Ultrasound

Ultrasound is really an extension of the physical exam. Diagnostic ultrasound can be used to further characterize a palpable lesion (i.e. cystic versus solid). It can also be used to identify a correlate of a mammographically lesion/abnormality and characterize this as well. Once a lesion is identified on ultrasound, the ultrasound can be used to guide various needle procedures such as cyst aspiration to assist targeting and ensure complete decompression. It can also be used to guide larger core needles to their target to endure accurate sampling. If a lesion is seen on ultrasound, using this modality to guide percutaneous biopsy is generally preferred over stereotactic localization and guided biopsy as it it less complicated (and less uncomfortable) for both the patient and breast surgeon. Ultrasound can also be used for monitoring percutaneous excision or ablation of benign lesions (i.e. fibroadenomas). Ultrasound of the axilla may identify abnormal lymph nodes and be used to guide fine needle aspiration (FNA) to see if they contain metastatic cancer cells. Intraoperative ultrasound can be used by the breast surgeon to localize the lesion to be excised including aiding the ability to obtain clear margins at excision. Finally, after final pathology confirms clear margins, if a patient is an appropriate candidate for APBI, ultrasound can be used by the breast surgeon in the office to percutanously access the surgical cavity and guide placement of the device which the radiation oncologist will use to insert (and remove) the radioactive seeds. Ultrasound is really an extension of the physical exam. Diagnostic ultrasound can be used to further characterize a palpable lesion (i.e. cystic versus solid). It can also be used to identify a correlate of a mammographically lesion/abnormality and characterize this as well. Once a lesion is identified on ultrasound, the ultrasound can be used to guide various needle procedures such as cyst aspiration to assist targeting and ensure complete decompression. It can also be used to guide larger core needles to their target to endure accurate sampling. If a lesion is seen on ultrasound, using this modality to guide percutaneous biopsy is generally preferred over stereotactic localization and guided biopsy as it it less complicated (and less uncomfortable) for both the patient and breast surgeon. Ultrasound can also be used for monitoring percutaneous excision or ablation of benign lesions (i.e. fibroadenomas). Ultrasound of the axilla may identify abnormal lymph nodes and be used to guide fine needle aspiration (FNA) to see if they contain metastatic cancer cells. Intraoperative ultrasound can be used by the breast surgeon to localize the lesion to be excised including aiding the ability to obtain clear margins at excision. Finally, after final pathology confirms clear margins, if a patient is an appropriate candidate for APBI, ultrasound can be used by the breast surgeon in the office to percutanously access the surgical cavity and guide placement of the device which the radiation oncologist will use to insert (and remove) the radioactive seeds.

Ultrasonography uses a sound beam, like the sonar of a submarine. The beam is generated by a transducer which is placed on the skin. The sound wave produces a signal every time it hits something, and the computer generates an image from all the returning signals. Ultrasound has been used in Radiology since the 1970's, and now that computers can be attached to just about everything we can produce even clearer images. For the breast we started using it to look at a lump that was felt either by the patient or her doctor. You could place the transducer on the skin at the spot where the lump is felt and you could see what was there. I diagnosed my own breast cancer this way, when I felt a lump.
We can also use ultrasound in the same way if we see something on a mammogram and we are not sure exactly what it is. As I mentioned in response to an earlier question, we now recommend it for women who have dense breast tissue. Ultrasonography uses a sound beam, like the sonar of a submarine. The beam is generated by a transducer which is placed on the skin. The sound wave produces a signal every time it hits something, and the computer generates an image from all the returning signals. Ultrasound has been used in Radiology since the 1970's, and now that computers can be attached to just about everything we can produce even clearer images. For the breast we started using it to look at a lump that was felt either by the patient or her doctor. You could place the transducer on the skin at the spot where the lump is felt and you could see what was there. I diagnosed my own breast cancer this way, when I felt a lump.
We can also use ultrasound in the same way if we see something on a mammogram and we are not sure exactly what it is. As I mentioned in response to an earlier question, we now recommend it for women who have dense breast tissue.

