Systematic approach to difficult problems in breast sonography

Although there is an increasing use of more imaging modalities in breast imaging, the role of breast sonography has not diminished--in fact, the applications of sonography have increased with the improvement of high-frequency equipment. Compared with other breast imaging modalities, current sonographic equipment has excellent spatial resolution and outstanding image contrast. Furthermore, sonography does not have the disadvantages of other modalities such as magnetic resonance imaging including exposure to intravenous contrast, higher expense, patient claustrophobia, and potential adverse contrast reaction or renal damage. The primary disadvantage of sonography is that this technique is highly operator dependent, particularly in the breast. However, if one can overcome the barrier of operator dependence, then one potentially may reduce the cost of diagnosis of breast cancers. Although many articles review sonographic appearances of solid neoplastic breast masses, relatively little attention has been directed toward subtle or confusing clinical and sonographic findings of breast cancer. This review defines methods to sonographically approach identifying vague mammographic and subtle magnetic resonance imaging lesions. Furthermore, because sonography is operator dependent, this article also involves discussing some of the pitfalls of breast sonography and how to avoid them.