When Ultrasound May Be Helpful
There are times when an ultrasound may be appropriate in a cancer screening. Such is the case when you can feel a palpable lump, but the mammogram is normal. This is especially true for lumps found near the surface of the breast that mammograms sometimes miss.
In cases like these, a breast ultrasound may detect breast cancer better than a mammogram. The point here, however, is that when a lump is present, imaging is done for diagnosis, rather than screening.
There are some, however, who believe that the combined use of a mammogram and a breast ultrasound may be appropriate in certain scenarios. One example is in women with dense breast tissue.
According to a 2015 review of studies published in the American Journal of Roentgenology, the sensitivity of a mammogram drops from around 85 percent in the average woman to anywhere from 48 percent to 64 percent in women with dense breasts.
The same review cited a 2002 study in which the combined use of mammography and ultrasonography in 13,547 women with dense breasts increased the accuracy of screening from 74.7 percent to 97.3 percent.
Typical Us Patterns Of Specific Types Of Breast Carcinomas
The appearance of specific types of breast carcinoma have been studied. Although appearances vary greatly, some patterns are typical.
Mucin-containing carcinomas are often circumscribed but may have irregular margins. These lesions may be either hypoechoic or isoechoic relative to subcutaneous fat. In a study of these carcinomas by Conant et al involving 8 patients, US showed hypoechoic, solid masses in all of their cases. The lesions demonstrated acoustic shadowing or increased acoustic enhancement. Some lesions had circumscribed margins, and some were not circumscribed.
Tubular carcinoma is usually hypoechoic but is without circumscribed margins and acoustic posterior shadowing. Invasive ductal carcinoma typically appears as an irregularly shaped mass with spiculated margins with shadowing and architectural distortion of adjacent breast tissue. This lesion may contain malignant microcalcifications.
Invasive lobular carcinoma often does not cause a desmoplastic reaction. This type is frequently missed on mammography and may be difficult to see on sonograms. Butler et al reported that these lesions were ultrasonographically occult in 12% of their cases. In approximately 60% of cases, it appeared as a heterogeneous, hypoechoic mass with angular or ill-defined margins and posterior acoustic shadowing. In 15% of cases, US demonstrated focal shadowing without a discrete mass in 12% of cases, US showed a lobulated, circumscribed mass.
Percentage Of Carcinomas Identified In Breast Ultrasound
The relative percentage of carcinomas found in supplemental breast ultrasound examinations as a fraction of the total number of detected cancers was reported in four studies, with a mean percentage of 22.5% . The percentage as a fraction of the total population screened was calculated from all studies, with a mean value of 0.32% .
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Abnormal Mammogram Result Be Informed And Ask The Right Questions
If your mammogram screening was abnormal, dont panic. The free resource, Abnormal Mammograms and What to Do Next, details the different kinds of tests you may need and includes a list of specific questions to ask your doctor at your next appointment. Be prepared to understand your results and empowered with critical information about your next steps.
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Alexandra Shulman Reveals Her Breast Cancer Diagnosis And New Guidelines Mean Cases Can Be Missed
It was a clear, sunny, blue-sky day the day I learned I had breast cancer. The brutally unexpected so often seems to happen on such days.
For a few months over the past summer, I had an intermittent sharp pain under my left breast, as if the wire from a bra was cutting in.
Sometimes it woke me at night, sometimes it disappeared for days. But there was no lump or general tenderness.
When I mentioned the pain to anyone, they would say: Well at least its not breast cancer because you dont get a pain with breast cancer.
But then I read about how Girls Aloud singer Sarah Harding, who sadly died of breast cancer in September, experienced a pain which she attributed to a guitar strap rubbing her breast.
It made me think that I should get my pain investigated but not right then. At some point. In the future.
It was a clear, sunny, blue-sky day the day I learned I had breast cancer. The brutally unexpected so often seems to happen on such days
I have been religious about mammograms and going private to have them annually for many years.
I was due another but couldnt get hold of my gynaecologist who generally refers me for them, so I booked to see my GP.
It was a private GP because I knew that getting to see my very efficient NHS one would take more time and that arranging what would be considered a non-urgent mammogram would take longer. With a busy autumn ahead, I wanted to get this off my mental to-do list.
Well, now I knew.
