ULTRASOUND OF THE BREAST – PROTOCOL

Ultrasound is a valuable diagnostic tool in assessing the following indications: 

•Investigating a palpable lump
•Mammography abnormality
•Follow up of known lesion
•Mastalgia
•Nipple discharge
•Infection or mastitis
•Guidance for biopsy or hook wire localisation
Ultrasound increasingly enlisted as part of a comprehensive screening program along side mammography.

 limitation  

• Extremely large, mobile breasts will be difficult to scan thoroughly.
• Post injury, surgery or biopsy, the resultant haematoma will reduce detail and may obscure pathology.

• Breast u/s requires a high frequency transducer 8-15 MHz.
• Ideally a wide footprint probe.
• A lower frequency transducer may be required for the larger attenuative breasts, inflammatory masses and the axilla.
• The use of a stand off may be required for nipple, superficial/or skin lesions.
• Low PRF color and spectral Doppler capabilities for assessing vascularity of lesions.
  

 position 

• Patient supine
• You may need to roll the patient slightly to ‘spread’ the breast evenly. Elevate the side being scanned with a wedge under the shoulder.
• Raise the ipsilateral arm over the patient’s head.
• It is important to correlate the ultrasound with any palpable lumps indicated by the patient. Accordingly, if the patient can only identify the lump when she is erect than re scan the patient erect.

 SCANNING TECHNIQUE

The most common scanning technique is to initially scan using the grid scanning pattern, followed by a radial (clock face) technique for the hard copy imaging.

• Scan up and down the breast in rows, making sure you overlap each row slightly to ensure no breast tissue is overlooked. 

1. Begin in the upper outer quadrant, scanning in transverse. Slide inferiorly from top to bottom.
2. Move across and repeat the sweep inferior to superior.
3. Repeat this across the breast.
4. Rotate into a sagittal plane and repeat the pattern.

A variation, particularly in larger or mobile breasts, is to apply the grid pattern quadrant by quadrant.

 Radial scanning pattern 

The scan direction for Radial breast scanning.Hard copy imaging of regions of interest should be taken in 2 planes.

• The breast is scanned and described as a clock-face.
• Begin at 12 o’clock in a sagittal plane with the toe of the probe at the nipple.
• Scan by rotating the probe around the nipple.
• Depending on breast size, a second pass further from the nipple may be required.
• If pathology is identified, rotate the probe 90 degrees in the ‘anti-radial’ plane.

Breast implants 

• Should be scanned with the patient positioned as above.
• Treat the scan as a 2-fold examination:

1. The breast tissue.
2. The deeper implant. This may require lower frequency or a curved probe to investigate.

The implant should be anechoic with well defined margins. Folds are commonly seen in the implant surface.

Also, small traces of simple fluid will be seen overlying the implant but is contained by the overlying fibrous capsule that contains the implant. This fluid is routinely seen within the implant folds (see image below).

The normal appearance of a fold in an implant with normal physiological amount of capsular free fluid.The mammogram below shows the typical appearance of folds.

Most saline implants will have a small valve visible (see image below)

Must do these images 

• 12 O’Clock
• 2 O’Clock
• 4 O’Clock
• 6 O’Clock
• 8 O’Clock
• 10 O’Clock
• Nipple

               NERVE TUMOR, BENIGN 

 

 

Steve Ramsey, PhD.

Calgary, Alberta- Canada.

Credit goes to   Steve Halls for great ultrasound pictures