Ultrasound is used to map the internal structures of the breast using high-frequency sound waves. While it cannot replace mammography for screening, ultrasound can detect cancers not seen on mammograms, particularly in dense breasts. Benign lesions usually appear smooth, well-circumscribed, and hypoechoic or isoechoic compared to breast tissue. Malignant lesions tend to be irregularly shaped, hypoechoic, with angular margins and posterior shadowing. Ultrasound criteria help characterize breast abnormalities detected on other imaging as benign or warranting biopsy.

1. ULTRASOUND OF
BREAST

2. ▪ Breast ultrasound uses high-frequency
sound waves(linear probe 7-13 MHz) to
map the internal structures of the
breast.

3. Applications
▪ Though ultrasound is successfully used to aid assessment of
abnormalities detected by mammography, it should not be used
as a sole modality for screening as ultrasound does not always
detect cancers that are visualised mammographically.
▪ Conversely, used in conjunction with mammography, ultrasound
can detect clinically and mammographically occult cancers
particularly when there is a higher possibility of cancer.
▪ With new high-frequency transducers, it is also possible to detect
malignancy associated with mammographically detected
clustered microcalcifications.
▪ These lesions may be evident as irregular masses, abnormal
dilated ducts or clustered foci of increased echogenicity with
increased Doppler vascularity.

4. ULTRASOUND OF BREAST
▪ Technique
• High-quality images of the normal and
abnormal breast can be obtained with modern
ultrasound equipment.
▪ Initial examination
•Lighting
•patient positioning: support elbow, flat, supine
•Machine to patient’s right
•Image with right hand
•Operate machine with left hand.

5. Patient Position
MEDIAL LESIONS
▪ patient is supine
▪ ipsilateral arm is placed over the patient’s
head.
LATERAL LESIONS
▪ patient is opposite.
SUPERIOR LESIONS
▪ patient is SITTING

6. Equipment selection:
▪ Transducer
▪ At the minimum, a 7.5
MHz linear array probe
should be used.

7. Apply gentle uniform pressure
with the ultrasound
transducer
Increase transducer pressure for:
– greater penetration
– scanning the subareolar region.
Scanning is done in three directions.
1. Radial
2. Transverse
3. Longitudinal

9. ▪ Localization is by the
clock face.
12
6
6 3
9
6

11. ANATOMY
• The breast is located on the chest wall between
the second and the sixth ribs within layers of the
superficial pectoral fascia.
• The fat and fibroglandular tissues of the breast
are between the superficial layer of this fascia just
beneath the skin and the deep fascial layer that
lies just anterior to the pectoral muscle

13. • As few as seven or eight and as many as 20 lobes, loosely associated duct
segments, are the anatomic components of the breast.
• Each segment starts in the fine peripheral branches and ends in a large
collecting duct, its punctum visible on the nipple.
• The most peripheral ducts, the intralobular terminal ducts, end in the terminal
duct-lobular units that give rise to common malignant and benign pathologies
• The subclavian and axillary arteries and their lateral thoracic, thoracoacromial,
and internal mammary branches provide arterial supply to the breast.
• The venous plexus lies just beneath the nipple. Over 90% of the lymphatics of
the breast drain into the ipsilateral axilla, with a small percentage of drainage
into the internal mammary chain.
• In women who have had axillary dissections or mastectomies extending into
the axilla, lymphatic drainage may cross to the contralateral axilla

14. AXILLA
• The axilla contains lymph nodes, the brachial plexus, and axillary artery and
vein.
• The number and size of normal axillary lymph nodes varies widely from
individual to individual.
• Side-to-side symmetry of size, shape, and number of nodes may help
distinguish normal from abnormal.
• Nodes may be depicted in the axillae on mammograms; commonly two, three,
or more can be identified as circumscribed oval (often reniform) masses with
hilar fat and cortices of fibroglandular tissue density.
• With US, normal axillary or intramammary lymph nodes have echogenic fatty
hila and cortices that are hypoechoic to anechoic.

