Advanced breast ultrasound and interventions: An update

Abstract

Ultrasound (US) technology has made progress in detecting and characterizing breast lesions, using frequencies between 7 and 18 MHz in combination with advanced tissue imaging technologies such as compound and harmonic imaging, volume scanning, modern color flow and elastography. The updated Breast Imaging Reporting and Data System (BI-RADS®) lexicon incorporates these new technological concepts and their impact on management. To date, description of a lesion should cover the new BI-RADS® US categories of vascularity and elasticity as associated findings. US constitutes the assessment method of choice for women with clinical signs and symptoms. Fundamental US enhances sensitivity for detecting cancer by 6-30% in symptomatic breast cancer patients. In risk patients with radiodense breasts, additive US to screening mammography improves the supplemental diagnostic detection rate after negative mammography by three to four per 1,000 women with dense breasts. The generally accepted role of US in population-based screening focuses on the assessment of suspicious mammographically detected lesions. US is indicated and routinely used in breast centers for preoperative staging, to monitor therapy and to keep patients under surveillance after breast conservation. US-guided core needle biopsy is the standard interventional technique for all breast lesions that correlate with findings of other imaging modalities. Sensitivity of US-guided large core needle biopsy (CNB) is 93-98% specificity ranges from 95% to 100 %. The diagnostic accuracy of US-guided vacuum-assisted biopsy (VAB) is close to 100%. US-guided needle aspiration and CNB of the axilla should be used preoperatively to define metastatic lymph node involvement. Breast cancer screening based on automated whole breast US is an upcoming future horizon that will need sophisticated transfer of technological advancements to updated epidemiological concepts.