Breast ultrasound screening for cysts, fibrosis and breast cancer diagnostics

Medically reviewed: 14, January 2024

Breast ultrasound for cancer diagnostics

Breast ultrasound is a method of studying the morphological structure of breast tissue with the help of reflected high-frequency ultrasonic signals. Ultrasound of the breast can visualize and differentiate superficially and deeply located neoplasms with a size less than 5 mm with an accuracy of 85-95%.

With the help of ultrasound, diffuse and fibrocystic forms of mastopathy, mastitis, cyst, abscess, fibroadenoma, breast cancer are diagnosed. In the course of ultrasound, all segments of the mammary gland are examined – from the border with the chest wall to the nasal region, the study is accompanied by fixing the findings in the form of pictures (echograms). Ultrasound of the breast is carried out strictly in the first phase of the monthly cycle.

Key takeaways

1. Breast ultrasounds complement mammography as an additional imaging modality, providing valuable information about breast tissue composition and lesion characteristics. They excel in evaluating dense breasts, distinguishing between solid and cystic masses, assessing palpable lumps, and guiding interventional procedures like core needle biopsies. Ultrasonography does not employ ionizing radiation, making it a safe and accessible option for women of all ages, especially those with increased breast density or pregnancy concerns.
2. Proper technique is crucial for obtaining reliable diagnostic images during a breast ultrasound examination. Skilled sonographers utilize high-frequency linear transducers, optimize gain settings, apply appropriate pressure, and systematically scan the entire breast and axillary regions to ensure thorough assessment. By following standardized protocols, they minimize interpretation errors, reduce false-negative and false-positive results, and facilitate effective communication with referring clinicians.
3. Interpreting breast ultrasound findings requires specialized training and expertise due to the complexity and subjectivity inherent in image analysis. Radiologists must consider numerous features, including mass shape, margin definition, orientation, echogenicity, posterior acoustic phenomena, and surrounding architecture distortion. Additionally, recognizing common pitfalls, such as anisotropy or reverberation artifacts, contributes to accurate characterization and confident decision-making. Integrating clinical context, patient demographics, and correlative mammographic or magnetic resonance imaging (MRI) data enhances overall diagnostic accuracy and informs optimal management strategies.

With ultrasound of the mammary glands, the ultrasonic oscillations reflected from tissues with different density are fixed by the sensor and converted into digital signals that reproduce on the monitor the image of the anatomical region under study.

Breast ultrasound can distinguish and properly assess the structure of tissues by changing their density. The diagnostic merit of ultrasound of the mammary glands lies in the availability, informative, the possibility of repeated repetition, harmlessness.

The cost of ultrasound of the mammary glands is much lower than mammography or MRI. Therefore, modern mammology widely uses ultrasound to diagnose various diseases of the breast.

The disadvantage of ultrasound of the mammary glands is that the interpretation can be subjective, which does not exclude diagnostic and tactical errors.

Advantages of breast ultrasound before other diagnostic methods

The main advantages of ultrasound are:

• painlessness;
• security;
• high information content;
• low cost of the procedure;
• availability (devices are present in each clinic);
• quickness of the result;
• practicality (it is possible to control the process of removal of tissues during a biopsy).

Indications for breast screening ultrasound

The grounds for carrying out ultrasonography of the mammary glands are determined by consulting a mammologist. Through ultrasound of the mammary glands, the diagnosis of seals revealed during palpation of the breast is carried out, dynamic changes of previously detected benign formations are monitored.

Passage of ultrasound of the mammary glands is prescribed for complaints of palpable formations, soreness, changes in the shape or size of the breast; the appearance of asymmetry, swelling, inflammation, discharge from the nipple or its alterations.

For women younger than 35 years, adolescents, nursing and pregnant, ultrasound is the main method of examining the mammary glands. Ultrasound is performed for men with the purpose of diagnosing gynecomastia. Ultrasound of the mammary glands in some cases allows supplementing the questionable data of X-ray mammography in women in the premenopausal period.

Ultrasound is indicated for women planning or undergoing breast enlargement with endoprostheses, mammaplasty, sectoral resection of the breast and other operations.

Breast ultrasound is prescribed for various purposes:

• if you have any complaints;
• the study of neoplasms in the gland;
• diagnosis during pregnancy planning;
• assessment of glands in children, adolescents during breast formation;
• diagnostics performed on pregnant, lactating women;
• ultrasound of mammary glands with implants (assessment of the condition of prostheses);
• preparation for IVF or mammoplasty;
• addition to X-ray mammography;
• study of the state of mammary glands in men.

