Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging

Andrew Evans, Rubina M. Trimboli, Alexandra Athanasiou, Corinne Balleyguier, Pascal A. Baltzer, Ulrich Bick, Julia Camps Herrero, Paola Clauser, Catherine Colin, Eleanor Cornford, Eva M. Fallenberg, Michael H. Fuchsjaeger, Fiona J. Gilbert, Thomas H. Helbich, Karen Kinkel, Sylvia H. Heywang-Köbrunner, Christiane K. Kuhl, Ritse M. Mann, Laura Martincich, Pietro Panizza, Federica Pediconi, Ruud M. Pijnappel, Katja Pinker, Sophia Zackrisson, Gabor Forrai, Francesco Sardanelli, for the European Society of Breast Imaging (EUSOBI) , with language review by Europa Donna–The European Breast Cancer Coalition

This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40-74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered. • US is an established tool for suspected cancers at all ages and also the method of choice under 40. • For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings. • High-risk women can be screened with US, especially when MRI cannot be performed. • Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams. • Breast US is inappropriate as a stand-alone screening method.