on palpation or see a discrete
lump on ultrasound put a needle in it, using
ultrasound to guide you.