Many people are interested in how often it is possible to do ultrasound of the mammary glands. This procedure is absolutely safe method of breast diagnosis. It does not provide for surgical intervention and exposure to the body of ionizing radiation. Therefore, there are no contraindications to ultrasound diagnosis. This procedure is desirable to pass as a preventive measure to every woman about once a year, after 50 years – even more often.

When diagnosing fibrocystic mastopathy and mammary gland cysts, ultrasound is more sensitive than X-ray mammography. During ultrasound of the mammary glands, small cysts and nodules, inaccessible palpation through the skin, and also altered regional lymph nodes can be detected.

Ultrasound is used for biopsy of non-palpable mammary gland lesions. With ultrasound-detection of additional foci by their density, character, form with a high degree of reliability, mastitis, nodular and diffuse mastopathy, abscess, cyst, breast cancer, etc. can be diagnosed.

Since in the structure of the mammary glands there are cyclic changes associated with hormonal activity, ultrasound of the mammary glands is desirable to be performed in the first phase of the menstrual cycle (from 5 to 10 days). The accuracy of the results of breast ultrasound can be influenced by gigantomastia.

Breast ultrasound: Method of conducting

To determine the localization of the pathological focus, the division of the mammary gland into the nasal region and 4 quadrants (upper-outer, lower-external, lower-inner, upper-inner), and sectors according to the division of the dial of the clock (9.00, 12.00, 15.00.18.00 ).

To conduct ultrasound, the patient exposes the mammary glands and fits on the couch on her back. The chest is examined in the position on the side, standing or sitting with arms raised up.

In standard situations follow the following sequence of examination: the right mammary gland is examined by moving the sensor counter-clockwise along the circumference from the upper-outer quadrant to the upper-inner one; the left, on the contrary – from the upper-inner to the upper-outer quadrant.

This sequence allows you to exclude the fallout of any zones from the field of view of the researcher. In each quadrant, gland tissues are scanned from the nipple to the periphery. In the course of ultrasound of the breast, moderate compression is used, pressing the tissue of the gland with a sensor.

When carrying out ultrasound of the mammary glands, regional lymph nodes (supraclavicular, subclavian, anterolateral, axillary) can be examined, as well as ultrasound dopplerography of breast vessels. The price of a breast ultrasound with regional lymph nodes or blood flow is higher than in a conventional study. The duration of the ultrasound of the mammary glands does not exceed 10-15 minutes.

Breast ultrasound and Elastography method and its advantages

Separately, you should consider ultrasound with elastography in mammology. The tissues of the human body are rigid (elastic). Healthy areas and tissues of benign neoplasms are more elastic than cancer cells (their stiffness index is 28 times higher than normal).

Therefore, the level of elasticity can determine the presence in the body of oncology, and even at an early stage of the disease. Consider how the ultrasound of the mammary glands is made with elastography. A special sensor generates a beam that allows you to evaluate the stiffness of the tissues.

The received information is processed in a special program, on the basis of which the conclusion is drawn. The organ being analyzed is projected on the screen, healthy and affected cells stand out in different colors.

The accuracy of the detection of cancer cells by ultrasonic elastography is 95%.

Elastography allows to determine the smallest neoplasms that are not noticeable during palpation. Thanks to this procedure, you can completely exclude the need for biopsy or more accurately choose the coordinates for tissue collection.

After breast ultrasound: Interpretation of results

The variants of the structure of the mammary glands in women differ depending on the age, the presence in the anamnesis of pregnancy and childbirth. Normally, with ultrasound of the mammary glands, the structure and volume of the gland are matched, corresponding to the age, constitutional and physiological norms of the subject. Direct and indirect signs of pathology (focal changes, expansion of ducts, disturbance of vascularization, secondary changes in regional lymph nodes) is not determined.

In breast-feeding women, the glandular breast tissue is normally somewhat different from non-lactating patients. The mammar zone is a mid-echogenic zone, and inclusions of low-echo fat are also present.

The width of the ducts is approximately 1-2 mm, they should not have extensions, and to the periphery of the gland may taper. Milky sinuses widen in the region behind the nipples.

With the diffuse form of mastopathy, the ultrasound of the mammary glands reveals numerous small seals, evenly distributed in the tissues of the gland. In the case of predominance of the cystic component, multiple small cysts are defined – cavities with fluid. With the predominance of the fibrous component on the ultrasound of the mammary glands, the foci of the overgrown connective tissue are found.

• Nodular mastopathy (fibroadenoma) is defined as a limited area of ​​compaction;
• in fibroadenomatosis several foci of dense tissue are revealed.

Ultrasound of the mammary glands with mastitis is characterized by inflammatory edema of the tissues. With a mammary abscess, a limited, more often rounded formation with a foci of purulent fusion and an inflammatory edema around is determined. The cyst of the breast according to ultrasound is defined as a rounded, fluid-filled formation.

