Breast Ultrasound

What is breast ultrasound?

Breast ultrasound is a safe and radiation-free medical imaging method that displays breast tissue on a screen using high-frequency sound waves.

It plays a vital role in the diagnosis and evaluation of various breast conditions, particularly breast cancer, especially in dense breast tissue where mammography may be limited.

Why is breast ultrasound performed?

Breast ultrasound can be performed to evaluate the character of masses detected in the breast by imaging their size, shape, structure and features in detail, to make a diagnosis in the presence of breast pain, swelling or other symptoms, or to confirm results obtained with other imaging methods.

Breast ultrasound performed in addition to mammography in breast cancer screening is known to increase breast cancer detection rates, especially in women with dense breast tissue. For this purpose it is also frequently used in breast cancer screening. It is also the preferred screening method particularly in young women and pregnant women. It can also be performed to evaluate breast implants.

Who is breast ultrasound performed on?

Breast ultrasound can be performed on patients of any age who have a breast-related complaint. These complaints may include a palpable mass in the breast, pain, nipple discharge, newly developed nipple retraction, newly developed skin retraction of the breast, swelling and/or redness of the breast, and swelling and/or pain in the armpit; in these patients ultrasound can be used for diagnostic purposes.

Breast ultrasound is generally the first-choice imaging method in women younger than 40. In women under 40, pregnant and breastfeeding women, breast ultrasound should be performed if there is a palpable mass/firmness in the breast, breast pain, nipple discharge, redness of the breast and increased warmth.

In women older than 40 it is used in addition to mammography and helps to characterize abnormalities detected on mammography. In addition, breast ultrasound makes it possible to increase sensitivity in the diagnosis of breast cancer in women with dense breast structure on mammography.

In women with breast implants, ultrasound is performed to examine the condition of the prosthesis. When a biopsy is required, ultrasound is used as the guiding imaging method for taking a sample from abnormal tissue detected in the breast. If enlargement or a mass is detected in the breasts of male patients, an evaluation is made with breast ultrasound.

How is a breast ultrasound examination performed?

Breast ultrasound is performed by specialist radiologists. Depending on the area of breast tissue being examined, the examination is carried out with the patient lying on their back or on their side. As in all ultrasound examinations, imaging is performed by applying a water-based gel onto the breast skin. This gel helps to obtain clear images. The breast tissue is imaged by moving the ultrasound probe from the outer part towards the nipple level. The armpit region is also included in the examination. Ultrasound examinations are painless and are generally easily tolerated by patients.

How many minutes does breast ultrasound take?

Breast ultrasound examinations are completed in periods ranging between 30 and 40 minutes, depending on the characteristics of the patient's breast tissue or the abnormalities present in the breast.

What can be seen on breast ultrasound?

With breast ultrasound, the content of palpable or incidentally detected masses — whether they are fluid (cystic) or solid — the size and appearance features of the mass, whether it is suspicious for cancer, the need for biopsy, the condition of the milk ducts in those with nipple discharge, infection/inflammation conditions especially in breastfeeding women, and the integrity of the prosthesis in those with breast implants are evaluated.

Is any preparation required before breast ultrasound?

No special preparation is required before breast ultrasound.

Is breast ultrasound harmful?

Since ultrasound is an examination technique that does not contain radiation and creates images using sound waves, breast ultrasound examinations have no known adverse effect on human health. Therefore they can be safely performed in children, pregnant women and breastfeeding women.

Since breast ultrasound is a radiation-free and harmless examination, it can be repeated as often as desired in patients of any age.

Is it correct to perform breast cancer screening with breast ultrasound alone?

Breast cancer screening is performed over the age of 40. A combination of different methods such as clinical breast examination, mammography and breast ultrasound is generally more effective in ensuring the early detection of breast cancer. Mammography is the standard method used for breast cancer screening in women aged 40 and over. However, various studies have shown that breast ultrasound added to mammography increases cancer detection rates, especially in women with high breast tissue density.

Is breast ultrasound sufficient on its own to make a diagnosis?

Breast ultrasound is mostly sufficient on its own to make a diagnosis. In some cases, in order to make a definitive diagnosis, it needs to be evaluated together with other methods such as mammography, MRI examination and, in suspicious situations, a tissue sample (biopsy).

What does dense breast tissue mean, and does dense breast tissue affect the ultrasound examination?

Breast tissue basically consists of two main tissues, one being fat tissue and the other fibroglandular tissue that includes the glandular and connective tissue of the breast. The density of breast tissue is determined by the ratio of fat and fibroglandular tissues within the breast. In women with dense breast tissue, the breast contains more fibroglandular tissue while the fat ratio is lower.

Having dense breast tissue can affect the accuracy of imaging tests such as mammography and the breast ultrasound examination. In this type of breast, dense tissue can make it difficult for ultrasound waves to reach the deeper areas. This can make it more difficult to evaluate the ultrasound images.

What is the difference between mammography and breast ultrasound?

Mammography is a breast X-ray that uses a low dose of X-rays. It is the gold standard for early cancer screening in women over 40. Breast ultrasound, on the other hand, uses sound waves and contains no radiation. It is preferred at young ages or in dense breast tissue to distinguish whether masses are fluid or solid. These two methods are not alternatives to each other but complementary examinations.

Can breast ultrasound be performed during menstruation?

Although the patient being in their menstrual period does not create a problem for breast ultrasound imaging, it may be uncomfortable for the patient since the breasts can be sensitive during these periods. The week after menstruation ends is the most comfortable period in this respect.

Is frequent repetition of breast ultrasound harmful?

There is no radiation in ultrasound. This makes ultrasound a safe medical imaging method. Therefore breast ultrasound can be repeated as often as desired in patients of any age, including children, pregnant women and breastfeeding women.

Can I continue my daily life after having a breast ultrasound?

Immediately after the breast ultrasound examination, patients can continue with their work, daily routines or other activities.

Are breast ultrasound and mammography the same thing?

Mammography and breast ultrasound are different examinations and the information they provide may also differ. Mammography is a radiological imaging method in which the breast tissue is compressed within a device, X-rays are used, it contains a low dose of radiation, and it is accepted worldwide as the gold standard for breast screening after the age of 40.

In addition to breast ultrasound, mammography also visualizes small areas of calcification called microcalcifications, which form due to cellular calcium accumulation in the breast tissue and are an early sign of breast cancer. Microcalcifications cannot be distinguished on ultrasound examination.

What is BI-RADS (Breast Imaging Reporting and Data System)?

The term BI-RADS, frequently encountered in breast reporting, is a common reporting language introduced by the American College of Radiology and accepted worldwide in breast examinations. It helps to determine the risk level of abnormalities detected in the breast according to their imaging features, and then to decide what approach should be applied for the patient. After the breast examination they perform, radiologists indicate a BI-RADS category ranging from 0 to 6 in their report.

• BI-RADS 0: Additional imaging is needed.
• BI-RADS 1: Normal findings
• BI-RADS 2: Benign findings
• BI-RADS 3: Probably benign (risk <2%)
• BI-RADS 4: Findings suspicious for malignancy (risk 2–95%)
• BI-RADS 5: Highly likely malignant (risk ≥95%)
• BI-RADS 6: Case diagnosed with breast cancer by biopsy result

While BI-RADS 1 requires no follow-up, annual follow-up is recommended for BI-RADS 2 and follow-up at 6-month intervals for BI-RADS 3. A biopsy is required for suspicious masses reported as BI-RADS 4 and 5.

How long does it take for the breast ultrasound result to come out?

Breast ultrasound results usually come out the same day.