Role of direct contact, real-time breast ultrasound: one year's experience

Direct contact US was used for evaluation of 206 patients referred for a palpable mass not visualized on mammography or for evaluation of a smooth, well-marginated mass or masses on mammography; 67 solid lesions, 90 simple cysts, 7 complex cysts, 2 hematomas, and 1 case of mastitis were identified. Thirty-nine additional lesions appeared as normal breast tissue by ultrasound. Surgical biopsy was performed in 40 women. Of the 29 sonographically-visible solid lesions that were biopsied, five were carcinomas. Of the seven lesions not visualized by ultrasound that were biopsied, two were carcinoma (mean diameters 0.9 and 0.4 cm). Of the 4 complex cysts biopsied, 1 intraductal carcinoma (0.4 cm) was found and this was surgically felt to be an incidental cancer adjacent to a hemorrhagic cyst. In the patient population studied, there was no significant difference in biopsy confirmation of carcinoma whether lesions were identified on ultrasound or whether mammographic or palpable lesions appeared as normal breast tissue by ultrasound. Standoff devices were not used. Without the use of standoff devices, in our patient population, the lack of sonographic detection of a palpable or mammographically demonstrated mass should not dissuade or delay surgical biopsy.