How is breast ultrasonography performed?

Updated: Jan 24, 2017
  • Author: Durre Sabih, MBBS, MSc, FRCP(Edin); Chief Editor: Mahan Mathur, MD  more...
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The patient is examined in the appropriate position already described. The breast is examined in a defined pattern to ensure that the whole organ is visualized; this usually means scanning the breast in a raster pattern in both the longitudinal as well as horizontal planes. Scanning then proceeds radially and finally in oblique planes, for measuring the long and short axes of lesions and also along ducts.

Special attention must be given to the nipple and the peri-nipple subareolar region. The ducts within the nipple and immediately near it cannot be seen with the usual technique. Usually the nipple is compressed when scanned orthogonally and appears as a poorly shadowing nodule within or even deep to the skin as it is pushed into the breast substance by probe pressure. The nipple and its ducts achieve a more favorable geometry with the ultrasound beam if it is rolled to one side by the probe with varying degrees of peripheral pressure. The breast can be supported by the other hand to really flatten the breast contour against the probe to give additional information.

Ultrasound guidance for biopsies is both safe and effective. Taking a biopsy of any lesion that is visible on ultrasound is technically possible. One must keep in mind that the breast flattens against the chest wall during ultrasound, so an oblique needle path carries a risk of injury to underlying muscles or even the pleura and lungs. Therefore, the needle path should be as parallel to the chest wall as possible to minimize the risk of injury to deeper tissues.

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