(April 7, 2009 - Insidermedicine) Dr. Lee Wilke, MD, discusses what she would do if she had a lump in her breast and was to get an ultrasound as part of the evaluation. Dr. Wilke is Assistant Professor of Surgery at the Duke University School of Medicine.
At the 2008 San Antonio Breast Cancer Symposium, we spoke with Dr. Lee G. Wilke, an Assistant Professor of Surgery at the Duke University School of Medicine.
If I had a lump in my breast, is an ultrasound useful in evaluation?
Dr. Wilke: If there is a lump in the breast, an ultrasound is a very important adjunct to mammography as a means to evaluate that lump. Ultrasounds are used in clinicians' offices as well as in the radiological offices to further evaluate a lump. I think an ultrasound is a very important piece of information to be added to the mammogram to further evaluate whether the lump looks benign or cancerous.
What is an ultrasound?
Dr. Wilke: An ultrasound is a simple technology uses sound waves to and converts them back into a picture that we can interpret. That picture shows us whether the lump looks like a cyst, where it has fluid in the middle of it. Or whether it is solid and has irregular edges. The sound waves bounce off each of those masses differently.
What features of a patient's case make an ultrasound useful?
Dr. Wilke: If the mass is palpable and can be felt it is important to add an ultrasound to get further characterization of that mass, in addition to the mammogram. They should be used together in order to better characterize the mass itself. An ultrasound is not necessarily used for calcifications or abnormalities that are first detected on mammogram. But for a mass that can be felt, an ultrasound can be very important piece of that evaluation.
Are ultrasounds only used for diagnostic imaging?
Dr. Wilke: Ultrasounds can be used in the operating room to assist the surgeon in evaluating where the mass is, how much to resect, and to make sure that the mass has been completely resected. They are also used in the radiological suite to evaluate the lymph nodes and to make sure whether the lymph nodes look abnormal or not.
What are the limitations of an ultrasound?
Dr. Wilke: The limits of ultrasound are that it does not always appreciate everything that is happening in the breast. That is why we can't use ultrasound without mammograms. We don't necessarily yet use ultrasound as a screening tool because they are dependent on the person operating the ultrasound to evaluate the breast.
Dr. Wilke: If I had a breast lump I would certainly want an ultrasound because I think they better characterize the difference between benign and malignant masses. It gives us a better look at how big the mass is, what its location is and if there are any additional areas of abnormality in the vicinity. It tells us whether it is round, tall, fat, short, and gives us a really good look at what the mass looks like.