44 Questions
What is the recommended frequency range for a hand-held, direct contact transducer used in breast ultrasound?
5 - 10 MHz
Historically, what ultrasonic method was used to examine the breast with ultrasound in the early eighties?
Large, automated water path scanners
What is the current consensus on using ultrasound as a screening tool for breast cancer?
Ultrasound is not sensitive enough for breast cancer screening
What organization recognizes breast ultrasound as a separate specialty with a separate registry examination?
ARDMS
What is the recommended range of frequency for the high frequency hand-held, direct contact transducer used in breast ultrasound?
5 - 15 MHz
What is the primary focus of this module on the use of diagnostic ultrasound in the examination of the breast?
To provide an introductory overview of breast ultrasound
What is NOT recommended as one of the clinical indications for breast ultrasound?
Screening the general population for breast cancer
Which type of breast lesions often show some degree of enhancement on sonography?
Fibroadenomas
What is a common feature of most breast carcinomas on sonography?
Hypoechoic solid lesions
What is a characteristic feature of fibroadenomas on sonography?
Well-marginated thin capsule
What is a distinguishing feature of breast carcinomas compared to benign lesions on sonography?
Irregular or poorly-defined borders
What feature is characteristic of a desmosplastic reaction around breast carcinomas?
Echogenic fibrous reaction
What is a typical shape of fibroadenomas on sonography?
Oval wider than tall
What is a common characteristic of most breast carcinomas on sonography?
Internally more heterogeneous than benign lesions
What feature is often seen around breast carcinomas on sonography?
Echogenic fibrous reaction
What is a distinguishing feature of fibroadenomas compared to carcinomas on sonography?
Some degree of enhancement
What is the typical size range of normal mammary ducts in high resolution ultrasound?
1 - 8 mm
What is the appearance of fibroadenomas on ultrasound?
Well-marginated solid masses with uniform low-level internal echoes
What is the most common appearance of galactoceles on ultrasound?
Well-defined complex cystic masses
What is the role of ultrasound in determining breast masses?
Determining if a mass is cystic, solid, or complex, and localizing a mass for biopsy or FNA
What is the role of Cooper’s ligaments in breast ultrasound?
Provide the supporting framework for the breast and can generate refractive edge shadowing
What is the typical appearance of the pectoralis major muscle on breast ultrasound?
Hypoechoic striated layer against the chest wall
What are the limitations of ultrasound in detecting certain breast carcinomas?
Detecting certain breast carcinomas less than 1 cm in size
Which type of ultrasound removes operator variability and produces consistent 3D data sets for objective review?
ABUS
What is the primary purpose of using ABUS?
To assess or screen patients with dense breasts
What is the main advantage of hand-held breast ultrasound over ABUS?
It involves scanning the breast in an organized fashion, using the nipple as a reference
What can help distinguish hypoechoic solid masses from cysts in hand-held breast ultrasound?
Doppler ultrasound
What can be technically difficult to image in hand-held breast ultrasound?
The nipple/areolar area
What allows for more accurate referencing of breast lesions on high-end ultrasound systems?
Extended field of view option
What determines the ultrasound appearance of the normal breast?
The internal architecture
What is a distinguishing feature of fibroadenomas compared to carcinomas on sonography?
Well-circumscribed margins
What is the primary purpose of using ABUS?
To assess or screen patients with dense breasts
What organization recognizes breast ultrasound as a separate specialty with a separate registry examination?
American Registry for Diagnostic Medical Sonography (ARDMS)
What is the role of Cooper’s ligaments in breast ultrasound?
To support the breast tissue
What is the recommended range of frequency for the high frequency hand-held, direct contact transducer used in breast ultrasound?
5 - 10 MHz
What allows for more accurate referencing of breast lesions on high-end ultrasound systems?
Extended field of view option
What is a common characteristic of most breast carcinomas on sonography?
Irregular shape
What is the primary advantage of Automated Breast Ultrasound Systems (ABUS) over hand-held breast ultrasound?