16. NIPPLE AND AREOLA
• The nipple-areolar complex is quite variable, with areolar width narrow in some
women or extending for 1 or 2 cm in others, making the nipple a more reliable
landmark than the areola.
• Normal nipples can be prominent, flat, or inverted.
• If an abnormality is suspected, or for interpretive confidence, look at the
contralateral
• breast as you would for any other paired organ.
• The nipple’s crevices and irregular surface cause posterior attenuation, and an
offset pad or thick layer of gel can provide a medium for clear depiction .
• The skin of the areola tapers as the areola extends to either side of the nipple.
• The width of normal skin over the breast is 0.2 cm except for the region of the
inframammary fold and the areola, where the skin is normally a little thicker.

17. Ultrasound of the Breast
▪ Recent studies show if strict criteria for
lesion analysis are followed, specificity of
ultrasound in determining benign or
malignant reaches 70%.

18. ▪ All macroscopic breast structures can be easily
imaged with adequate sonographic equipment.
The breast can be divided into four regions
▪ skin, nipple, subareolar tissues
▪ subcutaneous region
▪ parenchyma (between the subcutaneous
and retromammary regions)
▪ retromammary region.
Sonographic Breast
Anatomy

19. Ultrasound interpretation
▪ The subcutaneous fat layer is demonstrated
superficially as hypoechoic tissue compared to the
glandular tissue from which it is separated by a well-
defined scalloped margin.
▪ Normal ducts are often visible, particularly in the
subareolar region, as anechoic tubular structures.
▪ Deep to the glandular tissue, a retromammary fat
layer is usually visible and, behind this, the structures
of the chest wall.

21. Sonographic Breast
Anatomy
▪
▪
▪
▪
▪
▪
▪
▪
▪
Skin
Subcutaneous fat
Cooper’s Ligaments
Breast parenchyma
Retromammary fat
Pectoralis muscle
Ribs
Pleura
Nipple

23. Cooper's ligament
skin
fibroglandular tissue

24. Nipple
•Consists of both dense
connective tissue and
connective tissue of
the duct which can
cause posterior
acoustic shadowing

25. Ribs
•Easily identified bone
attenuates causing an
acoustic shadow

26. Duct
•Tubular branching
structures

27. Ultrasound showing dilated ducts (lactating)
The duct appears as branching hypoechoic structure within
echogenic glandular tissue.

28. Intramammary vessel running branching under
the skin.

29. Lymph Node
• Solid nodule
• Ovoid
• Echogenic fatty hilum

34. INDICATIONS
▪ Symptomatic breast lumps in women aged less than 35
▪
▪
▪
▪
▪
▪
▪
▪
▪
years.
Breast lump developing during pregnancy or lactation.
Assessment of mammographic abnormality (± further
mammographic views)
Assessment of MRI or scintimammography detected
lesions.
Clinical breast mass with negative mammograms.
Breast inflammation.
The augmented breast (together with MRI).
Breast lump in a male (together with mammography).
Guidance of needle biopsy or localisation.
Follow-up of breast cancer treated with adjuvant
chemotherapy.

35. INDICATIONS
▪ The original role of breast sonography is in
the differentiation of cystic and solid lesions.
▪ Ultrasound complements both clinical
examination and mammography.
▪ It is also successfully used as a 'second-look'
procedure where an abnormality has been
identified using MRI or scintimammography.

36. INDICATIONS
▪ Because it does not use ionising radiation, it is
the examination of choice in young women and
is valuable in the assessment of the
mammographically `dense' breast.
▪ Ultrasound plays an important role in the triple
assessment of symptomatic lesions.
▪ Being the only `real-time' imaging modality also
means it can be used to accurately localise or
biopsy breast lesions.

