ULTRASOUND

The sonar examination is done at the same time as the mammogram.  It is included in the fee for the mammogram.  Alone, it is not the method of choice to examine the breast. The mammogram must first be scrutinized by the radiologist and then he / she (not another person or sonographer) must verify what is seen on the mammogram, whether it is only a normal breast tissue density, a cyst, or a tumor. This is very important! The reliability of a mammogram diagnoses is enhanced 100% by the sonar done straight after the mammogram.  This must be done by the same radiologist and not by another person. This will exclude any false positive and / or false negative diagnoses on the mammogram, alone. The combined methods bring your examination almost in par with other methods (eg.MRI) comparing false neg. and false positives.

Only ultrasound probes with 10 MHz or higher should be acceptable. The probes used for abdominal work cannot, and should not, be used. They lack resolution!

With ultrasound we can differentiate solid from fluid containing (cysts) structures. Fluid containing structures are almost never cancerous. On the mammogram we cannot make this difference!  Both are white structures on the mammogram but the ultrasound gives us an immediate clue.

In young women with dense, non-fatty breasts, the ultrasound can often be used successfully without a mammogram. Some cancers present with small calcification and this type of Cancer cannot be seen on ultrasound. Therefore we are reluctant to resort only to using ultrasound to exclude cancer in women over the age of 40.

In any case, all breast masses, even in young women should be examined with both these moralities.

All clinicians should be aware that  fine needle aspirations (FNA) change the character of lesions on mammograms and ultrasound. It makes it extremely difficult to evaluate lesions on the mammogram and ultrasound after the FNA was done. Bleeding into the lesion causes an innocent cyst to look solid and the great value of ultrasound and mammography is lost for months ahead.

Ultrasound is a valuable tool to guide needles into small lesions accurately. One can clearly see your needle tip and verify, visually, that you are sampling the lesion in question.

See drawbacks of FNA below.

A needle should no be placed into a breast lesion without ultrasound guidance. The lesion is often missed and a negative outcome on the cytology is obtained. Often doctors are tempted to put a needle into a mass, to see whether it is cystic and to relieve stress in the patient. If fluid is struck and the mass disappears with aspiration, it is OK but if no fluid is aspirated, it could mean that the needle was misplace (not into the lesion) and  bleeding that is caused, changes the character  on future mammograms and ultrasounds for a long time. This leads to unnecessary stress and interventions that now have to be resorted to in order to make an accurate diagnosis or to exclude cancer.