1. The role of ultrasound in breast imaging Dr Francien Malan Drs Van Wageningen & Vennote 31 October 2007

2. How does ultrasound work?  High frequency sound wave  Crystal probe serves as both transmitter and detector of sound waves  Different tissue types  Signal coming back translated into real time black and white picture by computer software

4.  Palpable masses  Mammographically detected masses  Dense breasts  Young patients  Pregnant/ lactating woman  Breast implants  Guided aspiration/ biopsy/ localisation Uses of ultrasound in breast imaging

5. Palpable abnormality  Ultrasound especially useful if mammogram shows no obvious abnormality  +/- mammo shows abnormality  Young patients  Benefits of ultrasound

6. Cystic or solid?

7. Simple cyst Typical fibroadenoma

8. cancer

9. Dense/white breasts Fatty/ dark breasts

10.   Dense breasts means a relatively large percentage of fibroglandular tissue and little fat   50% of patients <30yrs   1/3 of patients > 50yrs   Can’t “see through”   Ultrasound useful!!!

11.  Young patients (<30/ <35yrs)  Should be first investigation; mammogram only if ultrasound equivocal  Palpable lesions in young woman most commonly cysts or fibroadenomas

12.  Most common problem in lactating woman is mastitis +/ breast abcesses  + US guided drainage of abcess

13. Implants

14.  Indications the same as for women without implants  Also for evaluation of implant complications such as rupture

15. Ultrasound guided cyst aspiration/ biopsy  Aspiration of cysts are done when cyst has atypical features, pain relief, relief of anxiety, cosmetic reasons  Biopsy done when after clinical evaluation/ mammography and ultrasound the nature of lesion is still uncertain

16. What happens?  Outpatient  Sterilised, anaethetised  Needle is guided into cyst under direct ultrasound vision  Cells obtained to path lab for evaluation

18. Ultrasound guided localisation  Localisation is done prior to surgical resection of lesion to guide surgeon to the lesion, can be done with u/s or mammogram  Inpatient, fasting, sterile conditions, local anaesthetic, localisation needle guided into lesion, wire strapped to arm, patient goes to theatre.

19.  Lesion visible on ultrasound, not clinically palpable; may or may not be visible on mammogram  Benefits of real time guidance of wire into lesion; 3D perspective; relatively quick; Why ultrasound for localisation?

20. Why mammogram for localisation?  Microcalcifications  Small lesion deeply seated in large breasts  Area of suspicion on mammogram not visible on ultrasound

21. Complications  Unsuccessful  Hematoma  Minor discomfort  Infection

22.  Many cancers are not visible on ultrasound  Microcalcifications  Inderteminate > biopsy Limitations of breast ultrasound

23. CANNOT REPLACE REGULAR SELF EXAMINATION AND MAMMOGRAPHY AS PRIMARY SCREENING TOOL FOR BREAST CANCER!!!!