Characteristics Of The Development And Validation Cohorts
The quantitative morphologic scores were obtained using the DL-CAD software for the development and validation sets . Surgery was performed on all lesions with malignant biopsy results and some of the lesions with benign biopsy results . Clinical and imaging follow-up was performed using US for the non-excised lesions proven to be benign through biopsy , and lesion stability was confirmed in all the cases. The characteristics of the development and validation cohorts are summarized in Table . The age of the patients and size of the breast masses in the US were comparable between the two cohorts . The proportion of BI-RADS category 3 lesions was significantly higher in the development cohort than in the validation cohort . In the development cohort, there were 256 benign and 43 malignant masses. In the validation cohort, there were 155 benign and 9 malignant masses. The proportion of malignancy was significantly higher in the development cohort than in the validation cohort . Among the quantitative morphologic scores extracted from the DL-CAD software , the round shape score and all descriptor scores of the echo pattern, margin, and posterior features were significantly different between the two cohorts . However, the oval shape score, irregular shape score, and parallel and non-parallel orientation scores were all comparable between the two cohorts .
Table 1 Characteristics of the development and validation cohorts.
Breast Ultrasound And Dense Breast Tissue
Studies have shown mammography combined with breast ultrasound may find slightly more breast cancers than mammography alone in women with dense breasts .
Again, mammography plus breast ultrasound leads to more false positive results than mammography alone . False positive results must be checked to be sure theres no breast cancer. Follow-up tests, and sometimes a biopsy, are needed to check a false positive result.
There are no special screening guidelines for women with dense breasts. Breast ultrasound is not part of the NCCN or the ACS breast cancer screening recommendations for women at average risk or for women at higher than average risk .
Learn more about breast density and breast cancer risk.
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What Are The Limitations Of Ultrasound Imaging Of The Breast
- Ultrasound is one of the tools used in breast imaging, but it does not replace annual mammography.
- Many cancers are not visible on ultrasound. Many calcifications seen on mammography cannot be seen on ultrasound. Some early breast cancers only show up as calcifications on mammography. MRI findings that are due to cancer are not always seen with ultrasound.
- Biopsy may be recommended to determine if a suspicious abnormality is cancer or not.
- Most suspicious findings on ultrasound that require biopsy are not cancers.
- Many facilities do not offer ultrasound screening, even in women with dense breasts, and the procedure may not be covered by some insurance plans.
- It is important to choose a facility with expertise in breast ultrasound, preferably one where the radiologists specialize in breast imaging. Ultrasound depends on the abnormality being recognized at the time of the scan as it is a “real-time” examination. This requires experience and good equipment. One measure of a facility’s expertise in breast ultrasound can be found in its ACR accreditation status. Check the facilities in your area by searching the ACR-accredited facilities database.
Re: Anyone Ever Misdiagnosed With Fibroadenoma
Hi Doodlefly, I was diagnosed with a fibroadenoma 3 weeks ago following core needle biopsy. However the radiologist who did the ultrasound was extremely shocked at the result as the image wasn’t in keeping with a typical FB. I also have a tender underarm and under ultrasound, whilst my lymph nodes look ok, there is a shadow that looks like fat bruising – radiologists words, and he’s not sure what that is. Said it might go once the FB was removed. I opted to have the FB removed and did so last Wednesday however my consultant said the mass he removed wasn’t a FB and now I’m waiting for the lab results to find out what it is. Before discharge, I had a breast cancer nurse specialist who introduced herself and gave me her card if I have any questions while waiting for the results….she touched on the fact I should be prepared that it could be cancer but not to worry too much as they really didn’t know what this was at present. My view is that if you have the option, get the FB removed and with your symptoms I’d definitely get myself looked at you simply can’t take any chances!
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Anyone Ever Misdiagnosed With Fibroadenoma
New here. I have a Question:
Has anyone ever been MISDiagnosed with Fibroadenoma to learn later they have Breast Cancer?
2 years ago I went in for my first Baseline Mamogram. I was 36.
I had little red dots appear on my breast. Started in the right breast.
So, I was at the doctor for a Pre Op for a Surgery I was about to have.
Surgery was unrelated, I had a VERY LARGE Benign Tumor removed from my upper Thigh. This was the size of a tennis ball.
Doc sent me for a Baseline Mam.
