Breast ultrasound and new technologies

doi:10.1016/S0720-048X(98)00070-9

European Journal of Radiology

Volume 27, Supplement 2, May 1998, Pages S242-S249

https://doi.org/10.1016/S0720-048X(98)00070-9 Get rights and content

Abstract

Technological advances are opening new fields of investigation for breast ultrasound. Specificity and color Doppler, staging and extended clinical roles in benign conditions are reviewed according to the state-of-the-art technology. Annular arrays are the best technical choice but new broadband linear arrays approach their quality and allow to visualize very slow flows within the breast. Still limitations exist and ultrasound is not suitable for screening. Providing better definition of normal as well as abnormal features, high-resolution sonography improves the specificity of the diagnosis for the majority of nodules and allows a better definition of both local and regional staging in nodular and diffuse conditions. Color Doppler and contrast media are increasing ultrasound specificity and are particularly useful in evaluating vascularity during therapies. Impressive results are achieved in the study of multifocal and multicentric carcinomas, in determining the degree of tumoral invasion of the surrounding tissues and of the ducts. Local and regional staging are greatly improved; the information given to the surgeon is more precise and allows easier therapeutic decisions. The diagnostic role of high-frequency ultrasound is also convincing in most benign conditions like inflammations, traumas and duct ectasia. In most of these conditions sonography is the best imaging modality to study the disease type and extent. The ability to monitor treatment efficacy or the natural outcome makes ultrasound and color Doppler a gold standard for breast inflammations.

Section snippets

Ultrasound is not suitable for screening. The reduced field of view and the great dependency on the operator’s experience are the main limitations of this technique.

When compared to mammography breast sonography is also short of satisfactory quality controls. In use instrumentation has often inadequate contrast and spatial resolution. On the contrary state-of-the-art technology allows enough resolution to discriminate the very subtle differences of acoustic impedance among the breast tissues.

State-of-the-art technology

The use of new composite ceramics with a very wide bandwidth improves axial resolution up to its maximum theoretical values. These ceramics offer multiple frequencies in a single transducer and in broad band arrays. This allows the receiver to be tuned to variable frequencies to maximize the sensitivity at various depths. Resolution in the near field is improved and, at the same time, there is enough penetration in the far field. Lateral resolution and sensitivity can be improved by focusing

Specificity and color Doppler

Many sonographic patterns are non-specific, with a frequent overlap between benign and malignant findings. Morphology of the margins is considered the only reliable pattern to clarify the type of growth of a solid nodule, expansive or infiltrating.

An infiltrating growth shows irregular and spiculated margins, which appear even more irregular when associated to reactive desmoplasia; high resolution sonography magnifies this characteristic (Fig. 10). Spiculation seems to be the most distinctive

Staging carcinoma

Staging of carcinoma includes the evaluation of multiple parameters, tumor size, vascularity and fixation, local infiltration and ductal invasion for local staging; skin, underlying fascia and muscle invasion and lymphatics infiltration for regional staging.

Most of these can be adequately assessed with high frequency sonography [3]. Still clinical investigations are concentrated on multifocality and ductal invasion; these two parameters are crucial in planning a more extensive use of

Extended clinical roles in benign pathology

The clinical impact of benign breast pathology is often underrated.

Cysts, fibroadenomas and duct ectasia are very frequent; they often need periodic controls and may induce anxiety. Other benign pathologies like inflammations and traumas have increased their frequency and need urgent evaluation to discriminate the cases that need drainage or even surgery. Clinical experience clearly demonstrated that high frequency sonography is the best choice to investigate these conditions 6, 21, 22.

Recent

Acknowledgements

Appreciated technical support was given to the authors by D.E. Paul from Acuson, USA, R. Muzi from Esaote Biomedica-Italy, and P. Von Behren from Siemens Medical Systems, USA. Clinical research with contrast medium was supported by Schering AG, Germany.

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View full text

Breast ultrasound and new technologies

Abstract

Section snippets

State-of-the-art technology

Specificity and color Doppler

Staging carcinoma

Extended clinical roles in benign pathology

Acknowledgements

Eur J Radiol

Gynecol Oncol

Instrumentation

High-resolution ultrasound assists in breast diagnosis

Diagn Imag Int

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions

Radiology

Breast

Color Doppler signals from breast tumors. Work in progress

Radiology

Color Doppler ultrasound and spectral analysis of tumor vessels in the differential diagnosis of solid breast masses

Invest Radiol

Solid breast lesions: evaluation with power Doppler US

Radiology

Microbubble contrast agent for color Doppler US: effect on breast masses. Work in progress

Radiology