Breast ultrasound and ultrasound-guided breast biopsy

A practical guide

Jill DonnellyBreast and General Surgeon

Clarifications:

The Triple Assessment Rule

Core biopsy and needle aspiration

This presentation applies to

Women who have:

Breast symptoms of pain &/or lump

Localised to one breast quadrant

This presentation does not apply to:

Women having breast screening

Women with:

Nipple symptoms

Diffuse symptoms

For women with symptoms of pain &/or a lump localised to one quadrant:

Ultrasound and ultrasound-guided core biopsy are the investigations of choice.

Mammography has no initial role.

90% of patients are in this group.

After history, assessment steps:

Step 1. Examination – lump yes or no?

Step 2. Ultrasound symptomatic quadrant.Discrete lesion – yes or no?

Step 3. If the answer is yes to Step 2 or 3:core biopsy or needle aspiration is required.

Step 4. Lesion solid on ultrasound: biopsyLesion cystic on ultrasound: aspirate

Common breast lumps

Fibroadenoma

Benign breast change (lumpiness)

Cyst

Cancer

Benign breast change

No discrete abnormality seen on ultrasound

Requires biopsy because lump present on palpation (Triple Assessment rule)

Ultrasound features of benign lumps:

Respect tissue plainsLong axis horizontalWall clearly-definedPosterior brightness (cysts)

Ultrasound features of malignant lumps

Interrupt tissue plainsLong axis verticalWall irregular, poorly-definedPosterior shadowing

Summary

If you feel a discrete lump on palpation or see a discrete lump on ultrasound put a needle in it,

using ultrasound to guide you.