What is the role of ultrasound in breast imaging, and when is it used?

• A. Replaces mammography
• B. Not useful in dense breasts
• C. Used only after MRI
• D. Differentiates cystic from solid lesions and guides biopsy

Answer: (D)

Ultrasound in breast imaging is used to characterize what a lump might be in real time and to guide sampling when needed. The main idea is to distinguish cystic (fluid-filled) from solid lesions. Cysts typically appear dark (anechoic) with smooth, well-defined borders and posterior sound enhancement, while solid masses show internal echoes, more varied margins, and may display blood flow on Doppler. This differentiation helps decide how to manage the finding and how it should be categorized on imaging.

Ultrasound is also invaluable for guiding biopsies because the needle can be seen during the procedure, allowing precise sampling of the target lesion. It’s especially helpful in dense breasts or in younger patients, where mammography can be less sensitive, and it complements mammography and MRI rather than replacing them. It’s used to evaluate a palpable lump, to further assess findings seen on mammography or MRI, and to target biopsy or localization when needed.