Surgical office-based ultrasound of the breast

How surgical office-based ultrasound (US) influences the management of nonpalpable, new or increasing size, mammogram-detected breast masses was evaluated. Ninety-seven patients had diagnostic US only; of these, 67 had their mass diagnosed as a simple cyst, and 30 had a negative US. Fifty-three additional patients underwent US-guided aspiration and/or biopsy (US-GAB) of their breast mass after diagnostic US. Of 12 patients with diagnostic US of "simple cyst," US-GAB confirmed each to be cysts. Of five patients with diagnostic US of "fibroadenoma," four had fibroadenomas and one had insufficient tissue on US-GAB. In all five cases a fibroadenoma was diagnosed at open biopsy. Of 27 patients with diagnostic US of "indeterminate" (cyst versus solid/complex cyst), 15 had cysts, one had a fibroadenoma, and one had a papilloma on US-GAB; the latter two were confirmed on open biopsy. Ten of these 27 patients had fibrocystic change identified on US-GAB; six were benign on open biopsy, and four had no change on follow-up mammogram. Of nine patients with diagnostic US of "suspicious," three had carcinomas, five had fibrocystic change, and one had insufficient tissue on US-GAB; three cancers were confirmed, and the remaining six were benign on open biopsy. There were no false positives and no false negatives among those patients undergoing US-GAB. In conclusion, office-based ultrasound of the breast performed by surgeons can accurately diagnose nonpalpable simple cysts and can accurately guide needle aspiration and/or biopsy of probable fibroadenomas, indeterminate, or suspicious masses for diagnosis of cystic, benign solid, or malignant lesions.