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Dr. Edward Jankhe
Department of Radiology
Providence Saint Joseph Medical Center, Burbank, CA

Ultrasound uses sound waves to evaluate tissue characteristics. The ACR Standard for performance of the Breast ultrasound examinations lists as appropriate indications for breast sonography.

1. Identification and characterization of palpable abnormalities and evaluation of ambiguous mammographic findings.

2. Guidance of interventional procedures

3. Evaluation of breasts containing silicone implants for leakage of silicone into the surrounding tissue.
4. Breast sonography is the initial imaging technique to evaluation palpable masses in women under 30 and in lactating and pregnant women.

Ultrasound of the breast should not be performed as a screening study for occult masses. Ultrasound is an inappropriate technique to search the breast for microcalcifications.

The ultrasound examination should be performed preferentially with a high-resolution linear array transducer, ordinarily with a 7-10 MHz transducer frequency, although curved linear or sectors transducers may be used if the others are unavailable. Rarely a 5 MHz transducer may be used for large breasts or deep lesions.

Examples of breast ultrasound.

  • Cyst simple vs. complex
  • Solid benign mass-fibroadenoma
  • Solid ill-defined vs. lobulated mass - malignant

Recently the FDA has given pre-market approval for use of the ATL HDI 1000 digital ultrasound technology to be used as an adjunct in evaluation of solid breast masses. Evaluation is based echogenicity, margins, orientation of the mass and, to a lesser extent, on color-flow doppler evaluation of the lesion and a corresponding area in the contralateral breast.

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