37. Breast Ultrasound and
Mammographic Correlation
Dense breast

38. Fatty breast

39. ▪ In practice, needle biopsy should be performed as
part of triple assessment in the presence of a discrete
solid mass.
▪ Not all breast pathology presents as a discrete lesion.
Inflammatory or lobular cancers may present as areas
of scattered indeterminate attenuation.
▪ The use of colour and power Doppler can also aid in
benign-malignant differentiation of solid masses.
▪ In general, malignant masses tend to show an
increased number of vessels that penetrate deep into
the tumour with a branching morphology.

40. Abnormal breast parenchymal
pattern
● Simple cyst
● Complex cyst
● Chronic abscess
● Galactocoel
● Fibrocystic disease
● Duct ectasia
● Fibroadenoma
● Cystosarcomaphyllodes
● Lipoma

41. Simple Cyst
● Breast cysts are the commonest cause of breast lumps in women
between 35 and 50 yearsof age.
● Acyst occurswhen fluid accumulatesdue to obstruction of the
extralobular terminal ducts,
either due to fibrosis or because of intra ductal
epithelial proliferation.
● Acyst is seen on USGas a well-defined, round or oval,
single or multiple anechoic structure
with a thin wall .

42. Cyst on U/S

43. Complex cyst
● When internal echoesor debris
are seen, the cyst is called a
complex cyst.
● These internal echoes may be
caused by floating cholesterol
crystals, pus, blood or milk of
calcium crystals

44. Simple Cysts
– anechoic
–smooth, thin
margins
–posterior acoustic
enhancement

45. Abscess of the breast
● Patients maypresent with fever, pain, tenderness to touch and
increased white cell count.
● Abscessesare most commonly located in the central or subareolar
area.
● An abscess may show an ill-defined or a well-defined
outline. It may be anechoic or may reveal low-level
internal echoes and posterior enhancement

46. Abscess on U/S

47. Galactocoel(lacteal cyst or milk
cyst)
● It isaretention cyst containing milk or amilkysubstance that is
usuallylocated in the mammarygland
● It is caused by aprotein plug that blocks off the outlet
● It isseen in lactating women on cessation of lactation
● Patient typically presents with apainless breast lump
occuring over weeks to month

48. Galactocoel
(internal contents moving with change in
position of breast)

49. Fibrocystic disease
● Thiscondition is referred to bymany different names:
fibrocystic disease, fibrocystic change, cystic disease, chronic
cystic mastitis or mammary dysplasia.
● About half of these breast masses are usually classified as
indeterminate and will eventually require abiopsy.

50. Fibrocystic disease on U/S
extremely variable depends on the stage and extent of
morphological changes.
● In the earlystages, the USGappearance may be normal, even
though lumps maybe palpable on clinical examination
● There maybe focal areas of thickening of the parenchyma, with or
without patchyincrease in echogenicity .
● Discrete single cysts or clusters of small cysts may be seen in some
● Focal fibrocystic changesmay appear assolid masses or thin-
walled cysts.

51. Fibrocysticdisease on U/S

52. Duct ectasia
● Thislesion has avariable appearance.
● Typically, duct ectasia may appear as a single or
multiple tubular structure filled with fluid
● Old cellular debris mayappear asechogenic content. Ifthe debris
fills the lumen, it can be sometimes mistaken for asolid mass,
unlessthe tubular shape is identified

53. Ductal Ectasia on U/S

54. Fibroadenoma(breast
mouse)
● Fibroadenoma is an estrogen-induced tumor that forms in
adolescence.
● It is the third most common breast lesion after fibrocystic
disease and carcinoma
● It usually presents as afirm, smooth, oval-shaped, freely movablemass
(breastmouse) on palpation.
● It is rarely tender or painful.The size is usually under 5 cm,
though larger fibroadenomas are known. Fibroadenomas are
multiple in 10–20% and bilateral in 4% of cases. Calcifications
may occur.

