What is the role of ultrasonography (US) in breast cancer surgery?

Updated: Feb 01, 2017
  • Author: Paul R Fisher, MD; Chief Editor: Eugene C Lin, MD  more...
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Berg et al showed the possible benefit of combining preoperative whole-breast US with mammography when breast-conservation surgery is planned. [55] US demonstrated additional sites of multifocal and multicentric carcinoma, facilitating preoperative planning.

Several investigators have studied the role of US in the assessment of axillary lymph nodes for tumor involvement. Normal lymph nodes usually have a prominent echogenic fatty hilum and a thin hypoechoic cortex. Lymph nodes that lack a fatty echogenic hilum or are heterogeneous are considered suspicious. The appearances on US of benign and malignant lymph nodes overlap; therefore, US-guided fine-needle aspiration biopsy (FNAB) of suspicious lymph nodes has been advocated. Krishnamurthy et al found that in approximately 12% of cases, false-negative results occur with US-guided axillary lymph node FNAB. [75]

Deurloo et al showed that US-guided axillary lymph node FNAB reduces the number of the more time-consuming sentinel-node biopsy procedures that are needed. [76]

Intraoperative US may be used to localize breast masses. It obviates the need for preoperative needle localization, offers more flexibility in choosing the incision site than preoperative needle localization, and may allow assessment of the tumor's extent. However, intraoperative US is operator dependent, and as with breast needle localization, it may not help in localizing the carcinoma. [77, 78, 79, 80, 81]

US plays a role in the postoperative assessment of patients with breast cancer. It may be helpful in evaluating both postoperative breast masses and breast infections. Edeiken et al showed that US offers a benefit in the detection of recurrent cancer on breasts reconstructed with autogenous myocutaneous flaps. [82]

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