Breast ultrasound is a test that detects focal changes in the breast and breast cancer. It should be performed regularly, because only then it has a chance to become a screening test that allows to identify abnormalities at an early stage of their development. Any changes observed during breast ultrasound are classified according to the BIRADS category. Find out how the test is performed and what are the indications for its performance. How is breast ultrasound different from mammography?

Breast ultrasoundis an imaging examination that allows you to perform breast diagnostics in a non-invasive way. Breast ultrasound is performed not only in the case of suspected changes in the breast, but also for the prevention of breast cancer, as early detection of various types of changes in the breast increases the chance of a faster and more effective recovery. All changes are described in the BIRADS scale, which enables precise specification and possible referral of the patient for further diagnosis.

Breast ultrasound examination - what is it?

Breast ultrasound examination is performed with the use of a special device equipped with a head. This head, smeared with gel, touches the woman's breast during the examination and sends ultrasound waves to deeper tissues.

These tissues reflect acoustic waves and send them back to the device, thanks to which it is possible to read the ultrasound result immediately.

Each tissue reflects sound in its own way, thanks to which the doctor performing the examination is able to find out in which of them there are abnormalities and whether it is a benign or malignant lesion, requiring a biopsy .

How to prepare for breast ultrasound examination?

There is no need to prepare yourself for breast ultrasound. However, it is good if the patient comes to them right after the menstruation, i.e. in the first half of the cycle.

Before the examination, the patient undresses from the waist up, puts her on the couch and raises her hands up. Thanks to this, the doctor can examine the lymph nodes to which the lymph from the mammary glands drains.

The whole examination is based on the fact that the doctor moves the head covered with a special gel over individual sections of the breast, checking if there is something disturbing. If not,the patient may show up for the next ultrasound in a year's time.

If the test result shows changes in the breast, further diagnosis is necessary.

How often do breast ultrasound examinations be performed?

Ultrasound examination is dedicated primarily to people between 20 and 40 years of age. If a woman is under 30 and there are no changes in her breasts, she can do them every 2 years.

And if she is over 30, she should have an ultrasound scan every year as part of prophylaxis.

The woman should be prompted by the following symptoms or factors to perform this test more frequently:

  • breast soreness,
  • leakage of strange discharge from the nipple,
  • family burden, i.e. when there have been cases of breast cancer in a close family,
  • pregnancy,
  • breast injury,
  • use of hormone replacement therapy,
  • confirmed mutation of BRCA-1 and BRCA-2 genes,
  • enlargement of the lymph nodes under the arms,
  • palpation (during self-examination of the breast) of a thickening, lump or other lesion,
  • breast size change,
  • retracting the nipple.

Breast ultrasound examination - and mammography. What's the difference?

Breast ultrasound and mammography are tests for detecting both benign and malignant changes in the breasts.

Breast ultrasound examination is intended for young women up to 40 years of age, as their breast structure is slightly different from that of women in their forties. The difference is that young women have the advantage of glandular tissue over adipose tissue and with such proportions their breasts are better visualized by an ultrasound.

On the other hand, in women over 40, adipose tissue predominates in the breasts, which is better read by a mammograph. Age, however, does not preclude breast ultrasound in people of 40+.

In women who use hormone replacement therapy, even after the age of 40, glandular tissue may predominate over adipose tissue, therefore they should perform an ultrasound.

In addition, there are women with small breasts in whom the mammograph is not able to correctly read the image of their body and the screening for breast cancer should then be an ultrasound.

Ultrasound examination for older women is also complementary to mammography. Because while a mammograph is able to show a tumor at a very early stage with the help of microcalcifications, it will not show, like an ultrasound, whether it is a benign or malignant lesion.

Therefore, breast ultrasound in women over 40 should become a complementary test when it comes to cancer diagnosticsbreasts.

Breast ultrasound during pregnancy - is it a good idea?

Many pregnant women wonder if they should perform breast ultrasound. The answer is: absolutely.

Ultrasound is a non-invasive examination that will not harm the fetus, and will allow to detect disturbing changes in the breasts that may arise under the influence of hormonal changes at an early stage.

Pregnant ultrasound should be performed in the first or second trimester. Thanks to this, it is possible to monitor if there are no mutations, cystic or malignant changes in the breasts.

When an alarming change is found in a pregnant woman, standard diagnostics for breast cancer is performed, including a biopsy.

