As an important non-invasive test for breast cancer screening, the importance of breast ultrasound has been agreed by the industry, but any test has its limitations and a negative breast result cannot completely exclude breast cancer.
Breast ultrasound is not a substitute for mammogram and MRI, nor is it a substitute for diagnosis by a breast specialist, nor is it a substitute for histological pathology, which requires comprehensive analysis and evaluation by a breast specialist.
Since many women frequently change from hospital to hospital for follow-up examinations, and information cannot be shared between each hospital at present, and the current reports are sometimes a bit troublesome to keep, many people do not know where the reports are lost once they leave the hospital. It is a good idea to write down the location and size of the lump in a notebook or on a notepad on your cell phone and tell your doctor at your follow-up appointment. You can also take a picture of the report, save it, and print it out and provide it to your doctor at your follow-up appointment for easy comparison and analysis.
The information you need to remember in your mammogram report
①Location: First, find out if it is the left or right breast. The specific location of the breast lump, some hospitals are used to writing quadrants, the breast is divided into four quadrants: outer upper, outer lower, inner lower and inner upper. Some hospitals write the clock points, which, like our clocks, are clockwise. The corresponding points are the points of the clock. The purpose of this is to facilitate the clinician’s palpation, the next ultrasound review, and the preoperative positioning, and you can also self-examine the lump according to the specific location described to detect any changes in time. If you are not sure where the distance from the nipple is, you can use a ruler to measure it.
②Size: For solitary masses or masses less than 3, the ultrasonographer will usually describe their size one by one. In the case of multiple masses of the same nature, only the larger 1-3 masses are usually written, or masses larger than 10 mm are written. There are some physicians who write about each of the more than 20 masses, but this is the exception and does not have much practical value. The size of the lump is one of the most important reference indicators for follow-ups and follow-ups, so please make sure you remember it as much as possible.
[Detailed interpretation of mammogram report].
The mammography report is divided into three parts: ultrasound picture, ultrasound description, and ultrasound hints.
About ultrasound images
Ultrasound is different from X-ray, CT, MRI and other imaging examinations. The ultrasonographer observes real-time, dynamic images, and during the examination, the ultrasonographer will keep some typical images in the PACS system that are crucial to the diagnosis. Currently, there is no uniform requirement for image retention in China, but major hospitals have established some corresponding specifications, such as the requirement for clear images, correct body position identification, and more typical images for abnormal ultrasound performance.
In the report, due to the limited space, the ultrasonographer will usually choose 2-4 typical images to print in the report. With the help of the specialist, you will be able to understand the general shape of the mass. It does not matter if you do not know how to read them at all, because the images are reserved for the breast specialist and the ultrasonographer, all you have to do is to keep your report.
About the ultrasound description
The ultrasound description gives a brief description of the thickness of the glandular layer of the breast, the tissue structure, the echogenicity, and whether the ducts are dilated.
There are specific descriptions for abnormal echogenicity within the glandular layer of the breast, such as anechoic areas, hypoechoic areas, hypoechoic nodules, hypoechoic masses, etc.
This section below focuses on the description and diagnosis of specific masses
Specific location and size of the mass
①Location: left or right breast. Some hospitals are used to writing quadrants for the specific location of breast lumps, and the breast is divided into four quadrants: outer upper, outer lower, inner lower, and inner upper. Some hospitals write the clock points, which, like our clocks, are clockwise. The corresponding points are the points of the clock. Some hospitals will also write XX mm from the nipple in more detail.
②Size: For solitary masses or masses less than 3, the ultrasonographer will usually describe their size one by one. In the case of multiple masses of the same nature, only the larger 1-3 masses are usually written, or masses larger than 10 mm are written. There are some doctors who write about each of the more than 20 masses, but this is the exception and does not have much practical value.
Description of breast masses
①Echo type: Most of the masses show hypoechoic, but there are also hyperechoic, isoechoic, mixed echogenicity, etc.
②Morphology: oval or large lobulated, round-like, irregular-shaped. Irregular shape is often a suspicious sign of malignancy.
③Orientation: aspect ratio greater than 1; aspect ratio less than 1. Aspect ratio greater than 1 is a suspicious malignant sign.
④Boundaries: clear, unclear, indistinct, and hyperechoic halo. Highly echogenic halo is a suspicious malignant sign.
⑤ Margins: well-defined, not well-defined (blurred, angular, minutely lobulated, burr-like). Poorly defined margins are often a suspicious sign of malignancy.
(6) Posterior echogenic features: posterior echogenic enhancement, attenuation, mixed (both enhancement and attenuation). Posterior echogenic attenuation and mixture are often suspicious signs of malignancy.
