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What is a Breast Ultrasound?
Ultrasound is a radiology imaging technology that uses sound waves to characterize lumps or masses in the breast. Sound waves are emitted from crystals in a hand-held wand called a transducer or probe. The sound waves reflected back are presented as images for interpretation by a specialized radiologist to distinguish various findings. Because the radiology technology uses sound waves to characterize the breast tissues, it is also called a breast sonogram. The radiologist looks for changes that may be as obvious as masses or as subtle as slight pulling of the tissue called architectural distortion. Many of the findings we see on a breast ultrasound are too small or too deep to be felt on examination.
How Are Masses and Architectural Distortion Found?
Women who perform regular screening mammography have the best chance of finding early changes on a mammogram before they can be palpated on clinical or breast self-examination (BSE). If a mass is found on a screening mammogram, then diagnostic radiology imaging such as breast ultrasound or a diagnostic mammogram will be requested to get a closer look at a particular area. Which diagnostic imaging tools are used depends on many factors including the reason for the examination, the age of the patient, and any risk factors such as family history. Some masses are palpated in the breast instead of being found on a mammogram.
What About Lumps That Come and Go?
For breast lumps that come and go with the menstrual cycle, it is reasonable for a premenopausal (before menopause) woman to observe a nonsuspicious finding until after the next menstrual cycle. If the finding does not resolve after the next monthly cycle, then you should seek attention from your physician or dedicated breast imaging center. However, some women may present with serious breast complaints such as a fixed mass, skin change including thickening redness, nipple inversion, or bloody discharge is noted.
If you experience any of these serious symptoms or signs, then immediate imaging workup is indicated.
What are the Ultrasound Features of Breast Masses?
The radiologist looks for particular criteria of the mass such as shape, orientation, the margin of the mass, lesion boundary, echo pattern, and posterior acoustic features. This lexicon is established by the American College of Radiology and is called the Breast Imaging- Reporting and Data System (BIRADS). For example, a well-circumscribed isoechoic oval nodule oriented parallel to the skin with a distinct lesion boundary is most likely to be a benign fibroadenoma. These mass characteristics would be categorized as BI-RADS 3: Probably Benign. On the other hand, an irregular spiculated hypoechoic mass taller than wide with posterior shadowing with surrounding echogenic halo is more likely to be malignant (cancer). This lesion would be categorized as BI-RADS 5 with the recommendation for breast biopsy.
This is where experience matters. The Women’s Imaging Center specialized radiologists have decades of experience to help provide a more certain diagnosis.
Some Masses May Be Followed While Others Require Biopsy:
When an indeterminate or suspicious finding is discovered, the radiologist may recommend a needle biopsy to determine if the mass is benign (noncancerous) or malignant (cancer). A lesion seen by ultrasound can be biopsied using ultrasound as a guide, even if it cannot be felt on clinical or self-breast examination. The physicians at The Women’s Imaging Center use their extensive clinical experience to determine the need for biopsy. Please see our BREAST ULTRASOUND-BIOPSY service description for more information.
How do I Obtain My Biopsy Results?
Anytime that diagnostic breast ultrasound is performed for a symptom or abnormal mammogram finding, a specialized radiologist will be directly involved with your exam. The radiologist with extensive medical diagnostic radiology experience will be observing the imaging during the technologist’s exam. They will then visit with you and perform a directed clinical breast examination (CBE) if indicated. The specialist radiologist will review the ultrasound images and results with you in understandable terms. They will discuss with you any follow-up recommended.
It is important to follow through with the radiology imaging recommendations and with your referring clinician for any breast complaint.
If a breast biopsy is indicated, they will explain the recommended procedure of ultrasound-guided breast biopsy and a medical assistant will go over further details. The Women’s Imaging Center Patient Navigator and the Radiologist correlate the results and coordinate any follow-up care or management indicated.