It is common to have a breast ultrasound after a mammogram. This additional imaging is a standard part of breast health assessment, providing a clearer and more detailed picture of breast tissue. It serves as a supplementary tool to mammography, offering further insights when needed.
Reasons for a Breast Ultrasound
A breast ultrasound is often recommended to clarify findings from a mammogram, serving as a “magnifying glass” to examine specific areas of concern. One significant reason for this additional imaging is the presence of dense breast tissue. Dense tissue, which contains more glandular and fibrous tissue and less fat, can appear white on a mammogram, similar to how abnormalities might look, making it challenging to identify potential issues. An ultrasound, which uses sound waves instead of X-rays, can effectively see through this dense tissue, revealing masses that might be obscured on a mammogram.
Beyond dense tissue, ultrasound is used to further investigate ambiguous findings detected on a mammogram. For example, if a mammogram shows an area that is unclear or looks different from the surrounding tissue, an ultrasound can help determine if it is a fluid-filled cyst, which is typically benign, or a solid mass, which may require further investigation. Ultrasound can also evaluate specific concerns like calcifications or architectural distortions seen on a mammogram, providing a more detailed view of these areas.
When a patient or doctor feels a palpable lump not clearly visible or explained by a mammogram, an ultrasound is often the next step. It can differentiate between benign lumps, such as simple cysts or fibroadenomas, and solid masses that may be cancerous. For women under 30 with a palpable lump, ultrasound is often the initial imaging tool. For individuals at high risk for breast cancer, such as those with a strong family history, ultrasound can also be used as a supplementary screening tool alongside mammography. A recommendation for an ultrasound does not mean cancer is present; many findings turn out to be benign.
What to Expect During a Breast Ultrasound
A breast ultrasound is a non-invasive medical test that uses high-frequency sound waves to create images of the breast’s internal structures. This procedure does not involve radiation, making it a safe option for imaging. During the examination, you will typically lie on your back on an examination table, and a trained sonographer or radiologist will perform the scan.
The process involves applying a water-soluble gel to the skin over the breast. This gel helps the handheld transducer, a small probe, glide smoothly, allowing sound waves to travel effectively into the body. The sonographer will gently move this transducer over the breast, and sometimes the underarm area, to visualize the tissue. The procedure is generally painless, though you might feel some pressure from the transducer, especially if a tender area is being examined. A typical breast ultrasound takes approximately 10 to 30 minutes to complete, after which the gel is wiped off, and you can resume your usual activities immediately.
Understanding Ultrasound Results
A breast ultrasound provides detailed images that reveal the nature of breast tissue and any identified findings. It can differentiate between fluid-filled cysts and solid masses. Cysts typically appear anechoic (without internal echoes) with well-defined, thin walls and enhanced sound transmission, indicating they are benign. Solid masses, however, may have different characteristics, such as internal echoes or irregular shapes, which could warrant further investigation.
Findings from a breast ultrasound are often categorized using a standardized system, such as the Breast Imaging-Reporting and Data System (BI-RADS). This system assigns a numerical score, usually from 0 to 6, to findings from imaging tests like ultrasound, mammography, and MRI, helping radiologists communicate the significance of the findings and guide next steps. For instance, a BI-RADS 1 or 2 typically indicates no suspicious findings or benign findings, respectively. A BI-RADS 3 suggests a probably benign finding with a very low likelihood of malignancy, usually less than 2%, often warranting short-interval follow-up.
Beyond cysts, fibroadenomas are another common benign finding identified by ultrasound. These are solid, usually round or oval-shaped, and freely movable masses common in younger women. If the ultrasound reveals suspicious characteristics, such as a solid mass with irregular margins or a “taller than wide” shape, it may indicate the need for additional imaging, like an MRI, or a biopsy for a definitive diagnosis. A biopsy involves taking a small tissue sample for microscopic examination to determine if cancer cells are present.
Next Steps and Importance of Follow-Up
Following a breast ultrasound, discussing the results with your referring physician or radiologist is important. The radiologist who interprets the images will send a detailed report to your doctor, who will then explain the findings and recommend the personalized next steps. This discussion ensures you understand the nature of any findings and the proposed management plan.
The subsequent actions are individualized, depending on the ultrasound results and your overall health profile. These steps might range from routine annual mammograms and clinical breast exams for benign findings to short-interval follow-up imaging, such as another ultrasound in six months, for probably benign findings. If the findings are suspicious, a biopsy may be recommended to obtain a tissue sample for definitive diagnosis.
Mammography and ultrasound are complementary tools, each providing unique insights into breast health. Their combined use offers a more comprehensive assessment, helping to detect abnormalities that might be missed by one method alone. These procedures offer reassurance and guide appropriate care.