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Breast ultrasound and ultrasound-guided breast biopsy

Breast ultrasound and ultrasound-guided breast biopsy. A practical guide Jill Donnelly Breast and General Surgeon. Clarifications: The Triple Assessment Rule Core biopsy and needle aspiration. This presentation applies to Women who have: Breast symptoms of pain &/or lump

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Breast ultrasound and ultrasound-guided breast biopsy

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  1. Breast ultrasound and ultrasound-guided breast biopsy A practical guide Jill Donnelly Breast and General Surgeon

  2. Clarifications: The Triple Assessment Rule Core biopsy and needle aspiration

  3. This presentation applies to Women who have: Breast symptoms of pain &/or lump Localised to one breast quadrant

  4. This presentation does not apply to: Women having breast screening Women with: Nipple symptoms Diffuse symptoms

  5. For women with symptoms of pain &/or a lump localised to one quadrant: Ultrasound and ultrasound-guided core biopsy are the investigations of choice. Mammography has no initial role. 90% of patients are in this group.

  6. After history, assessment steps: Step 1. Examination – lump yes or no? Step 2. Ultrasound symptomatic quadrant. Discrete lesion – yes or no? Step 3. If the answer is yes to Step 2 or 3: core biopsy or needle aspiration is required. Step 4. Lesion solid on ultrasound: biopsy Lesion cystic on ultrasound: aspirate

  7. Common breast lumps Fibroadenoma Benign breast change (lumpiness) Cyst Cancer

  8. Benign breast change No discrete abnormality seen on ultrasound Requires biopsy because lump present on palpation (Triple Assessment rule)

  9. Ultrasound features of benign lumps: Respect tissue plains Long axis horizontal Wall clearly-defined Posterior brightness (cysts) Ultrasound features of malignant lumps Interrupt tissue plains Long axis vertical Wall irregular, poorly-defined Posterior shadowing

  10. Summary If you feel a discrete lump on palpation or see a discrete lump on ultrasound put a needle in it, using ultrasound to guide you.

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