Ultrasonography in Breast Cancer - Research Paper Example

Number] Ultrasonography in Breast Cancer While looking at the recent cases of breast cancer that come forward every day, one can assess the importance of ultrasonography in the evaluation of breast cancer. There are increasing techniques that are used day by day and they are introduced to make sure breast cancer is cured as it is one of the most rapidly growing cancers in women nowadays. Medical studies have confirmed the role and use of ultrasonography in evaluating breast cancer in patients. The use of ultrasonography is, however, to evaluate the palpable masses which are mammographically occult, the clinically breast lesions suspected in women who are 30 years of age or younger than that, and evaluation of the abnormalities that are seen on mammograms1. This shows that the ultrasonography is a step taken later than the mammography as it evaluates the results on the mammograms and images them. In fact, the imagers of breast cancers also believe that ultrasonography is used as the primary modality to evaluate the palpable masses seen in women older than 30 years of age and mammography, also, is an adjunctive technique. Since ultrasonography is primarily used as the evaluating step, it also helps in the guidance of biopsies, surgeries and other therapeutic procedures. The evaluating role of ultrasonography has started being used in the treatment and guidelines of breast cancer, but the research on its role in cancer screening is still not confirmed, but studies have shown several aspects to the issue. The role of ultrasonography has developed and matured over time, otherwise initially it was considered as a method which was comparatively cheaper and effective in identifying the cystic breast masses and differentiating them from the solid masses. As the research study advanced, it was established that ultrasonography is not only a method to differentiate, rather it also was useful in providing valuable information and evaluation of the nature of the solid masses and other breast lesions along with the extent to which they are present. This meant that it was an effective and an important technique in evaluating, analyzing and treating the breast cancer2. The technique of ultrasonography does not involve exposing the cancer patient to the ionizing radiation, which, according to the studies, is a factor which is more important for pregnant and young patients. For ultrasonography, the medical studies say that the patients cannot be exposed to radiation because their breasts are sensitive for radiation. This means that comparing mammography with ultrasonography; mammography is associated with the increase in the risk to acquire radiation-induced neoplasm. Moreover, the breasts of younger women appear to be dense on mammograms and this is a factor which reduces the sensitivity of the diagnosis of mammography. Additionally, the breast ultrasonography is superior to the mammography as it involves the evaluation of the breast abscesses too. The role of ultrasonography is also categorized by the different groups of patients who would be subjected to this technique. For this, the research is still under investigation and no proper results have been taken out for this. The patients that come in the special groups for whom the technique is not approved yet are the one with dense breasts mammographically and the ones who have a high risk of breast carcinoma. For these patients the technique seems to be under question. Moreover, the breast magnetic resonance imaging role is also under expansion and seems to be an important part of the study. The technique of ultrasonography is related to physics and includes the sound waves that travel at a frequency of higher than 1MHz. These waves are propagated through the vibration of molecules and consist of certain properties. These properties are wavelength, frequency, propagation velocity, amplitude, acoustic power and intensity. When it is applied on the patient to evaluate breast cancer, it interacts with the tissues. This is described by attenuation, refraction, scattering, reflection, and diffraction3. The attenuation takes place when a medium is traversed and a loss of ultrasound takes place. This is because of absorption of the ultrasound energy through conversion to heat, refraction, reflection, and scattering. Attenuation is then increased, and the beam penetration is reduced by the higher distance from the transducer, less homogenous medium to be able to traverse due to the increased acoustic impedance mismatch and a higher frequency of transducers. Fluid offers least resistance and air forms a virtual barrier to the ultrasound. The ultrasonography waves are reflected at the tissue boundary and interface. The echoes that are reflected return back to the transducer and then form the basis of ultrasound imaging. The reflection amount depends upon the acoustic impedance of the traversed tissues from the beam. Refraction is when the ultrasound beam encounters different velocities and the proportions of the beam which is transmitted not reflected will undergo bending, or refraction. These phenomenons also allow the image quality to improve by using the acoustic lenses which focus the beam of the ultrasound and improvise the resolution. Diffraction is the beam of the ultrasound which spreads out from the transducer and it lessens the intensity of this beam. These are the physical properties of the ultrasonography and further it is important to analyze its use in the breast cancer screening. When it is about the screening tools used for breast cancer, mammography is known to be an effective tool but some studies suggest that it may be less sensitive in diagnosing cancer in the mammographically dense breast tissues. Using ultrasonography as a screening tool for breast cancer is not recommended for the women with high risk and dense breasts. To test its implementation, there were many research projects that were carried out and they had reported that there are reasonable results seen from its use. Yet, ultrasonography as a screening tool can be practically used in general application once the number of serious issues is resolved4. The factors that need serious consideration are interobserver variability, unknown sensitivity and the low specificity which leads to the biopsy evaluation of benign lesions. It was also found out that ultrasonography can be useful to detect the occult breast cancer in a dense breast if it is performed carefully. Ultrasonography is a technique which generally requires skilled practitioners, top quality examinations and technical equipment and thus it