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Breast Ultrasound

Ultrasound is an imaging modality that has been incorporated into widespread use in breast centers throughout the country. It is a “non ionizing” source of pictures, or put another way, there is “no radiation” involved. The principles that it uses are the same as radar. Sound waves, (or “ultra” sound—much higher frequencies than the human hearing range), are aimed into the breast, and are reflected back at various speeds depending upon what they encounter in their path. The returning sound waves are then “read”, and form a picture.

Usually, the patient is lying down on her back while her breast is being scanned. There is no compression involved. Gel is applied to the breast as a coupling medium. The gel allows transmission of the sound waves into the breast much more readily than with an air interface. (This is along the same principle as listening to sound piped through water vs. out on the land; you will hear much better in the water!)

Ultrasound gives the radiologist different information than the mammogram. When necessary, and used in conjunction with each other, the two provide invaluable information. Ultrasound is very useful in determining if a mass seen on the mammogram is cystic or solid. If a mass is determined to be a simple cyst, there is no increased risk of breast cancer. A cyst is a fluid filled sack, and in most instances, over time, will be reabsorbed by the body. A solid mass implies a tumor, or collection of cells, and not fluid. It is then up to the doctor to determine if this is benign, (not cancer), or malignant. The tumor may look obviously benign to the doctor, but usually will need some form of needle biopsy for verification. Sometimes the mass will have a combination of cystic and solid features.

In addition, ultrasound is wonderful for providing supplementary information to the radiologist in a patient with “dense” breasts, or patches of high “optical density” within breasts. It is a window into the internal structures of the dense areas. (If you’ve ever received a report on yourself that says that your mammogram is normal, but that information could be missed because of the density of the breasts, this is what they are referring to.)

Ultrasound is also very useful in exploring the etiologies of various symptoms, and with assisting in biopsy procedures.

Could ultrasound be used for screening?

The answer is both yes and no. Ultrasound will not pick up most calcifications, (calcium deposits), in the breast. (Up to 40% of cancers can present with calcifications.) Mammography demonstrates calcifications easily. Ultrasound could be an adjunctive screening tool in women with dense breasts. They would need a mammogram, and then in addition, ultrasound of one or both breasts would be useful. (We, in the industry, are working on screening ultrasound tools right now.)

These are the most common uses of breast ultrasound, but there are many more. If your doctor requests that you obtain a breast ultrasound, you can rest assured that it is not a painful test, and will be used to clarify a question in the data gathering to ensure good breast health.

Click here to view an interview about the Breast Health Center and why you need to get a mammogram!

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