Diagnosis of the cyst is confirmed by puncture with fetal content for analysis. In breast cancer, ultrasound is found to be densified without clear boundaries with infiltrative growth. By the location of the tumor, the presence of changes in regional lymph nodes determine the stage of the disease. If a breast cancer is suspected, confirmation of an ultrasound diagnosis by biopsy is required.

How mastopathy is visualized

Mastopathy – dyshormonal benign breast disease, which is characterized by glandular proliferation (pathological proliferative process). In women with this problem, there is a strong tenderness of the breast before menstruation, seals in the gland during palpation. What does mastopathy look like on ultrasound, depends on the form and characteristics of the disease.

Diffuse mastopathy is visualized in the form of many small seals, located throughout the gland relatively evenly. If the cystic component predominates, a large number of small cavities with a liquid are noted in the tissues. If diffuse mastopathy has a fibrous component, connective tissue seals are noticeable.

Nodular mastopathy (fibroadenoma) appears usually after a diffuse stage. On ultrasound, the fibroadenoma of the mammary gland is visualized as a limited area of ​​compaction.

When to do ultrasound of the mammary glands with mastopathy? As in other cases, in the first phase of the menstrual cycle.

What is characterized by lactostasis and mastitis on ultrasound

Most often mastitis is lactational in nature and occurs in women during the feeding of a child. At the same time, the temperature rises, the skin turns red, swelling of the tissues and local pain appear. Ultrasound of the breast with lactostasis (milk stagnation) shows the presence of inflammatory edema. In iron, there is an increased content of liquid.

Not cured mastitis leads to the appearance of an abscess – in the tissues of the gland pus accumulates. On ultrasound, this stage manifests itself as a limited formation with a fluid inside. An inflammatory swelling is observed around the abscess.

What does a cyst in the breast look like?

The cyst is a capsule with a liquid inside, which is located in the middle of healthy tissues. It is usually formed from the enlarged duct of the gland on the background of hormonal failures in the body. The feeling of raspiraniya and pulling pain appears with increasing neoplasm in the volumes, and in the early stages the disease may not manifest itself.

How does the cyst of the breast look like on ultrasound? It is visualized as a circular formation with a liquid inside. Usually, when diagnosing this disease, the capsule contents are biopsy. It is best to do this under the supervision of ultrasound.

What speaks about the presence of breast cancer

Breast cancer can be suspected with deformity of the gland, the presence of a seal in it, retraction of the nipple. How does breast cancer look on ultrasound, depends on the stage and features of the course of the process. Usually it is visualized as a seal without clear boundaries, characterized by infiltrative growth (sprouting into neighboring areas). Cancer cells can grow into lymph nodes. If there is a suspicion of a malignant formation, puncture is performed, other methods of diagnosis are used.

Breast ultrasound and pregnancy

The mammary gland changes immediately after fertilization, which is often the first sign of pregnancy for a woman. The breast becomes sensitive, somewhat painful, increases in size, the nipples darken, veins appear on the skin. Over time, the colostrum begins to release colostrum. Of course, these changes are noticeable when performing ultrasound diagnostics.

Breast ultrasound during pregnancy may be required in such cases:

• the discharge from the nipples is bloody;
• chest hardened, strongly sore or changed color;
• the glands increased unevenly;
• in the chest there is a condensation or a depression.

The presence of pruritus is not an alarming symptom. During the growth of the gland the skin stretches, discomfort appears. To avoid the formation of stretch marks, a woman should use a special cream.

Breast ultrasound allows you to evaluate how hormonal changes take place in the body of a future mother. It must be prescribed before mammography (if there are indications for carrying out this procedure).

If a woman is diagnosed with fibrocystic mastopathy, cysts filled with immature milk may appear on the background of pregnancy. In this ultrasound of the breast is a fairly informative method of diagnosis and allows you to put an accurate diagnosis. After the ultrasound can be punctured.

Ultrasound of the breast during pregnancy is mandatory for women who have previously been treated for breast cancer. There is a possibility of relapse on the background of a sharp hormonal adjustment. In this case, pregnancy carries a danger to the life of the patient and a woman is recommended for medical abortion. However, with all the advice of a mammologist, oncologist and gynecologist, every woman has a chance to give birth to a child after healing from a malignant tumor.

Cost of breast ultrasound in US

Sonography is an accessible and safe modern technique that allows effective detection of pathological changes and differential diagnosis of breast diseases. Diagnostic procedure is carried out in many clinics of the capital and the region, has a democratic value. Prices for breast ultrasound in United States are determined by the scope of the study (the need for simultaneous scanning of regional lymph nodes), the urgency of conducting, the location and reputation of the medical center, the organizational and legal form of the medical diagnostic organization.