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Diagnostic Medical Sonography

 

Breast Sonography

Breast Sonography(2)

 

What is Breast Sonography?

Breast sonography utilizes sound waves to acquire images of the breast. A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram. Ultrasound scanning of the breast, involves using high-frequency sound waves to produce images of the breast tissue.

Breast sonography is a new specialty registry available to sonographers and students.  Breast sonography is most frequently used to better evaluate any abnormality seen in a screening or diagnostic mammogram or during a clinical breast exam performed by a physician.  Ultrasound allows images of the breast from almost any orientation.  A sonogram can efficiently determine if a suspicious area on a mammography film is a cyst versus a solid mass.  If a solid mass is found, a biopsy is usually done under ultrasound guidance to determine if the mass is benign or malignant.

There are many benefits of breast sonography:

  • After a mammogram, ultrasound can provide new clinical information for women with dense breasts.
  • When breast masses or abnormalities are found, ultrasound is a good choice for characterizing the mass.
  • Ultrasound, in most cases, can eliminate the need for a biopsy.  However, if a biopsy is necessary, ultrasound guidance is used to ensure the correct tissue is being biopsied.
  • Breast sonography does not use X-rays or other potentially harmful types of radiation. 
  • Ultrasound has excellent contrast resolution. This means, that an area of fluid (cyst) and an area of normal breast tissue are easy to differentiate on an ultrasound. 

How is a Breast Sonogram Performed?

For a breast ultrasound, a small handheld instrument called a transducer is passed back and forth over the breast. It sends out high frequency sound waves (above the range of human hearing) that are reflected back to the transducer. A detector analyzes the sound waves and converts them into a picture that is displayed on a video monitor.

The patient will be asked to undress from the waist up and gel will be placed on their breast. To protect patient privacy a gown is given to drape around your shoulders and the songrapher will use towels to drape the breast as well.  The patient is asked to remove all jewelry from around the neck. Gel is placed on the breast so the transducer can pick up the sound waves as it is moved back and forth over the breast. A picture of the breast tissue can be seen on a monitor. The transducer will be pressed on the breast and an image will appear on the screen.  The sonographer will take diagnostic images.  A breast ultrasound exam usually takes between 15 and 30 minutes to complete. Additional time may be needed if a mammogram will be done before the ultrasound or if a biopsy is also scheduled. The patient may be asked to wait until a radiologist has reviewed the images. The radiologist may want to do more ultrasound views of some areas of your breast.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

Some Common Uses of Breast Sonography:

  • Determining the Nature of a Breast Abnormality 
  • The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography.
  • Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.
    Doppler ultrasound is used to assess blood supply in breast
     lesions.
  • Supplemental Breast Cancer Screening

Mammography is the only screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of glandular tissue and less fat, many cancers can be hard to see on mammography.

Many studies have shown that ultrasound and magnetic resonance imaging (MRI) can help supplement mammography by detecting small breast cancers that may not be visible with mammography. This is usually only considered when the breast tissue is dense. It is hoped that by detecting such cancers, these other screening tests might help to further prevent deaths due to breast cancer beyond what is achieved with mammography alone. When ultrasound is used for screening, many abnormalities are seen which may require biopsy but are not cancer (false positives), and this limits its cost effectiveness.

Today, ultrasound is being investigated for use as a screening tool for women who:
 

  • have dense breasts
  • have silicone breast implants and very little tissue can be included on the mammogram
  • are pregnant or should not to be exposed to x-rays (which is necessary for a mammogram)
  • are at high risk for breast cancer based on family history, personal history of breast cancer, or prior atypical biopsy result.

Ultrasound-guided Breast Biopsy

When an ultrasound examination cannot characterize the nature of a breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures.

A breast biopsy involves removing some tissue—usually by a procedure involving a needle which can take small pieces of tissue under local anesthesia—from the suspicious area in the breast and examining it under a microscope to determine a diagnosis. Occasionally, a surgical biopsy is needed to make a diagnosis.

Ultrasound-guidance is used to assist physicians in obtaining tissue samples from the breast in three different biopsy procedures: a cyst aspiration, a fine needle aspiration (FNA) biopsy and a core needle (CN) biopsy. Most cysts do not require any procedure. FNA is most often performed to evaluate suspicious axillary lymph nodes (under the arm) in patients with known or suspected breast cancer. Most ultrasound-guided breast biopsies are performed using core or vacuum-assisted needle biopsy techniques.

For more information about earning potential and work environment for sonographers, visit the Inside Scoop.

Links:

  • Breast Ultrasound Foundation The Breast Ultrasound Foundation’s mission is to increase public and professional awareness of the role of quality ultrasound in the detection and management of breast cancer and in women’s health.
  • Society of Diagnostic Medical Sonographers The SDMS was founded in 1970 to promote, advance, and educate its members and the medical community in the science of Diagnostic Medical Sonography.
  • American Registry for Diagnostic Medical Sonographers ARDMS is an independent, nonprofit organization that administers examinations and awards credentials in the areas of diagnostic medical sonography, diagnostic cardiac sonography and vascular technology.
  • Joint Review Committee on Education in Diagnostic Medical Sonography The mission of the JRC-DMS and its sponsoring organizations is to cooperate to establish, maintain, and promote appropriate standards of quality for educational programs in diagnostic medical sonography and to provide recognition for educational programs that meet or exceed the standards.
  • Commission on Accreditation of Allied Health Education Programs CAAHEP is the largest programmatic/specialized accreditor in the health sciences field. In collaboration with its Committees on Accreditation, CAAHEP reviews and accredits more than 2000 educational programs in twenty-one health science occupations across the United States and Canada.

Images:

 

BreastImage1

Ultrasound image showing
adjacent breast masses: 
one a simple cyst, the other
debris filled.

Breastimage2

Colorflow shows small
superficial vessels at the
nipple.

Breastimage3

Solid irregular breast
mass with calcification
(calcium deposits).

 

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