Ultrasonography

Ultrasonography

Ultrasonography is the primary imaging modality in young women with dense breast tissue in whom mammograms are di ffi cult to interpret. Ultrasonography can distinguish cystic from solid lesions. Simple cysts do not require further work-up and follow-up can be avoided. Therapeutic aspiration may be performed for cysts causing pain ( Figure 58.4 ). A well-circumscribed, mobile, solid mass in a young woman is suggestive of a fibroadenoma and has an extremely low likelihood of malignancy . Such a finding requires reassurance and imaging follow-up ( Figure 58.5 ). Solid masses with an irregular shape and ill-defined margins (indistinct, angular or spiculated) are suspicious for malignancy and require biopsy ( Figure 58.6 ). Ultrasonography of the axilla is performed when cancer is diagnosed, with guided percutaneous biopsy of any suspicious lymph glands.

Figure 58.3 Clinical breast examination. (a) Patient lying supine for palpation. for a comprehensive examination. Figure 58.4 Therapeutic aspiration of a complicated cyst. Ultraso nography shows needle aspiration of a sharply de /f_i ned, anechoic cyst with internal echoes – the /f_l oating debris. Breast Imaging Reporting and Data System (BI-RADS) score 2 ( Table 58.1 ).