Q. What does the ultrasound scan of my breast show?

Answered by
Dr. Padmesh Jain
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 03, 2021

Hello doctor,

I have sent you the ultrasound scan of my breast, and I would like your opinion if this is possibly a cyst, a fibroid, or a cancer mass.

#

Hello,

Welcome to icliniq.com.

I saw the single image of the ultrasound of the breast (Sonomammography) (attachment removed to protect the patient's identity). I am analyzing the report as per the white paper of ACR (American College of Radiology) on BI-RADS (Breast Imaging-Reporting and Data System). According to BI-RADS, the lesion in the image is oval-shaped, oriented parallel to the chest wall (wider than taller), with circumscribed margin, solid hypoechoic echo pattern, and posterior acoustic enhancement. The above features described of the breast lesion favor a Benign etiology, most likely a fibroadenoma (BIRADS 2 /3). However, I would like to know the status of axillary nodes, which become enlarged and necrotic in cancer, whereas do not show such changes in benign lesions such as fibroadenoma or cyst.

Though the image shows a Doppler box for assessment of internal vascularity of the lesion, the PRF (pulse repetition frequency) scale is large, which should have been lowered for proper doppler evaluation. So, I would like to see more images with appropriate Doppler settings and gains for further evaluation.


The Probable causes:

Developmental.

Investigations to be done:

Biopsy, if needed.

Probable diagnosis:

Fibroadenoma of Breast.

Treatment plan:

Observation and follow-up mammography and sonomammography.

Regarding follow up:

Follow-up with more images.

Hello doctor,

Thank you for your response.

When I asked for a copy of my scans, only the image that I sent you was provided, and I also did not get much feedback from them about the concern. They reported that the growth was suspicious, and since the image was not completely black (small white spots within the mass), it could mean a solid, and parts of the mass did not have sharp edges. They also indicated that I have two smaller cysts in the same breast that are of no concern, and there are no enlarged lymph nodes. Do you think that the PRF scale being large would have caused some of these abnormalities that they are concerned about in the image?

You have been a true blessing, as this got me completely frightened. Though you do not have much information to go off (one scan), your response has made the next few days bearable until I await the next steps.

My sincerest gratitude!

#

Hi,

Welcome back to icliniq.com.

I am happy that I could allay some of your apprehension and address your concern.

  • For Doppler assessment of a breast lesion, it is important to apply less pressure by the probe to detect the flow; else, blood vessel compression makes it difficult to deduct. Secondly, the PRF should be low for the flow to be elucidated.
  • Colour Doppler gives flow velocity and flow direction (by default, red is towards the transducer probe, and blue is away from it). However, very low vascular flows are missed.
  • Here Power Doppler comes to the rescue. Though power Doppler does not indicate flow direction, it is susceptible to detect low vascular flows in a lesion.

If they are generous enough to scan you again, ask for it.

It is good that there is not any suspicious axillary node involvement. Simple cysts at your age are definitely benign and not of concern. Your breast lesion falls under BI-RADS category C, for which a short interval follow-up is advised after six months. Such lesions statistically have less than two percent chances of becoming malignant.

However, if you have a strong family history of breast cancer (in sister, mother, grandmother) and also have been smoking, then I personally feel that you should go for a biopsy and histopathological evaluation of this lesion rather than waiting, contemplating, and having sleepless nights. If you have none of these, do not worry and get a follow-up scan done after six months.

I hope this helps.

Wishing you Health, Happiness, and Peace.


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