55. Fibroadenoma on U/S
● Awell-defined lesion.Acapsule can usually be identified.
● The echotexture is usually homogenous and hypoechoic as
compared to the breast parenchyma, and there maybe low-level
internal echoes
● Typically, the transverse diameter is greater than the antero-
posterior diameter

56. Fibroadenoma on U/S and
Mammography

57. Cystosarcoma phyllodes
● This is alarge lesion that presents in older women
● Some authorsconsider it to be agiant fibroadenoma
● The mass may involve the whole of the breast. It usually
reveals well-defined margins and an inhomogeneous
echo texture, sometimes with variable cystic areas.

58. C.Phylloides on U/S

59. Lipoma in breast parenchyma
● Lipoma is aslow-growing, well-defined tumor.
● It may be achance finding or the patient may present with
complaints of increase in the size of the involved breast, though no
discretely palpable mass can be made out.
● The tumor is soft and can be deformed by compression
with the transducer.

60. Lipoma on U/S and
Mammography
● Athin capsulated
echo genic mass
with astippled or
lamellar
appearance

61. Breast ultrasound
criteria for benign
lesions
● Smooth and well circumscribed
● Hyper echoic, iso echoic or mildlyhypo echoic
● Thin echogenic capsule
● Ellipsoid shape, with the maximum diameter being in the
transverse plane
● Three or fewer gentle lobulations
● Absence ofanymalignant findings

62. Breast ultrasound
criteria for malignant
lesion
● Malignant lesions are commonly hypo echoic nodular lesions with ill-
defined borders, which is ‘taller than broader’and has spiculated
margins, posterior acoustic shadowing and micro calcifications
● Three-dimensional scanners with the capability of reproducing high-
resolution images in the coronal plane provide additional important
information.
● It was initially believed that color Doppler scanningwould add to the
specificityof USGexamination, but this hasnot proven to be very
efficacious

63. WHO classification

64. Invasive ductal carcinoma

65. Ductal carcinoma in situ
•A microlobulated mild hypoechoic mass
with ductal extension and normal acoustic
transmission is considered the most
common feature in sonographically
detected DCIS.
•It is possible in everyday practice to
identify the DCIS process as it grows in the
ductal system of the breast.

66. Invasive lobular carcinoma of the
breast
•Heterogeneous, hypoechoic mass
with angular or ill-defined margins
and posterior acoustic shadowing.
•An ill-defined heterogenous
infiltrating area of low echogenicity
with disproportionate posterior
shadowing is one of the
sonographic characteristics of
invasive lobular carcinoma.

67. Metastases to the breast
•Lymphoma/leukemia:
most common extra
mammary source
•Melanoma
•Sarcoma
•Lung cancer
•Gastric
•Ovarian
•Renal cell cancer
•Malignant mesothelioma
•Ca cervix
•Rectal cancer
•Papillary thyroid cancer
•On ultrasound,
metastatic masses tend to
have circumscribed
margins with low-level
internal echoes and,
occasionally, posterior
acoustic enhancement.
•Color Doppler
interrogation most often
shows increased
vascularity.

68. Malignant breast mass on U/S

69. Gynecomastia
Enlarged male breast tissue due to
hormonal imbalance
● It could be uni or
bilateral
● Oestrogen and
Testosterone are
not adequately
balance

70. Breast Ultrasound
Imaging Characteristics
▪ size
▪ shape
▪ border definition
▪ internal echogenicity
▪ posterior enhancement
▪ architectural changes

71. Analytic Criteria
• Margins
• Retrotumoral acoustic phenomena
• Internal echo pattern
• Echogenicity
• Compression effect on SHAPE
• Compression effect on INTERNAL
ECHOES

72. Benign Characteristics
▪ Ellipsoid shape
▪ Thin definable
capsule
▪ Two or three
lobulations
▪ Hyperechogenicity.

73. Solid Mass -
Malignant
• Irregular shape
•Irregular/ill-defined
borders
• Almost anechoic
• Angular margin
• Taller than wide

