Breast Ultrasound

Breast Ultrasound

Description
Breast ultrasound involves exposing the breast to high-frequency sound waves which are converted into images on a monitor. Ultrasound complements other tests. If an abnormality is seen on mammography or felt by physical exam, ultrasound is the best way to find out if the abnormality is solid (such as a benign fibroadenoma, or cancer) or fluid-filled (such as a benign cyst). However, the breast ultrasound cannot determine whether a solid lump is cancerous or not. Calcifications are also not seen through ultrasound.

Uses
•  The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam and to characterize potential abnormalities seen on mammography.

Ultrasound imaging can help to determine if an abnormality is solid (further characterize solid masses and differentiate a non-cancerous lump of tissue from a cancerous tumor) or fluid-filled (such as a benign cyst). Ultrasound can also help show additional features of the abnormal area.
•  Ultrasound and other imaging methods can help supplement mammography by detecting small breast cancers that may not be visible with mammography.
•  Evaluate dense breasts usually in younger women
•  Monitor the growth of a cyst or guide the placement of a needle to drain the it
•  Evaluate breast symptoms, such as pain, redness, and fever
•  Evaluate women with fibrocystic breast disease
•  Evaluate breasts with silicone implants
•  Evaluate pregnant women with breast masses safely
•  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.
•  The Breast Clinic also has capabilities for intra-operative ultrasound which helps guide the surgeon in some excisions of very small lumps.

Preparation
•  You will be asked to undress from the waist up and to wear a gown during the procedure.
•  You can have a breast ultrasound even if you are pregnant.
Preparation
•  You will be asked to undress from the waist up and to wear a gown during the procedure.
•  You can have a breast ultrasound even if you are pregnant.

Procedure
•  Most ultrasound examinations are painless, fast and easy.
•  You will lie on your back with your arm raised above your head on the examining table.
•  A clear gel is applied to your breast to   secure contact with the body and eliminate air pockets between the transducer and the skin. The radiologist then presses the transducer firmly against the skin and sweeps it back and forth over your breast until the desired images are captured.
•  You may be asked to change positions during the exam.
•  Once the imaging is complete, the gel will be wiped off your skin.
•  After an ultrasound exam, you should be able to resume your normal activities.
•  The ultrasound examination is usually completed within 30 minutes.

Limitations
•  There may be varying degrees of discomfort from pressure as the transducer is pressed against the area being examined.
•  Ultrasound is one of the tools used in breast imaging, but it does not replace annual mammography and careful clinical and self breast examination.
•  Many cancers are not visible on ultrasound.
•  In some cases, ultrasound is not able to determine whether a mass is cancerous, and a biopsy will be recommended.
•  Many calcifications seen on mammography cannot be seen on ultrasound. Some early breast cancers only show up as calcifications on mammography.
•  It is important to choose a facility with expertise in breast ultrasound, preferably one where the radiologists specialize in breast imaging. Ultrasound depends on the abnormality being recognized at the time of the scan by the radiologist and this requires   experience and good equipment.

Reference:
- Department of Obstetrics & Gynecology

Ultrasound-Guided Core Needle Biopsy

What is an Ultrasound-Guided Core Needle Biopsy?

Ultrasound-guided core needle biopsy is a minimally invasive procedure used to obtain tissue samples for microscopic examination for suspicious breast lumps using a special needle (core needle). Ultrasound guidance is used to find the area, which usually cannot be felt.

How will you prepare for an ultrasound-guided core needle biopsy?

• There are usually no diet restrictions, ate and drink as usual
• Take usual medications on exam day
• Aspirin and anticoagulants increase the risk of bleeding and bruising.

(Patients taking anticoagulants (blood-thinners) or aspirin should contact the doctor managing those medications to see if they can safely stop them prior to the biopsy)

• Herbal substances that affect bleeding, such as Gingko biloba, should be stopped two weeks prior to appointment
• Advise the Breast Clinic nurse of allergies to latex, lidocaine, as well as any history of anticoagulants, prior to appointment
• Wear comfortable two-piece clothing
• Bring the previous breast ultrasound result

Howan ultrasound-guided core needle biopsy done and what will you experience during the procedure?

During the procedure

• You will asked to remove your top and change into a hospital gown
• You will wait in the reception area until the nurse escorts you the ultrasound room
• The surgeon will review the procedure with you, answer any questions, and have you sign a consent form
• You will be asked to lie on a table with one arm raised above your head. You will be able to watch the ultrasound screen as the surgeon performs the procedure
• The skin in the area to be biopsied is cleaned with cutasept (antiseptic). A local “numbering” anesthetic, usually lidocaine, is administered, which will numb the area to be biopsied. It usually stings when it is being injected.
• A special “core” needle is inserted into the breast and tissue is removed. The process is repeated to obtain several tissue samples.
• As the samples are taken, a loud click will be heard. The process will be explained throughout the procedure
• If discomfort is experienced, the surgeon can administer additional anesthetic
• Tissue samples are the sent to the pathology department for processing, interpretation and reporting

Aftertheprocedure

• The surgeon will apply pressure on the biopsy area for several minutes to stop any bleeding; the biopsy area will be closed with a steri-strip and sterile dressing
• You should be able to drive or return to work following the biopsy
• Avoid heavy lifting for the next three days to prevent bleeding or extended bruising
• Take a non-aspirin pain reliever, like Mefenamic Acid or Paracetamol, upon your physician’s prescription for discomfort. Do not resume anticoagulants until your surgeon informs you that it is safe to do so.
• Remove dressings and shower the morning after the biopsy
• Leave the steri-steps in place. Your surgeon will remove it on follow up
• Check the biopsy area daily; contact your surgeon if there is excessive pain, bleeding, swelling, drainage, redness, or the area is warm to touch.

How long the ultrasound does guided core needle biopsy take?

• It usually takes about 30 minutes if only one lump will be biopsied. Longer if more than one lump after the biopsy

When will the results be ready?

• You will get the biopsy result 3-4 working days after the biopsy procedure

What is the benefit of the ultrasound guided core needle biopsy?

• It gives you an accurate diagnosis of what kind of lump you have so you and your surgeon can plan what kind of surgeon you will need.

What are the risks of the ultrasound guided core needle biopsy?

• You may experience pain or bleeding during or after the procedure. The bleeding is easily controllable with pressure and does not require surgery. You will be given pain medication if pain is experienced

What is the possible alternative of the ultrasound-guided mammotome biopsy?

• Open surgical biopsy

If you desire, we will coordinate a referral for you with any own physicians for any concerns.

Please call us at:

BREAST CENTER

6^th floor, Nursing Tower, The Medical City

Ortigas Avenue, Pasig City, Metro Manila, Philippines

Tel. No. (632) 988-1000 or (632) 988-7000 ext. 6527

References:

-       www.breastcancer.org

-       www.radiologyinfo.org

-       Advanced Therapy of Breast Disease, 2^nd Ed 2004, Singeltary, Robb, Hortobagyi

-       Diseases of the Breast, 4^th Ed 2009, Harris, Lippman, Morrow, Osborne

-       The Medical City-Breast Center

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.