Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Mammary Gland Biology and Neoplasia
Published in: Journal of Mammary Gland Biology and Neoplasia 2/2006

01-04-2006

A Review of Breast Ultrasound

Authors: Chandra M. Sehgal, Susan P. Weinstein, Peter H. Arger, Emily F. Conant

Published in: Journal of Mammary Gland Biology and Neoplasia | Issue 2/2006

Login to get access

Abstract

Frequent advances in transducer design, electronics, computers, and signal processing have improved the quality of ultrasound images to the extent that sonography is now a major mode of imaging for the clinical diagnosis of breast cancer. Breast ultrasound is routinely used for differentiating cysts and solid nodules with high specificity. In combination with mammography, ultrasound is used to characterize solid masses as benign or malignant. There is growing interest in using Doppler ultrasound and contrast agents for measuring tumor blood flow and for imaging tumor vascularity. Ease of use and real-time imaging capability make breast ultrasound a method of choice for guiding breast biopsies and other interventional procedures. Breast ultrasound is used in many forms. B-mode is the most common form of imaging for the breast, although compound imaging and harmonic imaging are being increasingly applied to better visualize breast lesions and to reduce image artifacts. These developments, together with the formulation of a standardized lexicon of solid mass features, have improved the diagnostic performance of breast ultrasound. Several approaches that are currently being investigated to further improve performance include: (1) computer-aided-diagnosis; (2) the assessment of tumor vascularity and tumor blood flow with Doppler ultrasound and contrast agents; and (3) tissue elasticity imaging. In the future, ultrasound will play a greater role in differentiating benign from malignant masses and in the diagnosis of breast cancer.
Literature
1.
Wild JJ. The scientific discovery of sonic reflection by soft tissues and application of ultrasound to diagnostic medicine and tumor screening. Third Meeting of the World Federation for Ultrasound in Medicine and Biology (Scientific Exhibit Section) Brighton, England—July 1982. (Cantab) Medico-Technological Research Institute of Minneapolis, Minneapolis, Minnesota, USA
2.
3.
Wade G. Ultrasonic imaging by reconstructive tomography. Acoust Imag 1980;9:379–431.
4.
Greenleaf JF, Bahn RC. Clinical imaging with transmission ultrasonic computerized tomography. IEEE Trans Biomed Eng BME 1981;28:177–85.
5.
Hiller D, Ermert H. Ultrasound computerized tomography using transmission and reflection mode: application to medical diagnosis. Acoust Imag 1982;12:553–64.
6.
Schreiman JS, Gisvold JJ, Greenleaf JF, Bahn RC. Ultrasound transmission computed tomography of the breast. Radiology 1984;150:523–30.PubMed
7.
Scherzinger AL, Belgam RA, Carson PL, Meyer CR, Sutherland JV, Bookstein FL, et al. Assessment of ultrasonic computed tomography in symptomatic breast patients by discriminant analysis. Ultrasound Med Biol 1989;15:21–8.PubMedCrossRef
8.
Friedrich M, Hundt E, Maderlechner G. Computerized ultrasound echo tomography of the breast. Eur J Radiol 1982;2:78–87.PubMed
9.
Kremkau FW. Diagnostic ultrasound: principles and instruments. 5th ed. Philadelphia: WB Saunders; 1984.
10.
Hedrick WR, Hykes DL, Starchman DE. Ultrasound physics and instrumentation. 3rd ed. St Louis: Mosby; 1995.
11.
Zagzebski JA. Essentials of ultrasound physics. St Louis: Mosby; 1996.
12.
Stavros AT. Breast ultrasound. Philadelphia: Williams and Wilkins; 2004.
13.
Helmut M. The practice of breast ultrasound: techniques, findings, differential diagnosis. New York: Thieme; 2000.
14.
Bassett LW, Kimme-Smith C, Sutherland LK, Gold RH, Sarti D, King W, 3rd. Automated and hand-held breast US: effect on patient management. Radiology 1987;165:103–8.PubMed
15.