(7) Calcification: coarse calcification, microcalcification outside the mass, and microcalcification within the mass. Microcalcifications within the mass are often a suspicious sign of malignancy. Ultrasound is not sensitive to the detection of calcifications, so if your mammogram suggests microcalcifications, it is possible that the ultrasound suggests no abnormal findings.
(8) Blood flow signal: no significant blood flow signal; stellate blood flow signal; slightly abundant, more abundant, abundant blood flow signal; malignant masses are often combined with abundant blood flow signal.
If you see one of these malignant signs in the description of the mass in your diagnostic ultrasound report, you do not need to be particularly nervous because the ultrasonographer will give you a diagnostic ultrasound opinion based on your medical history and ultrasound performance. You only need to pay attention to the specific location, size and ultrasound indication.
About ultrasound tips
Most hospitals currently use the Breast Imaging Reporting and Data System BI-RADS for the diagnosis of breast lumps for assessment classification
Category 0: unsatisfactory or incomplete examination (other imaging is needed).
Category 1: Negative or normal (no lesion found, possibility of malignancy is basically 0%, routine screening once a year.
Category 2: benign manifestation with essentially 0% chance of malignancy, regular 6-12 month screening is recommended.
Category 3: benign possibility, possibility of malignancy (possibility of malignancy > 0% but ≤ 2%), 3-6 months follow-up and other examinations are recommended.
Category 4: suspicious malignancy (may be cancer, need histopathological diagnosis), possibility of malignancy (possibility of malignancy >2% but <95%). 4 categories can be divided into 4a, 4b and 4c categories.
Category 4a: low suspicion of malignancy, likelihood of malignancy (malignancy possible >2% but ≤10%), histopathological diagnosis required; benign masses included in category 4a, such as fibroadenoma at age >40 years; intraductal papilloma; inflammatory disease.
Category 4b: moderate suspicion of malignancy, likelihood of malignancy (malignancy likely >10% but ≤50%), histopathological diagnosis required.
Category 4c: highly suspicious of malignancy, possibility of malignancy (malignancy possible >50% but <95%), histologic diagnosis required.
Category 5: highly suggestive of malignancy, possibility of malignancy ≥95%, histopathological diagnosis required.
Category 6: Biopsy pathology has confirmed malignancy.
There are also hospitals that do not use the classification and give a direct diagnostic opinion
Benign opinion: consider the possibility of cyst; consider the possibility of hyperplastic nodule; consider the possibility of fibroadenoma; consider the possibility of malignant tumor, etc.
Malignant opinion: do not exclude the possibility of breast Ca; consider the possibility of breast Ca; do not exclude the possibility of malignancy.
There is another opinion: nature to be determined; suggest further examination; nature to be determined, suggest further examination. The sonographer wrote this ultrasound tip after careful consideration. When would an ultrasonographer write such an ultrasound tip? It is usually when malignancy is suspected, or when the ultrasound presentation of the mass is atypical and the nature cannot be determined. If you encounter such a diagnosis, your primary care physician will prescribe a mammogram or MRI for you. If you were examined at a hospital or physical examination center that does not have a breast specialist, we recommend that you go to a higher level hospital for a review or other tests to confirm the diagnosis and, if necessary, a puncture biopsy or surgery.
About enlarged lymph nodes
Axillary lymph node scan is also included in the routine breast ultrasound. Many women are frightened to find enlarged lymph nodes in the ultrasound report. In fact, most swollen lymph nodes are benign, reactive enlargement and are not scary.
Some hospitals will add (benign form or fair form and structure) after the lymph node enlargement, which is a benign sign. And if the doctor writes in the diagnostic report that the lymph nodes are enlarged (poor morphology and structure); or bilateral axillary hypoechoic masses, the nature of which is to be determined and further examination is recommended; bilateral axillary lymph node lymph node enlargement, which does not exclude the possibility of metastatic lymph node enlargement or consider the possibility of metastatic lymph node enlargement, it is necessary to be highly alert.
What if the ultrasonographer writes only one sentence in the report about the sound of bilateral axillary lymph node enlargement? There is no need to panic, there must be a description of lymph nodes in the ultrasound description, so you should submit the report to the attending mammographer and let him help you to check the importance of breast ultrasound as an important non-invasive test for breast cancer screening. A negative ultrasound result cannot completely rule out breast cancer, but needs to be analyzed and evaluated by a breast specialist in combination with medical history, clinical manifestations and other imaging examinations.
There are too many specialized terms, which may make you confused. In short, you only need to read and understand that among the ultrasound findings, lumps suggesting BI-RADS category 0 need to be combined with MRI or mammography; BI-RADS category 1 and 2 are benign and should be routinely screened; BI-RADS category 3 need not be nervous and should be reviewed regularly for 3-6 months as ordered by the doctor; BI-RADS category 4 and 5 need histopathological examination.