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Introduction ⬇

Breast ultrasound is a noninvasive imaging study that is performed to differentiate cystic, solid, and complex lesions; for the diagnosis of disease in women with very dense breasts; in the follow-up care of women with fibrocystic breast disease; and in evaluating axilla in the patient newly diagnosed with breast cancer. It is recommended as the initial method of examination in a young woman with a palpable mass and in a pregnant woman with a newly palpable mass. The pregnant patient presents a dilemma because malignancies in pregnancy grow rapidly and the increased glandular tissue causes difficulties in mammography. Breast ultrasound may also be performed to evaluate women who have silicone prostheses in their breasts. The prosthesis is readily penetrated by the ultrasound beam, and tissues behind the prosthesis can be examined. Such prostheses are known to obscure masses on physical examination; they also absorb x-ray beams, obscuring portions of the breast parenchyma.

Breast ultrasound is a valuable guide during breast biopsies and needle localization procedures. Although not optimal, ultrasound visualization of the breast is an alternative for women who refuse to have an x-ray mammogram and for those who should not be exposed to radiation. Breast ultrasound is not an appropriate method for visualizing microcalcifications.

Procedure ⬆ ⬇

  1. Ask the patient to lie on an examination table and place their arm above their head on the side of the breast to be examined.

  2. Apply a couplant (ultrasound gel) to the exposed breast to promote the transmission of sound.

  3. Move the transducer slowly across the breast. A handheld transducer is usually used, although in some situations an automated breast scanner is used. The automated examination requires the patient to assume a position with the breast immersed in a tank of water. The tank contains transducers that are moved by remote control to image the breast.

  4. Tell the patient that the total examining time is approximately 15 minutes.

  5. See Chapter 1 guidelines for intratest care.

Procedural Alert

  1. If a breast ultrasound is to be performed on the same day as an x-ray mammogram, advise the patient not to apply any deodorant, powders, or lotions to the upper body on the day of the examination.

  2. If the breast ultrasound is to be used for guidance during a biopsy, make certain that a signed, witnessed consent form is obtained.

Clinical Implications ⬆ ⬇

Unusual and distinctive echo patterns may indicate the presence of:

  1. Cysts

  2. Benign solid growths

  3. Malignant tumors

  4. Tumor metastasis to muscles and lymph nodes

  5. Ductal ectasia

  6. Enlarged lymph nodes

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the examination. Tell the patient that there is no discomfort involved. Show the patient a video that explains the test, if available.

  2. Ensure that there is a signed consent in the patient’s medical record if an invasive procedure is to be performed.

  3. Tell the patient to remove all clothing on the upper portion of the body. Provide appropriate covering.

  4. Explain that a liberal coating of a coupling agent must be applied to the skin so that there is no air between the skin and the transducer and to allow for easy movement of the transducer over the skin. A sensation of warmth or wetness may be felt.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Counsel the patient appropriately about further testing (biopsy).

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal