The ultrasound examination of the breast is usually requested by the gynecologist or mastologist after feeling any lump during palpation of the breast or if the mammogram is inconclusive, especially in the woman who has large breasts and has cases of breast cancer in the family.
Ultrasonography is not the same as mammography, nor is it a substitute for this exam, being only an exam capable of complementing breast assessment. Although this test can also identify nodules that may indicate breast cancer, mammography is the most suitable test to be performed on women with suspected breast cancer.
The ultrasound of the breast can be done with doppler, contrast, in 3D, automated or through mammary elastography.
Possible examination results
After the exam, the doctor will write a report about what he saw during the exam, according to the Bi-RADS classification:
- Category 0: Incomplete evaluation, requiring another image exam to detect possible changes. Category 1: Negative result, no changes were found, just follow a routine routine according to the woman's age. Category 2: Benign changes were found, such as simple cysts, intramammary lymph nodes, implants or changes after surgery. Usually, this type of change represents solid benign nodules that are stable for 2 years. Category 3: Changes were found that are probably benign, requiring a repeat examination in 6 months, and then 12, 24 and 36 months after the first altered examination. The changes that may have been found here may be the nodules that suggest it is a fibroadenoma, or complex and grouped cysts. Malignancy risk of up to 2%. Category 4: Suspicious findings were found, and biopsy is recommended. The alterations can be solid nodules without characteristics suggestive of benignity. This category can also be subdivided into: 4A - low suspicion; 4B - intermediate suspicion, and 4C - moderate suspicion. Malignancy risk 3% to 94%, being necessary to repeat the exam to confirm the diagnosis.
- Category 5: Severe alterations were found, with great suspicion of being malignant. A biopsy is required, in which case the lump has a 95% chance of being malignant. Category 6: Confirmed breast cancer, awaiting treatment that may be chemotherapy or surgery.
How this exam is done
The woman should remain lying on a stretcher, without a blouse and a bra, so that the doctor passes a gel over the breasts and then the breast ultrasound device is placed in contact with the skin. The doctor will slide this equipment over the breasts and watch on the computer screen and there are changes that could indicate changes such as breast cancer.
Ultrasonography is not uncomfortable, nor does it cause pain, as in mammography, but it is an exam that has limitations, not being the best choice to diagnose breast cancer early, because it is not good to check changes smaller than 5 mm in diameter.
What is it for
Breast ultrasound is particularly indicated to investigate the presence of nodules or breast cysts in women with dense breasts and at high risk of breast cancer, such as those who have a mother or grandparents with this disease. Other situations where breast ultrasound can be requested, is in case of:
- Breast pain; Trauma or inflammatory breast processes; Palpable nodule and accompaniment of benign nodule; To differentiate a solid nodule from a cystic nodule; To differentiate benign and malignant nodules; To detect seroma or hematoma; To help observe the breast or lump during a biopsy; To check the status of breast implants; If chemotherapy is having the result expected by the oncologist.
However, this test is not a better option to investigate changes such as microcysts in the breast, any lesion smaller than 5 mm, and also in older women, who have flabby breasts.