I had the sugery on October 31 , 2013 . I was waiting for the results from the surgery and my Mom was supposed to go for a mamogram. SHe had not had one in 10 years. So, She said she would go , If I went with her and had mine done. So, we did.
I got a letter the next week from the breast center saying that my Mam was abnormal and I needed Diagnostic testing.
I had the right breast Diagnostic Mam. I waited. They called me back in for a Ultrasound. I waited. They Called me Back in again.
The tech said “The Radiologist Doctor wants to perform the Ultrasound himself.
Now I was worried.
He came in. asked my family history. I said None that I know of
He went over an area. then said “To be honest, I do not know what this is. I never saw anything like it”
So I told him my history with Lipomas. I have has 3 in my back and now one in my thigh.
So, I had an Ultrasound Guided Core Biopsy.
I was soooo Nervous.
Monday before THansgiving I got the call.
Pathological And Immunohistochemical Analysis
Histological tumor types of our study were divided into invasive ductal cancers and ductal carcinoma in situ . Invasive cancer was graded as grade 1 , grade 2 , or grade 3 . DCIS cases were classified as group 1 , group 2 , or group 3 .
Staining was performed for ER, PR, HER/neu-2, and Ki67. ER and PR positivity was defined as the presence of at least 1% positive tumor nucleus in the sample. HER/neu-2 expression was scored as . Tumors with a score of 3+ were classified as HER/neu-2 positive and tumors with scores of 0 or 1+ were classified as HER/neu-2 negative. Ki 67 was reported as the percentage of total number of tumor cells with nuclear staining. A percentage of more than or equal 14% defined positive ki67 status.
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When Should I Call My Doctor
- Feel a new or changing lump, dimpling, or other changes in your breast or armpit that are unusual for you.
- Have any nipple discharge, new inversion or skin changes of the nipple.
- Think a breast implant has ruptured.
A note from Cleveland Clinic
A breast ultrasound is a safe, painless test to examine targeted areas of breast tissue. Breast ultrasound provides detailed images of breast tissue and can help your provider diagnose breast cysts or lumps. For women with dense breasts, mammography is still the best screening tool. If you have dense breasts or a family history of breast cancer, ask your provider about scheduling a risk assessment with a clinical breast specialists and supplemental screening tools such as MRI and tomosythesis mammography.
Last reviewed by a Cleveland Clinic medical professional on 03/30/2021.
- American Cancer Society. . Accessed 3/3/2021Breast Ultrasound
- BreastCancer.org. . Accessed 3/31/2021Ultrasound
Application Of The Nomogram To Reduce Unnecessary Biopsies
After obtaining the risk scores from the diagnostic model, the optimal cut-off of the nomogram was determined to be 114 points to maximally improve the specificity with maintaining the sensitivity to 95% or higher. A comparison of the false positive rates, biopsy rates, and sensitivities between the BI-RADS final assessment and the diagnostic model using the nomogram with the determined cut-off is presented in Table . On application of the diagnostic model, the false positive rate significantly decreased in both the development cohort and validation cohort . Moreover, the biopsy rate significantly decreased in both the development cohort and validation cohort . The sensitivity did not significantly decrease in both the development cohort 98% vs. and validation cohort . When the nomogram threshold was applied to breast masses with BI-RADS 4A, 88 of the 174 masses in the development cohort and 78 of the 146 masses in the validation cohort were correctly reclassified as benign without missing any cancers .
Table 4 Comparison of the false positive rate, biopsy rate, and sensitivity between the radiologists BI-RADS assessment and the proposed nomogram.Figure 2Figure 3
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Now You Can Have A More Precise Diagnosis With Less Wait Time
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How Is Inflammatory Breast Cancer Diagnosed
Inflammatory breast cancer can be difficult to diagnose. Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram. In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis, which is an infection of the breast, or another form of locally advanced breast cancer.
To help prevent delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.
Minimum criteria for a diagnosis of inflammatory breast cancer include the following:
- A rapid onset of erythema , edema , and a peau d’orange appearance and/or abnormal breast warmth, with or without a lump that can be felt.
- The above-mentioned symptoms have been present for less than 6 months.
- The erythema covers at least a third of the breast.
- Initial biopsy samples from the affected breast show invasive carcinoma.
Imaging and staging tests include the following:
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Can You See Inflammatory Breast Cancer On Ultrasound
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