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Breasts Ultrasound References

Ultrasound (US) of the breast is the most common adjunct modality used for breast evaluation. It employs no ionizing radiation, does not require intravenous contrast material, is well tolerated and widely available. The breast is ideal subject for ultrasound imaging since it is superficially located and easily accessible (without overlying structures) for interventional procedures. In addition, the sensitivity of US is not affected by the type of breast tissue. Optimal results depend on having adequate equipment with high frequency transducers and are highly operator dependent. Reliability varies according to the operator’s expertise which determines the reproducibility of images, and rates of false negatives and false positives.

The indications for breast ultrasound include: evaluation of a palpable or mammographically visualized mass, guidance for interventional procedures, for radiation planning, the initial imaging technique for the young (under 30 years of age), in pregnant, or lactating women and for the evaluation of silicone implants. Additionally, it has been very useful for the second look targeted ultrasound after a suspicious lesion is seen on the MRI or Breast Specific Gamma Imaging for guidance of the biopsy. Screening is not an indication for breast ultrasound, however, various studies have shown that the addition of  ultrasound to mammography in high risk women with dense breast tissue will increase detection of breast cancer. The ACRIN 6666 study found that in this group of women, the addition of ultrasound to mammography yielded an additional 7.2 cancers per 1000 women. The sensitivity of combined mammography and ultrasound was 77.5% compared to 49% with mammography alone. In this multi-centered study, 29% of the cancers were only visualized by ultrasound. However, it is important to realize that the positive predictive value of screening ultrasound is low, that is to say that only 8.6% of the biopsies performed are positive for breast cancer compared to 14.7%. with mammography. The increased number of false positives resulted in additional biopsies and cost, creating unnecessary anxiety.


1. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology. 2002; 225(1): 165-175.
2. Berg WA, Blume J, Cormack JB, Mendelson EB. Operator dependence of physician-performed whole breast US: lesion detection and characterization. Radiology 2006; 241(2: 355-366.
3. BergWA, Mendelson EB, Blume JD, Cormack JB. Performance of experienced breast imagers in interpreting breast ultrasound: results of training in the ACRIN 6666 protocol. AJR AM J Roentgenol  2004;182(4):34.
4. Berg WA, Supplemental screening sonography in dense breasts. Radiol Clin North Am 2004; 42(5): 845-51.
5. Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US- diagnostic yield characteristics. Radiology 1998; 207(1): 191-99.
6.Tabár L, Vitak B, Chen HH, et al. The Swedish Two-CountyTrial twenty years later: updated mortality results and new insights from long- term follow up. Radiol Clin North Am 2000; 38(4): 625-51.
7. Buchberger W, Niehoff A, Obrist P, DeKoekoek-Doll P, Dunser M. Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR  2000; 21(4): 325-36.
8. Crystal P, StranoSD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR AM J Roentgenol 2003; 181 (!): 177-82.
9. Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound: a retrospective review. Cancer 1995; 76(4):626-30.
10. Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 2001; 221 (3): 641-49.
11. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al. Combined Screening with Ultrasound and Mammography alone in women at elevated risk of Breast Cancer JAMA 2008;299(18):2151-2163.

We are proud to announce that the article entitled "Reasons Women at Elevated Risk of Breast Cancer Refuse Screening Breast MRI:  ACRIN 6666" has been accepted by the RSNA 2009.  Included: Supplemental Yield of US, False Positives of US and Supplemental Yield of MRI


 The "Coming of Age" of Nonmammographic Screening for Breast Cancer

False Positives Induced by Annual Screening US added to mammography:  ACRIN 6666

Screening Breast Ultrasound as a Supplement to Mammography  

Combined Screening with Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer:   
Preoperative Axillary Lymph Node Ultrasound May Prevent Sentinel Node Biopsy


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