Ultrasound of the breast is a valuable tool in the management of breast problems. The primary benefit of breast ultrasound is to determine if a mass seen on mammogram or felt on exam is cystic or solid. If a lesion is confirmed to be a simple cyst it is benign and if asymptomatic can be observed. A mass which is solid or complex requires further diagnostic evaluation.
Ultrasound provides us with the most versatile biopsy options. I routinely perform either a fine needle aspiration or a core biopsy using the ultrasound for guidance. A fine needle aspiration obtains cells which are evaluated by cytology. In contrast, a core biopsy provides tissue for histology which significantly decreases the chance of a false negative report or inadequate sampling. Core biopsy is done at the time of ultrasound with local anesthesia and is very well tolerated. Performing a core biopsy will often allow a woman to avoid surgical resection of a benign lesion.
The main advantage of the surgeon viewing the ultrasound in “real-time” is that we can identify the location and nature of a lesion more accurately than viewing still images remote from the exam. As a breast clinician and surgeon combining my review of a patient’s mammogram, my clinical exam, and a breast ultrasound is invaluable towards developing a comprehensive diagnostic and therapeutic plan.
Breast ultrasound is not routinely indicated for breast cancer screening, but it is an extremely useful adjunct to mammography in women who have very dense breasts on mammography or exam, or in women who are at high risk for breast cancer. It is a technology that has no known risks, is painless to perform, and is vital to our management of women with breast problems.