Fibroadenomas are classically described as ellipsoid, well-circumscribed masses with fewer than four gentle lobulations, and they are wider than tall.

While breast ultrasound may detect additional breast cancers not seen on mammography in women with treated breast cancer, the risk of false-positive biopsies as a diagnostic consequence is far greater. No current guidelines support the use of breast ultrasound, either HHUS or ABUS, for supplemental surveillance in women with treated breast cancer ( Table 12.1 ).

My doctor found a lump in my breast during my yearly mammogram and then brought in an ultrasound technician to follow up with an ultrasound for a closer look. Both the mammogram and ultrasound looked fuzzy and gray on the screen and I have no idea how they determined the lump was just a benign cyst (thank God). What does breast cancer look like on a mammogram?

Breast Ultrasound and How It Is Used To Fight Against Breast Cancer ...

Breast Ultrasound

Breast Cancer Ultrasound: Uses, Procedure, and Results

Whole breast ultrasound has been investigated as a supplemental screening method in women with mammographically dense breasts. In the ACRIN 6666 trial in the USA, 80 2809 women underwent mammography and whole breast hand-held ultrasound by a physician. The combined modalities yielded 4.2 additional cancers per 1000 women screened (95% CI 1.1–7.2 per 1000) but at the cost of a large increase in the number of false positives with a Positive Predictive Value (PPV) of biopsy recommended by mammography combined with ultrasound of only 11.2% (95% CI 7.8–15.6%) compared with 22.6% (95% CI 14.2–33) for mammography alone.

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What does breast cancer look like in an ultrasound?

1. Berg WA, Vourtsis A. Screening breast ultrasound using hand-held or automated technique in women with dense breasts. J Breast Imaging 2019; 1:283-296

If you have noticed a change in your breasts or a mammogram has detected an abnormality, your doctor may arrange a breast ultrasound for you. A breast ultrasound is a non-invasive, painless test that uses sound waves to form an image of structures in the breast, which helps your healthcare provider determine whether these changes are caused by a non-cancerous or benign lump of tissue or a breast cancer based upon the shape, location and other characteristics visible on ultrasound. Occasionally the ultrasound can be inconclusive, and your doctor may request follow up ultrasound to monitor the lump and/or request a biopsy.


Breast cancer, ultrasound scan

Figure US-1. Handheld Ultrasound.

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Breast Ultrasound and Magnetic Resonance Imaging

To detect abnormalities in the breast , ultrasound machines send high-frequency sound waves towards the tissue while receiving those waves that echo/bounce back. The images of the breast tissue are created by these reflected sound waves, which are dependent on the internal structures of your breast/s such as boundaries between fluid and soft tissue or between bone and soft tissue.

Screening breast ultrasound, which scans the whole breast, can find some cancers that are not seen on a mammogram and may be an option for patients who are eligible for screening MRI but who cannot undergo, access, or tolerate MRI. Targeted (limited) ultrasound is used to evaluate a symptomatic area(s) (such as a lump), or an abnormality seen on mammography or other breast imaging exam.

Most studies of breast ultrasound as a supplemental screening modality have focused on women with mammographically dense breasts, 67 with varying additional risk factors, such as family history or personal history of breast cancer. Of 12 screening ultrasound studies conducted since 2000, the American College of Radiology Imaging Network (ACRIN) 6666 study 55,56 was the only prospective study evaluating the combination of mammography plus HHUS compared mammography alone, with 1 year follow-up for multiple screening rounds. In this study, 1426 of 2659 women (53%) had a personal history of breast cancer.

Breast Ultrasound (Sonogram)

What Does Breast Cancer Look Like On An Ultrasound

Secondary signs of breast cancer on ultrasound are changes in Cooper ligaments, breast edema, architectural distortion, skin thickening, skin retraction or irregularity, and suspicious microcalcifications.

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In the first screening round 55,56,68 conducted from 2004 to 2006, the cancer detection rate for mammography alone was 7.6 per 1000 examinations, and mammography/HHUS detected an additional 5.3 cancers per 1000 examinations. However, the number of recalls for additional evaluation increased 2.3-fold, from 115 per 1000 examinations for mammography alone to 266 per 1000 examinations for mammography/HHUS. The number of breast biopsies increased 4.2-fold, from 24 per 1000 examinations with mammography to 102 per 1000 with mammography/HHUS. The cancer yield for biopsies performed (PPV3) for HHUS was 8.6%, indicating that greater than 90% of biopsies performed revealed benign disease.

6. Kelly KM, Dean J, Comulada WS, Lee SJ. Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol 2010; 20:734-742

What Does Breast Cancer Look Like on an Ultrasound

How Does Breast Cancer Look Like In Ultrasound

Suspicious ultrasound findings in solid masses include acoustic spiculation; shadowing; taller than wide configuration; angulated, indistinct, microlobulated, or spiculated margins; irregular shape; and an echogenic halo.

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Key Elements

By the third screening round, 56,68 the mammography examinations had transitioned from film to digital, and mammography alone detected 9.9 cancers per 1000 examinations. Mammography plus ultrasound detected an additional 4.2 cancers per 1000. For women with a personal history of breast cancer, the incremental cancer detection rate for HHUS was the same as in women without this history. The recall rate in the second and third screening rounds remained high, at 94 per 1000 examinations for mammography alone and 168 per 1000 for mammography/HHUS, a 1.8-fold increase. Breast biopsies remained increased with mammography/HHUS screening (3.5-fold increase compared with mammography alone), and the cancer yield following biopsy remained low at 7.1%.

7. Berg WA, Zuley ML, Chang TS, et al. Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound After Tomosynthesis in Women With Dense Breasts (the DBTUST). J Clin Oncol 2023; 41:2416-2427

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