74. Irregular shape
• Irregular/ill-defined borders
• Almost anechoic
• Thick echogenic rim
• Posterior shadowing

75. Benign
Shape Oval/ellipsoid
Malignant
Variable
Alignment Wider than deep; aligned parallel to
tissue planes
Deeper than wide
Margins Smooth/thin
echogenic pseudocapsule with
2-3 gentle lobulations
Irregular or spiculated; echogenic 'halo'
Echotexture
Homogeneity of
internal echoes
Variable to intense
hyperechogenicity
Uniform
Low-level
Marked hypoechogenicity
Non-uniform
Lateral
shadowing
Present Absent
Posterior effect Minimum attenuation/posterior
enhancement
Other signs --------------
Attenuation with obscured posterior
margin
Calcification
Microlobulation
Intraductal extension
Infiltration across tissue planes and increased
echogenicity of surrounding fat

76. A typical fibroadenoma with homogeneous
internal echoes with an ovoid shape and
circumscribed margins -- benign.
There is posterior acoustic enhancement..

77. A typical 'tall' irregular spiculated hypoechoic
attenuating mass in keeping with a malignant
breast tumour.

78. An invasive lobular carcinoma presenting as areas of
scattered indeterminate attenuation.

79. Inflammatory breast cancer with secondary signs.
increased hyperechogenicity of the intramammary fat resulting in
loss of the normal glandular adipose differentiation Lymphatic
dilation is also apparent under the thickened subcutaneous layer.

80. A power Doppler image of an invasive grade 3 breast
cancer.
irregular tortuous and branching vessels penetrating into the
centre of the lesion.

81. ▪ The sonographic pattern varies with age
and individually, and depends on the
amount and type of contents, i.e. fat,
fibrous and glandular tissues.
▪ The fibrous and glandular components
are variably echogenic, while fat is
hypoechoic.

82. Benign ??
Malignant ??

83. Benign vs. Malignant

84. Benign ??
Malignant??

87. •BI-RADS® is designed to standardize breast imaging reporting and
to reduce confusion in breast imaging interpretations.
•It also facilitates outcome monitoring and quality assessment.
•It contains a lexicon for standardized terminology (descriptors)
for mammography, breast US and MRI.
•All mammographic, ultrasound, and breast MRI findings and
reports should closelyadhere to the BI-RADS lexicon and
assessment categories.
Breast Imaging and reporting data system(Bi-
RADS)

88. BIRADS
• Latest version classifies lesions into 0 - 6
categories:
• BIRADS 0: Incomplete, further imaging or
information is required. Eg: Compression,
magnification, special mammographic views,
ultrasound. This is also used when previous
images not available at the time of reading.

89. BIRADS
• BIRADS I: Negative, symmetrical and no masses,
architectural disturbances or suspicious calcification
present.
• BIRADS II: Benign findings, interpreter may wish to
describe a benign appearing finding. Eg: Calcified fibro
adenomas, multiple secretory calcifications, fat containing
lesions like Oil cysts, breast lipomas, galactoceles and mixed
density hamartomas, simple breast cysts.
• These lesions should have characteristic appearances and
may be labeled with confidence and make sure there is no
mammographic evidence suggesting malignancy.

90. BIRADS
• BIRADS III: probably benign, short interval follow
up suggested.
• BIRADS IV: suspicious abnormality.
• There is mammographic appearance which is
suspicious of malignancy.
• Biopsy should be considered.
• BIRADS IVa: low level of suspicion
• BIRADS IVb: intermediate level of suspicion
• BIRADS IVc: moderate level of suspicion for
malignancy

91. BIRADS
• BIRADS V: there is a mammographic appearance which
is highly suggestive of malignancy, action should be
taken.
• BIRADS VI: known biopsy proven malignancy
• The vast majority of mammograms fall into BIRADS I or
II.
• Risk of Cancer:
• BIRADS III: ~ 2%
• BIRADS IV: ~ 30%
• BIRADS V : 95%