Bassett LW, Ysrael M, Gold RH, Ysrael C. Usefulness of mammography and sonography in women less than 35 years of age. Radiology 1991;180:831–5.PubMed
16.
Lamas AM, Horwitz RI, Peck D. Usefulness of mammography in the diagnosis and management of breast disease in postmenopausal women. JAMA 1984;252:2999–3002.PubMedCrossRef
17.
Venta LA, Dudiak CM, Salomon CG, Flisak ME. Sonographic evaluation of the breast. Radiographics 1994;14:29–50.PubMed
18.
Jackson VP. The current role of ultrasonography in breast imaging. Radiol clin North Am 1995;33:1161–70.PubMed
19.
Bassett LW, Kimme-Smith C. Breast sonography. Am J Roentgenol 1991;156:449–55.
20.
Hogg JP, Harris KM, Skolnick ML. The role of ultrasound-guided needle aspiration of breast masses. Ultrasound Med Biol 1988;14 Suppl 1:13–21.PubMedCrossRef
21.
Nightingale KR, Kornguth PJ, Trahey GE. The use of acoustic streaming in breast lesion diagnosis: a clinical study. Ultrasound Med Biol 1999;25:75–87.PubMedCrossRef
22.
Gordon PB, Goldenberg SL. Malignant breast masses detected only by ultrasound. A retrospective review. Cancer 1995;76:626–30.PubMedCrossRef
23.
Kopans DB, Feig SA, Sickles EA. Malignant breast masses detected only by ultrasound: a retrospective review. Cancer 1996;77:208–9.PubMedCrossRef
24.
Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US-diagnostic yield and tumor characteristics. Radiology 1998;207:191–9.PubMed
25.
Berg WA. Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network (ACRIN). Am J Roentgenol 2003;180:1225–8.
26.
Drukker K, Giger ML, Mendelson EB. Computerized analysis of shadowing on breast ultrasound for improved lesion detection. Med Phys 2003;30:1833–42.PubMedCrossRef
27.
Jackson VP, Reynolds HE, Hawes DR. Sonography of the breast. Semin Ultrasound CT MR 1996;17:460–75.PubMedCrossRef
28.
Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196:123–34.PubMed
29.
Jackson VP. Management of solid breast nodules: what is the role of sonography? Radiology 1995;196:14–5.PubMed
30.
Paulinelli RR, Freitas-Junior R, Moreira MA, Moraes VA, Bernardes-Junior JR, Vidal CS, et al. Risk of malignancy in solid breast nodules according to their sonographic features. J Ultrasound Med 2005;24:635–41.PubMed
31.
Arger PH, Sehgal CM, Conant EF, Zuckerman J, Rowling SE, Patton JA, et al. Interreader variability and predictive value of US descriptions of solid breast masses: pilot study. Acad Radiol 2001;8:335–42.PubMedCrossRef
32.
American College of Radiology. BI-RADS: Ultrasound, 1st ed. In: Breast imaging reporting and data system: BI-RADS atlas, 4th ed. Reston, Virginia: American College of Radiology; 2003.
33.
Mendelson EB, Berg WA, Merritt CRB. Toward a standardized breast ultrasound lexicon, BI-RADS: ultrasound. Semin Roentgenol 2001;36:217–25.PubMedCrossRef
34.
Baker JA, Kornguth PJ, Soo MS, Walsh R, Mengoni P. Sonography of solid breast lesions: observer variability of lesion description and assessment. Am J Roentgenol 1999;172:1621–5.
35.
Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for sonography: positive and negative predictive values of sonographic features. Am J Roentgenol 2005;184:1260–5.
36.
Kuo WJ, Chang RF, Moon WK. Computer aided diagnosis of breast tumors with different US systems. Acad Radiol 2002;9:793–9.PubMedCrossRef
37.
Horsch K, Giger ML, Vyborny CJ, Venta LA. Performance of computer-aided diagnosis in the interpretation of lesions on breast sonography. Acad Radiol 2004;11:272–80.PubMedCrossRef
38.
Goldberg V, Manduca A, Ewert DL, Gisvold JJ, Greenleaf JF. Improvement in specificity of ultrasonography for diagnosis of breast tumors by means of artificial intelligence. Med Phys 1992;19:1475–81.PubMedCrossRef
39.
Koyama S, Obata Y, Shimamoto K, Ishigaki T, Ishii N, Isomoto Y, et al. Breast ultrasonography: computer-aided diagnosis using fuzzy inference. J Ultrasound Med 1997;16:665–72.PubMed
40.
Chen DR, Chang RF, Huang YL. Computer-aided diagnosis applied to US of solid breast nodules by using neural networks. Radiology 1999;213:407–12.PubMed
41.
