Breast ultrasound and ultrasound-guided breast biopsy. A practical guide Jill Donnelly Breast and General Surgeon. Clarifications: The Triple Assessment Rule Core biopsy and needle aspiration. This presentation applies to Women who have: Breast symptoms of pain &/or lump
Breast ultrasound and ultrasound-guided breast biopsy
A practical guide
Breast and General Surgeon
The Triple Assessment Rule
Core biopsy and needle aspiration
This presentation applies to
Women who have:
Breast symptoms of pain &/or lump
Localised to one breast quadrant
This presentation does not apply to:
Women having breast screening
For women with symptoms of pain &/or a lump localised to one quadrant:
Ultrasound and ultrasound-guided core biopsy are the investigations of choice.
Mammography has no initial role.
90% of patients are in this group.
After history, assessment steps:
Step 1.Examination – lump yes or no?
Step 2. Ultrasound symptomatic quadrant.
Discrete lesion – yes or no?
Step 3.If the answer is yes to Step 2 or 3:
core biopsy or needle aspiration is
Step 4.Lesion solid on ultrasound: biopsy
Lesion cystic on ultrasound: aspirate
Common breast lumps
Benign breast change (lumpiness)
Benign breast change
No discrete abnormality seen on ultrasound
Requires biopsy because lump present on palpation (Triple Assessment rule)
Ultrasound features of benign lumps:
Respect tissue plains
Long axis horizontal
Posterior brightness (cysts)
Ultrasound features of malignant lumps
Interrupt tissue plains
Long axis vertical
Wall irregular, poorly-defined
If you feel a discrete lump on palpation or see a discrete lump on ultrasound put a needle in it, using ultrasound to guide you.