93. Ultrasound - Breast
Imaging Lexicon

94. USG Breast
• Many descriptors for ultrasound are the same as
for mammography.
For instance when we describe the shape or
margin of a mass.
• Here we will focus on findings that are specific for
ultrasound:
• Breast Composition:
• Homogeneous echotexture-fat
• Homogeneous echotexture-fibroglandular
• Heterogeneous echotexture

100. Calcifications
• On US poorly characterized compared with
mammography, but can be recognized as
echogenic foci, particularly when in a mass.
In mass
Outside mass
Intraductal

101. Associated features
• Architectural
distortion
• Duct changes
• Skin changes
• Edema
• Vascularity
• Elasticity
assessment

103. Final Assessment Categories

105. BI-RADS 0
• Need Additional Imaging Evaluation
and/or Prior Mammograms For
Comparison.
•Always try to avoid this category by immediately
doing additional imaging or retrieving old films
before reporting. Even better to have the old
examinations before starting the examination.

106. BI-RADS I
• Negative:
• There is nothing to comment on.
• The breasts are symmetric and no masses,
architectural distortion or suspicious
calcifications are present.

107. BI-RADS II
• Benign Finding:
• Like BI-RADS 1, this is a normal assessment, but here, the
interpreter chooses to describe a benign finding in the
mammography report, like:
• Follow up after breast conservative surgery
• Involuting, calcified fibroadenomas
• Multiple large, rod-like calcifications
• Intramammary lymph nodes, Abscess, hematoma
• Vascular calcifications
• Implants
• Architectural distortion clearly related to prior surgery.
• Fat-containing lesions such as oil cysts, lipomas, galactoceles and
mixed-density hamartomas. They all have characteristically benign
appearances, and may be labeled with confidence.

108. BI-RADS-II

109. BI-RADS II
BI-RADS Category 2: Mass seen on
mammogram proved to be a cyst.

110. BI-RADS III
• Probably Benign Finding
Initial Short-Interval Follow-Up Suggested:
• A finding placed in this category should have less than a 2%
risk of malignancy.
• It is not expected to change over the follow-up interval, but
the radiologist would prefer to establish its stability.
Lesions appropriately placed in this category include:
• Nonpalpable, circumscribed mass on a baseline
mammogram (unless it can be shown to be a cyst, an
intramammary lymph node, or another benign finding),
• Focal asymmetry which becomes less dense on spot
compression view
• Solitary group of punctate calcifications

111. BI-RADS III

112. BI-RADS III
• If a BI-RADS 3 lesion shows any change during follow up, it will
change into a BI-RADS 4 or 5 and biopsy should be performed.
• Do perform initial short term follow-up after 6 months.
• Assuming stability perform a second short term follow-up
after 6 months (With mammography: image both breasts).
• Assuming stability perform a follow-up after one year and
optionally another year. Then use Category 2.

113. BI-RADS III – BI-RADS IV

114. BI-RADS IV
• Suspicious Abnormality - Biopsy Should Be Considered:
• This category is reserved for findings that do not have the
classic appearance of malignancy but are sufficiently
suspicious to justify a recommendation for biopsy.
BI-RADS 4 has a wide range of probability of malignancy (2 -
95%).
• By subdividing Category 4 into 4A, 4B and 4C , it is
encouraged that relevant probabilities for malignancy be
indicated within this category so the patient and her
physician can make an informed decision on the ultimate
course of action.

115. BI-RADS IV

116. BI-RADS IV
• Do use Category 4a in findings as:
-Partially circumscribed mass, suggestive of (atypical)
fibroadenoma
- Palpable, solitary, complex cystic and solid cyst
- Probable abscess
• Do use Category 4b in findings as:
- Group amorphous or fine pleomorphic calcifications
- Nondescript solid mass with indistinct margins
• Do use Category 4c in findings as:
- New group of fine linear calcifications
- New indistinct, irregular solitary mass

117. BI-RADS V
• Highly Suggestive of Malignancy.
Appropriate Action Should Be Taken:
BI-RADS 5 must be reserved for findings that are classic
breast cancers, with a >95% likelihood of malignancy.
• The current rationale for using category 5 is that if the
percutaneous tissue diagnosis is nonmalignant, this
automatically should be considered as discordant.
• Spiculated, irregular highdensity mass.
• Segmental or linear arrangement of fine linear
calcifications.
• Irregular spiculated mass with associated pleomorphic
calcifications.