Chen DR, Kuo WJ, Chang RF, Moon WK, Lee CC. Use of the bootstrap technique with small training sets for computer-aided diagnosis in breast ultrasound. Ultrasound Med Biol 2002;28:897–902.PubMedCrossRef
42.
Kuo WJ, Chang RF, Lee CC, Moon WK, Chen DR. Retrieval technique for the diagnosis of solid breast tumors on sonogram. Ultrasound Med Biol 2002;28:903–9.PubMedCrossRef
43.
Shankar PM, Dumane VA, Piccoli CW, Reid JM, Forsberg F, Goldberg BB. Classification of breast masses in ultrasonic B-mode images using a compounding technique in the Nakagami distribution domain. Ultrasound Med Biol 2002;28:1295–1300.PubMedCrossRef
44.
Sahiner B, Chan HP, Roubidoux MA, Helvie MA, Hadjiiski LM, Ramachandran A, et al. Computerized characterization of breast masses on three-dimensional ultrasound volumes. Med Phys 2004;31:744–54.PubMedCrossRef
45.
Dumane VA, Shankar PM, Piccoli CW, Reid JM, Forsberg F, Goldberg BB. Computer aided classification of masses in ultrasonic mammography. Med Phys 2002;29:1968–73.PubMedCrossRef
46.
Chen CM, Chou YH, Han KC, Hung GS, Tiu CM, Chiou HJ, et al. Breast lesions on sonograms: computer-aided diagnosis with nearly setting-independent features and artificial neural networks. Radiology 2003;226:504–14.PubMed
47.
Drukker K, Giger ML, Vyborny CJ, Mendelson EB. Computerized detection and classification of cancer on breast ultrasound. Acad Radiol 2004;11:526–35.PubMedCrossRef
48.
Sehgal CM, Cary TW, Kangas SA, Weinstein SP, Schultz SM, Arger PH, et al. Computer-based margin analysis of breast sonography for differentiating malignant and benign masses. J Ultrasound Med 2004;23:1201–9.PubMed
49.
Piliouras N, Kalatzis I, Dimitropoulos N, Cavouras D. Development of the cubic least squares mapping linear-kernel support vector machine classifier for improving the characterization of breast lesions on ultrasound. Comput Med Imaging Graph 2004;28:247–55.PubMedCrossRef
50.
Cary TW, Conant EF, Arger PH, Sehgal CM. Diffuse boundary extraction of breast masses on ultrasound by leak plugging. Med Phys 2005;32:3318–28.PubMedCrossRef
51.
Song JH, Venkatesh SS, Conant EF, Arger PH, Sehgal CM. Comparative analysis of logistic regression and artificial neural network for computer-aided diagnosis of breast masses. Acad Radiol 2005;12:487–95.PubMedCrossRef
52.
Weinstein SP, Seghal CM, Conant EF, Patton JA. Microcalcifications in breast tissue phantoms visualized with acoustic resonance coupled with power Doppler US: initial observations. Radiology 2002;224:265–9.PubMed
53.
Alizad A, Fatemi M, Wold LE, Greenleaf JF. Performance of vibro-acoustography in detecting microcalcifications in excised human breast tissue: a study of 74 tissue samples. IEEE Trans Med Imag 2004;23:307–12.CrossRef
54.
55.
Burkhardt C. Speckle in ultrasound B-mode scans. IEEE Trans Sonics Ultrason 1978;25:1–6.
56.
Entrekin R, Jackson P, Jago JR, Porter BA. Real time spatial compound imaging in breast ultrasound: technology and early clinical experience. Medicamundi 1999;43:35–43.
57.
Kwak JY, Kim EK, You JK, Oh KK. Variable breast conditions: comparison of conventional and real-time compound ultrasonography. J Ultrasound Med 2004;23:85–96.PubMed
58.
Kangas SA, Schultz SM, Conant EF, Weinstein S, Arger PH, Schnall MD, et al. Differences between conventional and compound ultrasound imaging of solid breast lesions (Abstract). Radiology Society of North America Chicago, Nov 28–Dec 3, 2004:142.
59.
Rosen EL, Soo MS. Tissue harmonic imaging sonography of breast lesions: improved margin analysis, conspicuity, and image quality compared to conventional ultrasound. Clin Imaging 2001;25:379–84.PubMedCrossRef
60.
Szopinski KT, Pajk AM, Wysocki M, Amy D, Szopinska M, Jakubowski W. Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med 2003;22:479–87.PubMed
61.
Kubota K, Hisa N, Ogawa Y, Yoshida S. Evaluation of tissue harmonic imaging for breast tumors and axillary lymph nodes. Oncol Rep 2002;9:1335–8.PubMed
62.
