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
A practical guide
Breast and General Surgeon
The Triple Assessment Rule
Core biopsy and needle aspiration
Women who have:
Breast symptoms of pain &/or lump
Localised to one breast quadrant
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: one quadrant:
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 one quadrant:
Benign breast change (lumpiness)
Benign breast change one quadrant:
No discrete abnormality seen on ultrasound
Requires biopsy because lump present on palpation (Triple Assessment rule)
Ultrasound features of benign lumps: one quadrant:
Respect tissue plains
Long axis horizontal
Posterior brightness (cysts)
Ultrasound features of malignant lumps
Interrupt tissue plains
Long axis vertical
Wall irregular, poorly-defined
Summary one quadrant:
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.