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INTRODUCTION

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Definitions

  1. Elastography: a non-invasive technique for characterization of masses based on measurement of tissue stiffness.

  2. Fibroadenoma: a benign fibroepithelial tumor containing both epithelial and mixed stromal elements.

  3. Papilloma: a benign neoplasm of ductal origin with proliferation of both myoepithelial and epithelial cells supported by a fibrovascular stalk.

  4. Phyllodes tumor: a type of tumor that can vary from benign to malignant, including borderline forms. It demonstrates a biphasic nature with a double-layered epithelial component surrounded by proliferated stroma.

  5. Mastodynia: breast pain.

  6. Neoadjuvant chemotherapy: administration of chemotherapy before surgical management.

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Sonography has emerged as an essential tool in breast evaluation. Although originally used as an adjunct to mammography to distinguish solid from cystic masses, advances in instrumentation and extensive clinical experience have allowed expansion of its roles to include characterization of solid masses, guidance for interventional procedures, and screening.

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Sonography is very operator dependent by nature,1 and this is especially true in the breast where standard anatomic references are limited. To achieve acceptable levels of sensitivity and specificity, it is important to optimize technical parameters, develop standard exam protocols, and carefully integrate sonographic findings with other imaging modalities and the clinical setting.

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INDICATIONS

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Diagnostic

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Diagnostic evaluation remains the main indication for breast sonography and can be performed as either the primary imaging test or as an adjunct to other imaging procedures. In young women and women who are pregnant, sonography is generally the first test performed for a new mass or other focal breast abnormality.2 If the sonographic evaluation satisfactorily explains the clinical abnormality, no further testing may be required. If sonography does not explain a persistent focal finding, additional evaluation with mammography would be needed.

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In other women, diagnostic evaluation of a focal clinical abnormality would generally begin with mammography, reserving sonography for supplemental assessment, either to characterize a mammographic abnormality or to increase the sensitivity of the evaluation should no mammographic abnormality be found.

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Implant assessment can be performed with mammography, sonography, or magnetic resonance imaging (MRI). Although less accurate than MRI, sonography is often a simple first test when rupture of a silicone implant is suspected.

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In asymptomatic women, sonography may be used to characterize abnormalities on screening mammography, and increasingly, sonography is the next modality to be used for evaluation of MRI-detected abnormalities that are not seen on mammography (so-called "second look" sonogram).

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Breast sonography is not indicated for generalized breast complaints such as diffuse background nodularity or nonfocal mastodynia.

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Screening

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Sonography as a screening method for breast cancer detection remains controversial.3 There is certainly evidence to support its use, especially in high-risk patients with dense breast tissue,4,5 but the issue of operator dependency has hindered its expansion into routine clinical practice. Recently published information from the American ...

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