In terms of screening I would recommend ultrasound if the tissue is very dense, with not much fat. I would also recommend it for patients who are moderately dense but have a strong family history or in whom we have difficulty adequately compressing their breast for mammography, either because of discomfort, or because the tissue is very thick. In terms of screening I would recommend ultrasound if the tissue is very dense, with not much fat. I would also recommend it for patients who are moderately dense but have a strong family history or in whom we have difficulty adequately compressing their breast for mammography, either because of discomfort, or because the tissue is very thick.

First, to clarify, I am NOT an MD or a clinician, I am a PhD and my area of expertise is in cancer biology. That being said, there are several different methods, in addition to mammography, that can be used to screen for breast cancer.
1. Ultrasound- Ultrasound is the use of high frequency sound waves that 'bounce' off of internal structures and can provide a picture of the inside of a breast.
2. Elastography- This is a variant of ultrasound in which two different images are obtained. The breast is imaged in the normal way and is then re-imaged while it is being compressed (squashed). The idea behind this is that normal breast tissue will easily squash down but cancers are hard and do not change shape when the breast is flattened out. When the two images are compared, areas can be identified that failed to flatten out.
3. Breast MRI-Magnetic resonance imaging uses a strong magnet to alter the properties of the water in the tissue being examined (breast tissue in this case) to create an image of the breast.

If any of the methods above lead to the suspicion of cancer, a biopsy can be performed to determine if cancer is present. Note that NO medical test is perfect and it is important to understand the limitations of the tests (see below).

Learn more about cancer detection and diagnosis methods on the CancerQuest website: http://www.cancerquest.org/cancer-detection-diagnosis. Videos are also available about medical testing. First, to clarify, I am NOT an MD or a clinician, I am a PhD and my area of expertise is in cancer biology. That being said, there are several different methods, in addition to mammography, that can be used to screen for breast cancer.
1. Ultrasound- Ultrasound is the use of high frequency sound waves that 'bounce' off of internal structures and can provide a picture of the inside of a breast.
2. Elastography- This is a variant of ultrasound in which two different images are obtained. The breast is imaged in the normal way and is then re-imaged while it is being compressed (squashed). The idea behind this is that normal breast tissue will easily squash down but cancers are hard and do not change shape when the breast is flattened out. When the two images are compared, areas can be identified that failed to flatten out.
3. Breast MRI-Magnetic resonance imaging uses a strong magnet to alter the properties of the water in the tissue being examined (breast tissue in this case) to create an image of the breast.

If any of the methods above lead to the suspicion of cancer, a biopsy can be performed to determine if cancer is present. Note that NO medical test is perfect and it is important to understand the limitations of the tests (see below).

Learn more about cancer detection and diagnosis methods on the CancerQuest website: http://www.cancerquest.org/cancer-detection-diagnosis. Videos are also available about medical testing.

Your physician will perform several tests to distinguish if the lump is normal or abnormal.
- Feeling the lump (palpation) to determine how hard and if the lump moves around. Cancerous lumps many times are hard and do not move.
- Diagnostic mammogram to determine size and location of the lump as well as learn more about the surrounding tissue and lymph nodes.
- Ultrasound test to determine if the lump is sold or filled with fluid.
- Thermal imaging (not common) measures shifts in physiological and metabolic activity.

If the lump appears suspicious, the next step is to have a biopsy and analyze cells from the lump. Your physician will perform several tests to distinguish if the lump is normal or abnormal.
- Feeling the lump (palpation) to determine how hard and if the lump moves around. Cancerous lumps many times are hard and do not move.
- Diagnostic mammogram to determine size and location of the lump as well as learn more about the surrounding tissue and lymph nodes.
- Ultrasound test to determine if the lump is sold or filled with fluid.
- Thermal imaging (not common) measures shifts in physiological and metabolic activity.

If the lump appears suspicious, the next step is to have a biopsy and analyze cells from the lump.