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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

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Breast ultrasound and ultrasound guided breast biopsy

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

Localised to one breast quadrant


This presentation does not apply to:

Women having breast screening

Women with:

Nipple symptoms

Diffuse symptoms


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

required.

Step 4. Lesion solid on ultrasound: biopsy

Lesion cystic on ultrasound: aspirate


Common breast lumps one quadrant:

Fibroadenoma

Benign breast change (lumpiness)

Cyst

Cancer


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

Wall clearly-defined

Posterior brightness (cysts)

Ultrasound features of malignant lumps

Interrupt tissue plains

Long axis vertical

Wall irregular, poorly-defined

Posterior shadowing


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.


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