Generality
Breast ultrasound is a diagnostic imaging exam that allows anatomical and structural study of the breast .
With breast ultrasound it is possible to identify breast cysts, ie formations of a benign nature, often with a liquid or mixed content, and fibroadenomas . This investigation also allows the diagnosis of the presence of inflamed tissues (as in the case of mastitis or abscesses ) and is important in the early diagnosis of more serious lesions, such as malignant tumors . Breast ultrasound also allows visualization of any changes to the lymph nodes of the axillary cables.
In most cases, breast ultrasound is not an alternative investigation to mammography and the two examinations are considered complementary. In breast diagnosis, the ultrasound examination is more suitable to evaluate the dense mammary tissues (in which the glandular component is prevalent) of young women, not always easily visible on mammography X-rays.
What is that?
Breast ultrasound is an exam that exploits the action of ultrasound (low-frequency and high-intensity sound waves, falling within the band not audible to the human ear, harmless to the body and its tissues) to study the parenchyma of the mammary gland and its pathological alterations.
Ultrasounds are generated by the vibration of piezoelectric crystals contained in the ultrasound probes and, according to a principle similar to the echo phenomenon, are reflected by the tissues of the breast, generating a series of reflected waves. The latter are recorded by the ultrasound probe and are decoded by the central unit of the instrumental apparatus, which transforms the information acquired into two-dimensional images visible on the monitor.
The ultrasound thus allows to visualize the mammary zones in which the density is different from that of the normal tissue, identifying areas of opacity and nodular formations of benign or malignant significance, and allowing to distinguish between lesions with liquid content and solid ones .
Ultrasound is an important exam for the diagnosis of breast cancer, especially useful for completing mammography in younger women, who have a dense breast in which the glandular component is prevalent. In fact, in the more compact breasts, the sensitivity of mammography (and therefore the ability to identify a tumor) is reduced and ultrasonography can be improved by offering more information.
Note: advantages and limitations of mammography
The major advantage of mammography is to be able to discover even small formations and micro-calcifications that can be a warning signal for malignant breast tumors. However, this remains a non-specific investigation technique, as it does not always succeed in establishing the nature of a training. This characteristic can be better highlighted and distinguished from ultrasound. Therefore, in the case of suspected lesions with mammography, it is useful to use the ultrasound examination later, in support of a correct diagnosis.
Generally speaking, breast ultrasound is the first level exam in women up to 35-40 years and is an excellent supplement to mammography after the age of 40.
What can you find out?
Breast ultrasound is indicated in all cases in which nodular formations are evident or palpable on medical examination or breast self-examination. The ultrasound scan makes it possible to verify the presence of lesions, even small ones, obtaining, at the same time, useful information about their probable malignant or benign nature .
Breast ultrasound is therefore aimed at obtaining images about suspicious lesions, in order to be able to examine their characteristics (margins, cystic or solid structure, etc.) and the relationships with other structures. This method also allows the evaluation of possible formation of axillary lymph nodes.
Ultrasound examination of the breast has proved to be particularly useful and reliable in the study of benign breast changes (fibrocystic disease, fibroadenomas, inflammatory pathology and dilatation of the galactophore ducts).
Moreover, if associated with the color-doppler technique, the ultrasound examination allows to study the vascularization of the nodular formations under examination. Ultrasound guidance is also useful in needle-aspiration and biopsy procedures, respectively for cytological and histological examination of the suspected lesion. More precisely, in the needle-aspirate a sample of cells is taken from the mammary nodule, which is then sent to the medical pathologist for the cytological study. The needle-biopsy, on the other hand, is a technique that allows to collect tissue fragments from the affected area, to perform a microscopic histological examination and to allow a more detailed analysis of the lesion.
How do you do it?
Breast ultrasound is a simple and safe diagnostic technique, which is performed by placing a small probe on the skin of the breast, after having deposited a small amount of conductive gel to facilitate the sliding of the instrument on the skin and improve the transmission of ultrasound waves.
To perform breast ultrasound, the patient is invited to lie down on a couch with her chest uncovered and her arms raised, placing her hands behind her head. Subsequently, the doctor rests the ultrasound probe first on one breast, then on the other and, slowly flowing with perpendicular and radial movements over the entire surface to be examined, begins to "capture" the images relating to the breast tissue, which are displayed on the monitor.
At the end, the radiologist can immediately provide the results of the examination or can request complementary tests to establish the diagnosis with certainty.
The examination is not painful, it lasts about 15-20 minutes and does not require the administration of any drug or contrast agent.
