Breast ultrasound and ultrasoundguided breast biopsy A practical

Breast ultrasound and ultrasoundguided breast biopsy A practical guide Jill Donnelly Breast 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: biopsy Lesion 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 plains Long axis horizontal Wall clearly-defined Posterior brightness (cysts) Ultrasound features of malignant lumps Interrupt tissue plains Long axis vertical Wall irregular, poorly-defined Posterior 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.