E5. Breast ultrasound – update

The advances made in recent years in high frequency ultrasound (US) transducer technology using broad bandwidth and high-dynamic range technology have led to considerable improvements in two-dimensional (2D) and three-dimensional (3D) greyscale diagnostic imaging of the breast. The role of elastography, focusing on the differentiation between benign and malignant lesions, continues to be evaluated. US is the method of choice to assess and sample, with core biopsy, most breast abnormalities, while stereotactical guided vacuum assisted biopsy (VAB) is the method of choice to sample screen-detected microcalcifications and architectural distortions not seen on US. In the dense breast, the addition of US to screening mammography improves the sensitivity for cancer considerably. The mean supplemental diagnostic yield of US after negative mammography is 3.2 per 1000 women with dense breasts. US is the first line imaging technique for symptomatic breast patients and women under the age of 40. The International Breast Ultrasound School (IBUS) and Breast Imaging-Reporting and Data System (BI-RADS) breast US guidelines have introduced some consistency to examination technique and reporting. Intraoperative surgeon-performed ultrasound focuses on the accurate definition of the resection segment or sector and the margin analysis of the resection specimen. US-guided VAB is being used increasingly for diagnosis of borderline lesions, to complete preoperative staging in patients with extensive ductal component and for therapeutic excision. Magnetic resonance imaging (MRI) is useful preoperatively to assess the extent of ipsilateral disease and to exclude the contralateral breast cancer, particularly for women at increased risk of mammographically occult disease.