118. BI-RADS V

119. BI-RADS V
• Don't use if only one highly suspicious finding
is present.
Then use Category 4c.

120. BI-RADS VI
• DO
• Use after incomplete excision
• Use after monitoring response to neoadjuvant
chemotherapy
• DON'T
• Don't use after attempted surgical excision with positive
margins and no imaging findings other than postsurgical
scarring. Then use category 2 and add sentence stating the
absence of mammographic correlate for the pathology.
• Don't use for imaging findings, demonstrating suspicious
findings other than the known cancer, then use Category 4
or 5.

121. BI-RADS VI

122. Examples of Reporting

123. • Indication for examination
Painful mobile lump, lateral in right breast. No previous history of breast pathology.
• Findings
No previous exams available.
• Mammography
Overall breast composition: b. Scattered areas of fibroglandular density.
Lateral in the right breast, concordant with the palpable lump, there is a mass with an oval
shape and margin, partially circumscribed and partially obscured.
The mass is equal dense compared to the fibroglandular tissue.
Location: Right breast, 9 o'clock position, middle third of the breast.
Size: approximation of largest diameter = 3 cm.
Additional US of the mass: Concordant with the lump and the mass on the mammogram
there is an oval simple cyst, parallel orientation, circumscribed, Anechoic with posterior
enhancement. Size : 3,5 x 1,5 cm.
In the right breast at least 2 more smaller cysts.
Assessment
BI-RADS 2 (benign finding).
The palpable mass is a simple cyst. There are at least two more, smaller cysts present in the
right breast.
• Management
• The palpable cyst was painful, after informed consent uncomplicated puncture for suction of
the cyst was performed.
• No indication for follow-up, unless symptoms return, as explained to the patient.

124. Discussion
● Although it may be impossible to distinguish
all benign from all malignant solid breast nodulesusing
USGcriteria, areasonable goal for
breast USGis to identify asubgroup of solid nodulesthat
has such alow riskof being malignant that
the option ofshort-interval follow-up can be
offered asaviable alternative to biopsy.

125. Combined studies
● Combined studies, which included USGand mammography, have
demonstrated nearly 100% negative predictive value for palpable
breast lesions, when both are used together.
● In astudy based on characterization of breast masses according to
BIRADS-US criteria, people have
found no statistical differences between fine-needle aspiration cytology
and USG with regard to sensitivity and Negative Predictive value (P>
0.05).
● It is also found USGcharacterization of breast lesions using BIRADS-
UScriteriato be highlyaccurate.

126. References:
•Rumack Ultrasound 5th ed
•https://radiologyassistant.nl/breast
1. Paredes ES. Atlas of mammography. Lippincott Williams & Wilkins. (2007)
ISBN:0781764335. Read it at Google Books - Find it at Amazon
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3. Dixon A. Breast Ultrasound, How, Why and When. Churchill Livingstone. (2007)
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4.Georgescu A, Enachescu V. (2009) The diagnosis of gynecomastia by Doppler Ductal
Ultrasonography. Etio-pathogenic, endocrine and imaging correlations – partial data. Med
Ultrason, Sept, Vol 11, No 3: 33-40
5.Georgescu AC, Enachescu V, Bondari A, Bondari S, Manda A, Simionescu C. A new concept:
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6.Teboul M (2003) Practical ductal echography: guide to intelligent and intelligible Ultrasound
imaging of the breast, Saned Editors, Madrid
7. Teboul M. Advantages of Ductal Echography (DE) over conventional breast investigation in
the diagnosis of breast malignancies. Med Ultrason. 2011;12 (1): 32-42. Pubmed citation

127. THANK YOU