The Role of Ultrasound in the Diagnosis of Breast Disease

9.1 Introduction High-resolution breast ultrasound has evolved during the past three decades to become an indispensable diagnostic tool in the breast imaging armamentarium. It continues to be a simple, inexpensive, widely available, and effective breast imaging technique. This chapter aims to summarize currently accepted indications for breast ultrasound, and highlight several potential areas of development and application. Existing indications for breast ultrasound in diagnostic practice include the following: (1) as an adjunct imaging method to evaluate abnormal findings during mammography and clinical breast examination, (2) as the imaging method of choice for symptomatic young and pregnant patients, (3) for acute breast imaging, (4) differentiating benign from malignant breast lesions, (5) application of color and power Doppler imaging, (6) breast cancer imaging, (7) imaging guidance for intervention, and (8) second-look ultrasound for abnormal breast MR or PET/CT findings. 9.2 Breast Imaging Reporting and Data System Ultrasound Nomenclature The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BIRADS®) lexicon for reporting breast ultrasound results was developed for mammographic-sonographic correlation. It is a structured reporting format for breast radiologists and breast physicians that incorporates clinical, mammographic, and breast ultrasound results, as well as a final clinical management recommendation. It includes a composite of ultrasound descriptors, a final diagnostic category based on the ultrasound findings, and an associated final management recommendation. Increased utilization of the ultrasound BIRADS® system clarifies communication and increases the consistency of imaging information shared between breast radiologists, surgeons, medical oncologists, family practitioners, and gynecologists regarding imaging abnormalities.