Kubota K, Ogawa Y, Nishigawa T, Yoshida S. Tissue harmonic imaging sonography of the axillary lymph nodes: evaluation of response to neoadjuvant chemotherapy in breast cancer patients. Oncol Rep 2003;10:1911–4.PubMed
63.
Sehgal CM, Brown GM, Bahn RC, Greenleaf JF. Measurement and use of acoustic nonlinearity and sound speed to estimate composition of excised livers. Ultrasound Med Biol 1986;12:865–74.PubMedCrossRef
64.
Law WK, Frizzell LA, Dunn F. Determination of the nonlinearity parameter B/A of biological media. Ultrasound Med Biol 1985;11:138–307.CrossRef
65.
Cosgrove DO, Kedar RP, Bamber JC, al-Murrani B, Davey JB, Fisher C, et al. Breast diseases: color Doppler US in differential diagnosis. Radiology 1993;189:99.PubMed
66.
Huber S, Delorme S, Knopp MP, Junkermann H, Zuna I, von Fournier D, et al. Breast tumors: computer-assisted quantitative assessment with color Doppler US. Radiology 1994;192:797.PubMed
67.
Raza S, Baum JK. Solid breast lesions: evaluation with power Doppler US. Radiology 1997;203:164.PubMed
68.
Birdwell RL, Ikeda DM, Jeffrey SS, Jeffrey RB Jr. Preliminary experience with power Doppler imaging of solid breast masses. AJR 1997;169:703.PubMed
69.
Sehgal CM, Arger PH, Kotlar EY, Pugh CR, Kirchoffer JI, Bovee KH. Quantitative analysis of color and power Doppler images to differentiate between malignant and benign lesions. J Ultrasound Med 1998;17:S105.
70.
Carson PL, Fowlkes JB, Roubidoux MA, Moskalik AP, Govil A, Normolle D, et al. 3-D color Doppler image quantification of breast masses. Ultrasound Med Biol 1998;24:945.PubMedCrossRef
71.
Sehgal CM, Arger PH, Rowling SE. Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications. J Ultrasound Med 2000;19:427–40.PubMed
72.
Lee SW, Choi HY, Baek SY, Lim SM. Role of color and power Doppler imaging in differentiating between malignant and benign solid breast masses. J Clin Ultrasound 2002;30:459–64.PubMedCrossRef
73.
Wilkens TH, Burke BJ, Cancelada DA, Jatoi I. Evaluation of palpable breast masses with color Doppler sonography and gray scale imaging. J Ultrasound Med 1998;17:109–15.PubMed
74.
Del Cura JL, Elizagaray E, Zabala R, Legorburu A, Grande D. The use of unenhanced Doppler sonography in the evaluation of solid breast lesions. AJR 2005;184:1788–94.PubMed
75.
Pugh CR, Arger PH, Sehgal CM. Power, spectral, and color flow Doppler enhancement by a new ultrasonographic contrast agent. J Ultrasound Med 1996;15:843–82.PubMed
76.
Kedar RP, Cosgrove D, McCready VR, Bamber JC, Carter ER. Microbubble contrast agent for color Doppler US: effect on breast masses. Work in progress. Radiology 1996;198:679–86.PubMed
77.
Huber S, Helbich T, Kettenbach J, Dock W, Zuna I, Delorme S. Effects of a microbubble contrast agent on breast tumors: computer-assisted quantitative assessment with color Doppler US-early experience. Radiology 1998;208:485–9.PubMed
78.
Alamo L, Fischer U. Contrast-enhanced color Doppler ultrasound characteristics in hypervascular breast tumors: comparison with MRI. Eur Radiol 2001;11:970–7.PubMedCrossRef
79.
Reinikainen H, Rissanen T, Paivansalo M, Paakko E, Jauhiainen J, Suramo I. B-mode, power Doppler and contrast-enhanced power Doppler ultrasonography in the diagnosis of breast tumors. Acta Radiol 2001;42:106–13.PubMedCrossRef
80.
Forsberg F, Goldberg BB, Merritt CR, Parker L, Maitino AJ, Palazzo JJ, et al. Diagnosing breast lesions with contrast-enhanced 3-dimensional power Doppler imaging. J Ultrasound Med 2004;23:173–82.PubMed
81.
Yang WT, Tse GM, Lam PK, Metreweli C, Chang J. Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. J Ultrasound Med 2002;21:1227–35.PubMed
82.
Hall TJ. AAPM/RSNA physics tutorial for residents: topics in US: beyond the basics: elasticity imaging with US. Radiographics 2003;23:1657–71.PubMed
83.
Gao L, Parker KJ, Lerner RM, Levinson SF. Imaging of the elastic properties of tissue—a review. Ultrasound Med Biol 1996;22:959–77.PubMedCrossRef
84.
