Ultrasound, Breast

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Ultrasound, Breast

Synonym/acronym: Mammographic ultrasound.

Common use

Used in place of or in conjunction with mammography to assist in diagnosing disorders such as tumor, cancer, and cysts.

Area of application

Breast.

Contrast

Done without contrast.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual monographs.

When used in conjunction with mammography and clinical examination, breast US is indispensable in the diagnosis and management of benign and malignant processes. Both breasts are usually examined during this procedure. Images displayed on a monitor can determine the presence of palpable and nonpalpable masses; size and structure of the mass can also be evaluated. This procedure is useful in patients with an abnormal mass on a mammogram, because it can determine whether the abnormality is cystic or solid; that is, it can differentiate between a palpable, fluid-filled cyst and a palpable, solid breast lesion (benign or malignant). It is especially useful in patients with dense breast tissue and in those with silicone prostheses, because the US beam easily penetrates in these situations, allowing routine examination that cannot be performed with x-ray mammography. The procedure can be done as an adjunct to mammography, or it can be done in place of mammography in patients who refuse x-ray exposure or in whom it is contraindicated (e.g., pregnant women, women less than 25 yr related to increased breast tissue density that produces unclear images.

This procedure is contraindicated for

    N/A

Indications

  • Detect very small tumors in combination with mammography for diagnostic validation
  • Determine the presence of nonpalpable abnormalities viewed on mammography of dense breast tissue and monitor changes in these abnormalities
  • Differentiate among types of breast masses (e.g., cyst, solid tumor, other lesions) in dense breast tissue
  • Evaluate palpable masses in young (less than age 25), pregnant, and lactating patients
  • Guide interventional procedures such as cyst aspiration, large-needle core biopsy, fine-needle aspiration biopsy, abscess drainage, presurgical localization, and galactography
  • Identify an abscess in a patient with mastitis

Potential diagnosis

Normal findings

  • Normal subcutaneous, mammary, and retromammary layers of tissue in both breasts; no evidence of pathological lesions (cyst or tumor) in either breast

Abnormal findings related to

  • Abscess
  • Breast solid tumor, lesions
  • Cancer (ductal carcinoma, infiltrating lobular carcinoma, medullary carcinoma, tubular carcinoma, and papillary carcinoma)
  • Cystic breast disease
  • Fibroadenoma
  • Focal fibrosis
  • Galactocele
  • Hamartoma (fibroadenolipoma)
  • Hematoma
  • Papilloma
  • Phyllodes tumor
  • Radial scar

Critical findings

    N/A

Interfering factors

  • Factors that may impair clear imaging

    • Excessively large breasts
    • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the breast.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s reproductive system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department by a health-care provider (HCP) who specializes in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient not to apply lotions, deodorant, bath powder, or other substances to the chest and breast area before the examination.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that the patient has not applied lotions, deodorant, bath powder, or other substances to the chest and breast area before the examination.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to change into the gown and robe provided.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table. The right- and left-side-up positions are also used during the scan to facilitate better organ visualization.
  • Expose the breast area and drape the patient.
  • Conductive gel is applied to the skin and a transducer is moved over the skin to obtain images of the area of interest.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold her breath.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • When the study is completed, remove the gel from the skin.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Cancer Society (www.cancer.org).
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Decisions regarding the need for and frequency of breast self-examination, mammography, magnetic resonance imaging (MRI) of the breast, or other cancer screening procedures should be made after consultation between the patient and HCP. The American Cancer Society (ACS) recommends breast examinations be performed every 3 yr for women between the ages of 20 and 39 yr and annually for women over 40 yr of age; annual mammograms should be performed on women 40 yr and older as long as they are in good health. The ACS also recommends annual MRI testing for women at high risk of developing breast cancer. Genetic testing for inherited mutations (BRCA1 and BRCA2) associated with increased risk of developing breast cancer may be ordered for women at risk. The test is performed on a blood specimen. The most current guidelines for breast cancer screening of the general population as well as of individuals with increased risk are available from the ACS (www.cancer.org), the American College of Obstetricians and Gynecologists (ACOG) (www.acog.org), and the American College of Radiology (www.acr.org). Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include biopsy breast, cancer antigens, chest x-ray, CT thorax, ductograpy, mammogram, MRI breast, and stereotactic biopsy breast.
  • Refer to the Reproductive System table at the end of the book for related tests by body system.