ABUS removes operator variability and produces consistent 3D data sets for objective review
What is the recommended reference for imaging in hand-held breast ultrasound?
The patient’s mammographic films
What is the role of Doppler in hand-held breast ultrasound?
Doppler can help distinguish hypoechoic solid masses from cysts
What feature can be technically difficult to image in hand-held breast ultrasound?
The nipple/areolar area
What allows for more accurate referencing of breast lesions in high-end ultrasound systems?
An extended field of view option
What is the primary focus of Automated Breast Ultrasound Systems (ABUS)?
To assess or screen patients with dense breasts
What is the typical ultrasound appearance of the normal breast dependent on?
The internal architecture
Study Notes
Breast Ultrasound Imaging: Key Points
- Normal mammary ducts are frequently seen in high resolution ultrasound, with typical ducts ranging in size from 1 - 8 mm.
- Many cancers arise within the ducts, including ductal carcinoma in situ (DCIS) and invasive ductal carcinoma.
- Cooper’s ligaments, also known as suspensory ligaments, provide the supporting framework for the breast and can generate refractive edge shadowing when caught obliquely by the ultrasound beam.
- The pectoralis major muscle is an important landmark in breast ultrasound, appearing as a hypoechoic striated layer against the chest wall.
- Ribs appear as oval hypoechoic structures behind the pectoralis major muscle and produce strong acoustic shadowing.
- Small blood vessels may be seen in the region of the axilla, and lymph nodes are most commonly seen in the axilla with an appearance similar to cervical lymph nodes.
- Ultrasound is considered an adjunct to mammography and the physical exam, and is most useful in various clinical settings such as determining if a mass is cystic, solid, or complex, and localizing a mass for biopsy or FNA.
- Ultrasound has limitations in detecting certain breast carcinomas, particularly those less than 1 cm in size, and has difficulty in differentiating benign and malignant masses.
- The most common breast masses are cysts, fibroadenomas, and carcinomas, and ultrasound is able to determine if a mass is solid, cystic, or complex, but is unable to reliably differentiate benign and malignant masses.
- Breast cysts can occur at any age, with a sonographic diagnosis based on specific criteria, and a complicated cyst may require cyst aspiration to ensure it is benign.
- Galactoceles are retention cysts caused by lactiferous duct obstruction, manifesting as painless breast lumps, and typically appear as well-defined complex cystic masses on ultrasound.
- Fibroadenomas are common, benign tumors occurring most frequently in younger females, and appear as well-marginated solid masses with uniform low-level internal echoes on ultrasound.
Automated Breast Ultrasound Systems (ABUS) and Hand-Held Technique
- Automated Breast Ultrasound Systems (ABUS) are available from various vendors such as Siemens and GE
- ABUS uses a large scanhead with a linear array transducer and scanning membrane, attached to an articulated arm
- ABUS removes operator variability and produces consistent 3D data sets for objective review
- ABUS is frequently used to assess or screen patients with dense breasts, as ultrasound can be better at examining dense breasts than mammography
- Hand-held breast ultrasound uses a high frequency 5 - 10 MHz linear array transducer
- Hand-held technique involves scanning the breast in an organized fashion, using the nipple as a reference
- Doppler can help distinguish hypoechoic solid masses from cysts in hand-held breast ultrasound
- The nipple/areolar area can be technically difficult to image in hand-held breast ultrasound
- Reference should be made to the patient’s mammographic films in hand-held breast ultrasound
- An extended field of view option on high-end ultrasound systems allows for more accurate referencing of breast lesions
- The breast consists of lobes of glandular tissue, fatty tissue, and a framework of fibrous tissue, nerves, and blood vessels
- The ultrasound appearance of the normal breast depends on the internal architecture, and the bulk of the breast lymphatics drain into the axillary nodes
Test your knowledge of Automated Breast Ultrasound Systems (ABUS) and Hand-Held Breast Ultrasound techniques with this quiz. Explore the technology, applications, and best practices for conducting ultrasound examinations of the breast, including the use of Doppler and referencing mammographic films.
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