Ophir J, Alam SK, Garra B, Kallel F, Konofagou E, Krouskop T, et al. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proceedings of the Institution of Mechanical Engineers, Part H–J. Eng Med 1999;213:203–33.
85.
Insana MF, Bamber JC. Tissue motion and elasticity imaging. Phys Med Biol 2000;45(6):v–vi (2 p preceding 1409).
86.
Wilson LS, Robinson DE, Dadd MJ. Elastography—the movement begins. Phys Med Biol 2000;45:1409–21.PubMedCrossRef
87.
Fatemi M, Greenleaf JF. Probing the dynamics of tissue at low frequencies with the radiation force of ultrasound. Phys Med Biol 2000;45:1449–64.
88.
Plewes DB, Bishop J, Samani A, Sciarretta J. Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography. Phys Med Biol 2000;45:1591–1610.PubMedCrossRef
89.
Fung Y. Biomechanics: mechanical properties of living tissue. 2nd ed. Berlin Heidelberg New York: Springer; 1993.
90.
Sarvazyan A, et al. Elasticity imaging as a new modality of medical imaging for cancer detection. Proc. Int. Workshop on Interaction of Ultrasound with Biological Media, Valenciennes, France. (1994). pp 69–81.
91.
Sarvazyan A, et al. Biophysical bases of elasticity imaging. Acoust Imag 1995;21:223–40.
92.
Hall TJ, Zhu Y, Spalding CS. In vivo real-time freehand palpation imaging. Ultrasound Med Biol 2003;29:427–35.PubMedCrossRef
93.
Hiltawsky KM, Kruger M, Starke C, Heuser L, Ermert H, Jensen A. Freehand ultrasound elastography of breast lesions: clinical results. Ultrasound Med Biol 2001;27:1461–9.PubMedCrossRef
94.
Garra BS, Cespedes EI, Ophir J, Spratt SR, Zuurbier RA, Magnant CM, et al. Elastography of breast lesions: initial clinical results. Radiology 1997;202:79–86.PubMed
95.
Sohn C, Baudendistel A, Bastert G. Diagnosis of the breast tumor entity “vocal fremitus” in ultrasound diagnosis. Bildgebung 1994;61:291–4.PubMed
96.
Sohn C, Baudendistel A, Kaufmann M, Bastert MG. The positive “vocal fremitus” in malignant breast tumors in color MEM ultrasound imaging—an exciting artifact in confirming the diagnosis. Geburtshilfe Frauenheilkd 1994;54:427–31.PubMedCrossRef
97.
Sohn C, Baudendistel A. Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report. Ultrasound Obstet Gynecol 1995;6:205–7.PubMedCrossRef
98.
Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am 2001;110:625–34.PubMedCrossRef
99.
Alizad A, Whaley DH, Greenleaf JF, Fatemi M. Potential applications of vibro-acoustography in breast imaging. Technol Cancer Res Treat 2005;4:151–8.PubMed
100.
Fatemi M, Wold LE, Alizad A, Greenleaf JF. Vibro-acoustic tissue mammography. IEEE Trans Med Imag 2002;21:1–8.CrossRef
101.
Schultz SM, Conant EF, Weinstein S, Kangas SA, Arger PH, Schnall MD, et al. Evaluation of ultrasound imaging parameters on the fremitus effects in breast imaging. Radiology Society of North America. Chicago, Nov 28–Dec 3, 2004;142.
102.
Kapur A, Carson PL, Eberhard J, Goodsitt MM, Thomenius K, Lokhandwalla M, et al. Combination of digital mammography with semi-automated 3D breast ultrasound. Technol Cancer Res Treat 2004;3(4):325–34.
Metadata
Title
A Review of Breast Ultrasound
Authors
Chandra M. Sehgal
Susan P. Weinstein
Peter H. Arger
Emily F. Conant
Publication date
01-04-2006
Published in
Journal of Mammary Gland Biology and Neoplasia / Issue 2/2006
Print ISSN: 1083-3021
Electronic ISSN: 1573-7039
DOI
https://doi.org/10.1007/s10911-006-9018-0

Other articles of this Issue 2/2006

Journal of Mammary Gland Biology and Neoplasia 2/2006 Go to the issue

OriginalPaper

Computed Tomography for Imaging the Breast

OriginalPaper

Advances in Optical Spectroscopy and Imaging of Breast Lesions

Preface

In Vivo Imaging of the Mammary Gland: The Shape of Things to Come

OriginalPaper

Current and Future Use of Positron Emission Tomography (PET) in Breast Cancer

OriginalPaper

Preclinical Imaging of Mammary Intraepithelial Neoplasia with Positron Emission Tomography

OriginalPaper

Probing the Microenvironment of Mammary Tumors Using Multiphoton Microscopy
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits