Targeted / Diagnostic Breast Ultrasound

Indications

• Characterize a mammographic mass, asymmetry, or palpable lump (cystic vs solid)
• Evaluate palpable abnormality, especially in dense breasts or in patients <30 / pregnant / lactating
• Assess focal pain, nipple discharge focus, or skin/nipple change
• Evaluate axillary lymph nodes; guide aspiration/biopsy

Patient prep

• No special prep; recent mammogram and palpable site available for correlation
• Identify the area of concern (palpable site or mammographic quadrant/clock position)

Contrast

Technique

• High-frequency linear transducer (typically 12-18 MHz)
• Scan the area of concern in two orthogonal planes (radial and antiradial)
• Document lesion size in 3 dimensions, clock position, and distance from nipple
• Assess for posterior features, margins, orientation, vascularity (color/power Doppler)
• Correlate sonographic finding with the mammographic abnormality before assigning BI-RADS

Series / Sequences

Key points

• Simple anechoic cyst with imperceptible wall and posterior enhancement = BI-RADS 2 (benign)
• Solid mass features favoring malignancy: not-parallel orientation, angular/spiculated margins, hypoechoic, posterior shadowing
• Confirm sono-mammographic concordance; nonpalpable lesion needs careful correlation to the imaging finding
• Use US BI-RADS lexicon; suspicious findings (4/5) proceed to US-guided core biopsy

References