is highly dependent on an operator. Up till today, it is recommended that ultrasonography should be used in screening but it should be reserved for some special situations, for example it can be used for the highly anxious patients who ask for it and for the women who have had mammographically occult carcinoma before. European Group for Breast Cancer Screening and its members have recognized the use of ultrasonography for breast cancer diagnosis and screening. The consensus of the Group on the importance of ultrasonography after a detailed review is that the current evidence shows that an ultrasound of the breast is a significant adjunct to mammography and clinical assessment of the breast abnormalities; palpable and impalpable. However the use in population screening in asymptomatic women is regarded with high rates of false negative and positive results. Currently, there is not much evidence which supports the ultrasound use in any age in the population breast cancer screening. There are many benefits of the use of ultrasonography in breast screening. It is used in the breast cancer screening as a follow up tool. The indications for the ultrasonography are the findings on mammography and the need for an evaluation of a palpable lesion found on a clinical exam5. When a woman is sent for the follow up ultrasonography, it does not indicate that she has higher risks for breast cancer; in fact the ultrasonography is done just to help in distinguishing the solid mass and the cyst which is fluid-filled which is the case in majority of the breast lesions. It also helps in indicating the very minor lesions that are not found at the clinical exams as they are small. Ultrasonography is actually the use of sound waves that use high frequencies to form images that are called sonograms. These sound waves are harmless and they pass through the breast during the process and then bounce back from the tissues and form an image of the structure inside. Bouncing back is also called echo. When there is an unexpected echo, it means that the masses are solid within the tissue. The ultrasonography has much to do with the breast density when it is used in breast cancer evaluation. For women who have high breast density, ultrasonography is often used to perform screening as mammograms become hard to interpret when they have dense breast tissues. Because of this, the ultrasonography is usually the first step of using an imaging method for the women under 35 years of age, though it is still not confirmed whether ultrasonography is the first screening method or it is a follow up of the mammography. At present the study says that ultrasonography alone does not lower the mortality rates for breast cancer unlike the method of mammography, which lowers the mortality. However, the reason for a breast screening ultrasonography is not only the dense breast tissue and the mammogram showing normal findings6. It is important to find out the rates at which the screening and detection rates have fluctuated using the technique of ultrasonography. This becomes important to analyze the practise that has taken place ever since the studies revealed this method. The more the technique came into practise, the more it shows how much it has been successful and satisfactory for both the patient and the doctor. The studies show that the rate at which the lesions are malignant breast cancer is very low. Malignancies are detected in mammography at a rate of about 5 women per 1000 women screened. When ultrasonography is the only method used to determine the malignancy, the rate is lower slightly. This means that mammography is more reliable. Moreover it had been emphasized that ultrasonography and mammography together would not have completely excluded the possibilities of breast cancer. Women who have negative mammograms and ultrasonography showing suspicious lesions may have the possibility of breast cancer. An ultrasonography report can indicate much about the breast cancer lesion. The first and foremost evaluation that a sonogram would give is the indication of the nature of the lesion: solid, liquid or both. The liquid masses are the cysts which are homogenous and dark in colour. A radiologist can best tell the textures and feels of the sonogram and what it represents. Ultrasonography report can also evidently indicate the shape and margin of the lesion which are the characteristics of the edges. This type of determination helps in assessing the cancerous nature of the lesion. Radiologists say that usually cancerous lesions have jagged edges7. The breast cancer lesions are mostly random in shape but not always and benign lesions are round or oval mostly. However, ultrasonography is not a clear test, a biopsy and a tissue analysis is always required. A biopsy has to take place even when the ultrasonography shows the presence of cysts, or fibrous nodules, because more than 15% of these growth types end up in malignancy. The echoes on the sonogram indicate that there are solid nodules that have blocked the way of the sound wave and it thus it has echoed back. Yet the analysis of these solid nodules requires expertise to reveal the clarity of the nature of the lesion. The ultrasonography may also be used with mammography to identify the stage of the breast cancer and evaluate the extent to which it is malignant. But overall, the ultrasonography technique is used as a very helpful tool and it has an important role in assessing the cancer. Along with the many techniques and treatments, this is also one of the recently developed methods and has been successful in accordance to the situations. It is used in breast cancer screening following the mammography and supports it by identifying the physical properties of the lesions with the help of sound waves. The equipment is high tech and the reports need special operators to analyze them before handing them to the doctors. However, more research over the technique will help in increasing the patient satisfaction and treatment of breast cancer. Work Cited Hamper Ulrike. Breast Ultrasound: A Systematic Approach to Technique and Image Interpretation. NY: Thieme, 1999. Print. Jellins Jack, Madjar Helmut. The Practise of Breast Ultrasound: Techniques, Findings, Differential Diagnosis. NY: Thieme, 2008‎. Print. ‎ Jordan Virgil, Morrow Monica. Managing Breast Cancer Risk. USA: PMPH, 2003‎. Print. ‎ Kopans Daniel. Breast Imaging. USA: Lippincott Williams & Wilkins, 2007‎. Print. ‎ Parker Steve, Rapp Cynthia. Breast Ultrasound. USA: Lippincott Williams & Wilkins, 2004‎. Print. ‎ Ueno Ei. Research and Development in Breast Ultrasound. Japan: Springer, 2005‎. Print. ‎ Read More