Breast ultrasound result according to BIRADS category

Changes observed during breast ultrasound are classified according to theBIRADScategory - that is, the scale created by the American Radiological Society. It assigns the image of the breast to 6 categories.

This is to facilitate patient guidance for further diagnostics and standardization of medical terminology.

During the classification, the doctor takes into account:

  • interview with the patient,
  • previous ultrasound results,
  • current ultrasound result
  • and the result of the physical examination.

BIRADS 1category is:

  • youthful breasts at all stages of development,
  • breasts that have a proper glandular-tissue structure, where the proportions are right. This also applies to the image of the breasts in pregnant or lactating women; as well as those that are subject to hormonal treatment.
  • breasts with a predominant structure of adipose or fibrous tissue and with stromal fibrosis,
  • correct male breasts,
  • correct milk pipework.

BIRADS 2 categoryare the breasts with mild changes, that is:

  • solid, fluid and lithium-fluid changes,
  • lesions that are hypoechoic, hyperechoic, or have mixed echogenicity. These also include well-delimited lesions, having a spherical or oval shape, with an advantage in the lateral-lateral dimension over the upper-lower dimension.

In the case of the BIRADS 2 category, the changes require control after 12 months, but there is no need to perform other diagnostic tests after their detection.

What changes can you talk about in this category? Mainly about various:

  • cysts,
  • lipomas,
  • angiomas,
  • type inflammatory lesionsempyema.

These also include:

  • hematomas,
  • traumatic breast changes,
  • fibrocystic dysplasia,
  • macro calcifications in the gland and in focal lesions,
  • fibroadenomas with accompanying microcalcifications, which are monitored and cytologically checked.

The BIRADS 3category is usually mild changes. They may also include (usually less than 2% of them) malignant changes. If a patient with it has been diagnosed with a family member who has had breast cancer or the patient is at an increased risk of developing cancer, then she must re-examine the ultrasound after 6 months and perform a biopsy of the lesion. The disorders included in the 3 BIRADS categories include:

  • hypoechoic changes,
  • oval changes, where the lateral-lateral dimension is higher than the upper-lower dimension,
  • lesions for which the image of the lymph nodes into which the lymph flows from the breast is correct,
  • lite changes that are well delimited.

Most often in the BIRADS 3 category we deal with:

  • fibroadenomas occurring singly or in multiple,
  • odpryskowiakami,
  • cysts with a thick fluid that is not compressible,
  • cysts in which the level of their fluid does not change even when changing the position of the breast,
  • conglomerates (collection and conglomerate) of small cysts.

The BIRADS 4category are those changes which, although suspicious, but during ultrasound examination do not indicate that they are malignant neoplasms. Even so, they are likely to be malignant, ranging from 2% to 90%.

These are usually:

  • those changes that cannot be classified as BIRADS 3,
  • those with the upper-lower dimension greater than the lateral-lateral,
  • their shape is irregular and the scratches are blurred (or only one of these features is present),
  • have abnormal vascularization,
  • the glandular tissue shows abnormalities at the architectural level,
  • changes with one or more foci, accompanied (or not) by an acoustic shadow,
  • lesions that are solid, lithium-fluid or hypoechoic.

When changing the BIRADS 4 category, it is necessary to perform a fine or core needle biopsy.

BIRADS 5are changes that are highly likely to be malicious. Usually, it is necessary to collect a histopathological specimen for themtests, and if it turns out that the lesion is cancerous, oncological treatment is planned. On the ultrasound image, such changes are those that:

  • have an advantage in the upper-lower dimension over the lateral-lateral dimension and are accompanied by calcifications,
  • are hypoechoic,
  • have abnormal vascularization, which can be seen e.g. on a colored Doppler,
  • are solid or lithium-fluid,
  • have angular edges or are spicular (change with an irregular center and numerous fibrous protrusions),
  • have an irregular shape.

BIRADS category 6are cancerous lesions confirmed by biopsy. When a neoplastic lesion is found in the breast, the treatment of choice is surgery involving excision of the mutant lesion.

There are two methods of surgical treatment:

  • sparing - where the tumor is removed and the margin of he althy tissue around it, as well as axillary lymph nodes
  • and a method involving the amputation of the entire breast, including the axillary nodes.
  • Cancer blood test detects BRCA mutations
  • Mammography or ultrasound - two tests to detect breast cancer
  • Benign lumps in the breasts. Breast changes are usually mild

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