Reliability and limits
In young women, the glandular component prevails, while with age, this part is reduced in favor of the fat and fibrous portion of the breasts. Breast ultrasound is an exam particularly suitable for women under 40, with radiologically dense breasts or when a mammography examination requires comparison.
- For breast cancer, ultrasound has an estimated diagnostic accuracy of 78 to 96%. If palpation identifies nodular changes or mammography shows suspicious areas, or is difficult to interpret, the ultrasound examination can help resolve the diagnostic doubt.
The use of breast ultrasound is limited by the impossibility of simultaneously visualizing the entire volume of the breast and the difficulty of identifying malignant lesions at an early stage (for this reason, the ultrasound examination is complementary to clinical evaluation and mammography). Furthermore, the ultrasound examination cannot replace mammography in the search for malignant tumor at an early stage, as it does not identify the microscopic calcifications detectable by mammography.
The reliability of this examination depends very much on the competence of the doctor who performs it: it is said, in fact, that the ultrasound is an "operator-dependent" investigation. For this reason, it is important that it be performed at a specialized center, by radiologist doctors with specific experience on breast disease and their ultrasound identification.
When is it indicated?
Breast ultrasound is performed as a diagnostic test on the doctor's advice in all cases in which a suspect symptom is present, such as an evident or palpable nodular formation during breast examination or breast self- examination .
This survey is also indicated to complete the mammography or magnetic resonance imaging, in the radiologist's opinion, in cases where a diagnostic comparison is needed.
Breast ultrasound is NOT a screening test for early diagnosis to be performed periodically in asymptomatic women (for example, annually).
The ultrasound examination is indicated above all in young patients (before the age of 35), as a diagnostic completion to the breast examination, due to its particular suitability for the study of dense glandular breast.
Breast ultrasound is chosen as an investigation even in the presence of an inflammatory pathology (mastitis, abscess and trauma) and for the control over time of the benign pathology of the breast (fibroadenoma, lipoma and cysts).
Breast ultrasound is an examination indicated in cases where:
- Study a breast in young women (before the age of 35), if the breast examination requires it;
- Establishing the solid or liquid nature of a nodule;
- Evaluate an asymmetric thickening detected by mammography;
- Examine a woman's breasts during pregnancy, in the presence of particular palpable nodules or inflammatory pathologies (mastitis, abscess and trauma);
- Check the course of the benign breast disease (fibroadenoma, lipoma or cyst) over time;
- Monitor a patient operated on for a tumor to evaluate a possible relapse;
- Make a needle collection on a suspicious nodule or a biopsy of non-palpable lesions, which can be shown as an ultrasound medicine
Breast ultrasound is one of the tests to undergo to diagnose the presence of tumor masses located in the thoracic area also for humans.
Is preparation necessary?
Breast ultrasound does not require any particular preparation by the patient. However, it is advisable to bring with you the results of the last ultrasound scans or mammograms performed, so that the doctor can evaluate during the examination if any anomalies found are pre-existing or new onset.
Are there any contraindications?
Breast ultrasound is a non-invasive examination, which does not cause any discomfort. The investigation is absolutely risk free and without any contraindication or secondary effect, since only ultrasound and not ionizing radiation are used.
Complementary examinations
The tools indicated for diagnosing breast cancer are varied.
Breast ultrasound is considered a complementary examination for breast examination and mammography. If during these investigations nodular alterations are identified (on palpation) or areas that generate suspicion (on the interpretation of the mammography picture), we proceed with the ultrasound examination, in order to exclude any diagnostic doubts and have the most precise response possible.
Mammography is the radiograph of the breast, useful for discovering the presence of nodules, micro-calcifications or other indirect signs of a possible neoplasm. The breast is compressed with a special device and the X-rays, passing through the mammary tissues, imprint the radiographic image on a plate (or in the computer). With mammography, around 85-90% of all neoplasms are identified before they are palpable; in fact, this survey is also used as a screening test for the early diagnosis of breast cancer.
When the outcome of these tests is uncertain, the suspect areas are subjected to needle aspiration (or agocentesis) or to needle-mammary biopsy, followed by cytological or histological investigation, in order to further discriminate the nature of the lesion.
Another investigation that allows us to obtain useful information to differentiate the characteristics of suspicious breast lesions is magnetic resonance . This survey is indicated when the mammary structure appears complex to the other visualization investigations, or when it is necessary to visualize in detail some images deemed abnormal (for example, in women who present a high risk of breast cancer, with diagnosis in place or previously operated ).
MRI can indeed identify a malignant tumor even in cases where mammography and breast ultrasound are not able to recognize it.
