Breast Ultrasound

A breast ultrasound (also called sonography) is an imaging test that sends sound waves through your breast to create a digital image of the inside of the breast. Breast ultrasound alone cannot be used to diagnose breast cancer. Other tests — including a breast biopsy — are always needed to make a diagnosis.    

There are two main types of breast ultrasound:

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  handheld ultrasound (most commonly used)

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  automated breast ultrasound or ABUS (a newer test used in combination with mammogram to screen women with dense breasts)

Both handheld and automated breast ultrasound are safe, noninvasive, and don't involve any radiation exposure.

It's important to know that ultrasound can't show all the breast changes that may be seen on a mammogram or breast MRI. For example, breast calcifications don't show up as well on ultrasounds as they do on mammograms. However, ultrasounds do sometimes detect breast cancers that weren't detected on mammograms.

Here's what to expect if you're getting a handheld breast ultrasound:

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  you will lie on your back on an exam table while a healthcare provider applies a clear, water-based gel on the skin of your breasts.

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  the provider will move a wand-like device called a transducer over the skin of your breasts.

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  the transducer will send and receive sound waves, creating an image that appears on a video monitor during the test. Individual images and short videos are saved as digital files.

The healthcare provider may also examine the axilla (the area under the arms) as part of a handheld ultrasound test to see if there are signs that cancer may have spread there.

Here's what to expect if you are getting an automated breast ultrasound (ABUS):

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  you will lie on your back on an exam table while a healthcare provider applies a layer of lotion on the skin of your breasts.

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  the provider will place a transducer that is larger and wider than the one used for traditional handheld ultrasound on the breast and apply gentle pressure.

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  approximately three scans of each breast will be taken. The ABUS software creates 3D digital images of the breast tissue.

Your doctor might recommend a breast ultrasound for a variety of reasons:

To get more information about a potential abnormality in the breast. Doctors use ultrasound to look at suspicious areas seen on a mammogram or breast MRI or felt on a physical exam of the breast. For example, an ultrasound is one of the best ways to find out if a lump is solid (such as a benign fibroadenoma or cancer) or filled with fluid (such as a benign cyst). Women under the age of 30 and those who are pregnant often receive ultrasound before any other imaging tests because ultrasound doesn’t involve any radiation exposure.

To screen for breast cancer in some people who don’t have symptoms. In some cases, doctors recommend that people with dense breast tissue get routine breast ultrasounds for screening in addition to mammograms. This is especially the case if the person has other factors that put them at higher-than-average risk for breast cancer. Ultrasound can sometimes detect early breast cancers that mammograms do not. There are no overarching expert guidelines on which women should have supplemental breast cancer screening with ultrasound.

To guide the needle during a biopsy procedure. A biopsy is the only way to know for sure if a suspicious area of breast tissue contains cancer. Ultrasound can be used to help precisely guide a needle to a suspicious area in the breast or underarm lymph nodes so that a sample of tissue can be removed and tested for cancer. This is called an ultrasound-guided biopsy. (Note that doctors don't always use the same type of breast imaging for the biopsy that was used to initially detect the suspicious area in the breast. For example, sometimes a suspicious area is detected using breast MRI and ultrasound is used to guide the biopsy needle).

Some things you may want to do to get ready for your breast ultrasound appointment:

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  Check with your insurance company to see what's covered. You might have some out-of-pocket costs, such as a deductible or co-insurance. Also, if the ultrasound is being used for breast cancer screening, it may not always be covered in all states and by all insurance companies. You and your doctor might want to make the case to the insurance company to cover it. Some states have laws about insurance coverage for supplemental breast cancer screening tests.    

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  Make sure you have a healthcare provider’s order (prescription) for the ultrasound. 

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  If your doctor has recommended that you receive an ultrasound as well as a mammogram for breast cancer screening, for convenience you might want to see if you can schedule the tests on the same day.

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  Wear a top with pants, shorts, or a skirt on the day of your ultrasound. Since you’ll have to undress above the waist, you may be more comfortable if you wear a two-piece outfit instead of a dress or jumpsuit. That way, you can keep your own clothing on from the waist down during the test. 

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  Don’t wear deodorant, antiperspirant, lotion, or powder under your arms on your chest area or breast skin on the day of your ultrasound. Particles from these products can show up on your ultrasound images.  

A radiologist (a doctor who specializes in interpreting medical images) will analyze the images from your ultrasound. The radiologist will send the images and a written report about the results to the doctor who ordered the test. 

You should also receive a written report by mail and/or through a patient portal. If you want a copy of the images, you can request to have them given to you on a CD. 

Radiologists use a scoring system called the Breast Imaging Reporting and Database System (BI-RADS) to report what they find on your ultrasound. The summary of your ultrasound results that is sent to the doctor always includes BI-RADS scores.

You may receive a call from the doctor who ordered the test or a call from the breast imaging facility to tell you about your results. If the radiologist saw something on the ultrasound that requires additional testing, usually you’ll receive a call shortly after the test.