Clinical Applications and Advancements in Breast Sonography: A Comprehensive Review

George Tsoukatos, BPS, R.T.(R)(ARRT)®

^*Medical Imaging Consultant, Germantown, NY

Address correspondence to: George Tsoukatos, BPS, R.T.(R)(ARRT)^®, Radiology Support Services, PO Box 215, Germantown, NY 12526. E-mail: radiologytechnique@gmail.com.

Disclosure Statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.

 ABSTRACT

Sonography is a valuable diagnostic modality in breast imaging and is both complimentary and an adjunct to digital mammography, digital breast tomosynthesis, and breast magnetic resonance imaging (MRI). Sonography may also be used as an additional breast cancer detection modality in women who have dense breast tissue and a negative mammogram. Currently, sonography is the primary medical imaging modality recommended for use in guiding breast biopsies and other types of interventional breast procedures for its ability to monitor real-time needle-to-lesion guidance. Although breast sonography may be performed by a sonographer or a trained mammographer, the radiologist also greatly benefits from hands-on real time scanning due to the high operator dependence of sonography. Sonography has evolved from the early days of B-mode 2-dimensional grayscale images to pulsed duplex, color Doppler, power Doppler, and spectral Doppler imaging, as well as harmonic and spatial compound imaging, and elastography. Over time, breast sonography has been incorporated as part of a successful examination process of suspicious lesions found on screening mammography. Advances made in sonographic imaging systems and transducers allow for confident characterization of not only benign cysts but also benign and malignant solid masses. Knowledge and understanding of proper scanning techniques and instrumentation are imperative for maintaining image quality and providing an accurate diagnosis. This includes a thorough knowledge of breast anatomy and the associated lymphatic systems and their interactions. This course will provide a review of current state-of-the-art sonographic technology, including recent advances as well as information on whole-breast and targeted sonography and how they relate to the patient's clinical history. The role of targeted breast sonography as a complimentary/supplementary imaging technique, in conjunction with other diagnostic imaging modalities including mammography, digital radiography, and breast MRI, for early diagnosis of breast disease and development of subsequent early treatment protocols will also be discussed. Finally, the review, characterization, and categorization of breast lesions as well as the role of sonography in guided biopsies will be outlined.