Normal Ultrasound Protocol Breast

Evidence 3

The following is a series of images that parallel the protocol as discussed in Evidence 2

• All images are of the same patient.• The patient (30 y/o) presented with a lump in the LEFT

breast. The lump was palpated by the patient 4 days prior however it was not identified by the referring GP. The patient indicated and described a small lump in 12 o’clock position.

• The ultrasound requested both breast be examined.• The patient did not indicate any concerns on the right

breast. • The examination was performed on a Toshiba Aplio 500

using a 12Mhz multiple frequency .

• Normal breast– 12 images of the breast at each hour of the clock– Images are annotated with the side and body

marker to show probe position

Images 1-4: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

Images 5-8: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

Images 9-12: Normal images in the o’clock position after appropriate scouting. All images display normal breast tissue.

• Nipple– Longitudinal and transverse image of the nipple

Images 13-14: Longitudinal and Transverse images of the nipple respectively.

• Axilla– Images of any lymph nodes in the short axis with cortical

measurements of reactive or suspicious nodes

Image 15: Transverse image of the Axilla. A normal appearing lymph node is seen. The short axis and cortical thickness are measured and are within normal limits.

Image 16: Transverse image of the Axilla. The same lymph node is seen. Low scale Colour Doppler does not show any increase in vascularity.

Image 17: Longitudinal Image of the axilla. No suspicious lymph nodes seen

• Pathology– Must be measured in two planes at 90 degrees

unless a simple cyst

Images 18 - 19: Two images of the pathology at 90 degrees displaying measurement. Note the change in body marker to indicate position

• Pathology– Colour imaging should be used to assess any

vascularity

Image 20: Doppler image indicated no increased vascularity within the lesion.

Image 21: Additional image identifying location and position of pathology.

• Pathology– Images of ROI must be taken and annotated

Note: The following images are of the left breast

Images 22-25: Specific images of the area of interest as indicated by the patient. In this region normal breast tissue is seen.

Personal Findings as reported to the Radiologist

For this examination:• Right breast

– In the 7.30 position there is a well defined solid lesion with no increased vascularity measuring 13x7x14 mm located 3cm from the nipple. This most likely represents a fibroadenoma.

• Left breast– In the region of interest normal breast tissue is seen. There

does not appear to be any mass or suspicious lesion in this region.

• Right and Left Axillae– Normal lymph nodes are seen bilaterally.

Radiologist Findings and Recommendations

• In this case the radiologist agreed that the lesion seen in the 7.30 o’clock position is most likely a benign fibroadenoma.

• Recommendation for a core biopsy was made. In addition, it was recommended that if a finding of benign fibroademona was confirmed, further periodical follow-up ultrasounds are recommended.

• Core biopsy has been arranged for this patient but not yet performed.