1. Normal Ultrasound Protocol Breast
Evidence 3

2. The following is a series of images that parallel the protocol as discussed in Evidence 2
All images are of the same patient.
The patient (30 y/o) presented with a lump in the LEFT breast. The lump was palpated by the patient 4 days prior however it was not identified by the referring GP. The patient indicated and described a small lump in 12 o’clock position.
The ultrasound requested both breast be examined.
The patient did not indicate any concerns on the right breast.
The examination was performed on a Toshiba Aplio 500 using a 12Mhz multiple frequency .

3. Normal breast 12 images of the breast at each hour of the clock
Images are annotated with the side and body marker to show probe position

4. Images 1-4: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

5. Images 5-8: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

6. Images 9-12: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

7. Nipple
Longitudinal and transverse image of the nipple

8. Images 13-14: Longitudinal and Transverse images of the nipple respectively.

9. Axilla
Images of any lymph nodes in the short axis with cortical measurements of reactive or suspicious nodes

10. Image 15: Transverse image of the Axilla
Image 15: Transverse image of the Axilla. A normal appearing lymph node is seen. The short axis and cortical thickness are measured and are within normal limits.

11. Image 16: Transverse image of the Axilla. The same lymph node is seen
Image 16: Transverse image of the Axilla. The same lymph node is seen. Low scale Colour Doppler does not show any increase in vascularity.

12. Image 17: Longitudinal Image of the axilla
Image 17: Longitudinal Image of the axilla. No suspicious lymph nodes seen

13. Pathology
Must be measured in two planes at 90 degrees unless a simple cyst

14. Images : Two images of the pathology at 90 degrees displaying measurement. Note the change in body marker to indicate position

15. Pathology
Colour imaging should be used to assess any vascularity

16. Image 20: Doppler image indicated no increased vascularity within the lesion.

17. Image 21: Additional image identifying location and position of pathology.

18. Note: The following images are of the left breast
Pathology
Images of ROI must be taken and annotated
Note: The following images are of the left breast

19. Images 22-25: Specific images of the area of interest as indicated by the patient. In this region normal breast tissue is seen.

20. Personal Findings as reported to the Radiologist
For this examination:
Right breast
In the 7.30 position there is a well defined solid lesion with no increased vascularity measuring 13x7x14 mm located 3cm from the nipple. This most likely represents a fibroadenoma.
Left breast
In the region of interest normal breast tissue is seen. There does not appear to be any mass or suspicious lesion in this region.
Right and Left Axillae
Normal lymph nodes are seen bilaterally.

21. Radiologist Findings and Recommendations
In this case the radiologist agreed that the lesion seen in the 7.30 o’clock position is most likely a benign fibroadenoma.
Recommendation for a core biopsy was made. In addition, it was recommended that if a finding of benign fibroademona was confirmed, further periodical follow-up ultrasounds are recommended.
Core biopsy has been arranged for this patient but not yet performed.