Ultrasound and mammography: what are the differences and purposes of these 2 tests that are so important for every woman

By Cristiano Antonino On Jan 19, 2023

Ultrasound and mammography: breast cancer is a neoplasm of great epidemiological importance, being the most frequently diagnosed cancer in women

According to recent statistics, an estimated 2.3 million breast cancer diagnoses worldwide in 2020 with 685,000 deaths.

Mammography

Mammography screening has been shown to have clear benefits in terms of reducing breast cancer mortality.

Mammography, in fact, is an indispensable tool for identifying breast cancer, as it allows it to be detected in its earliest stages.

Mammography is recommended and practised

– in asymptomatic women for periodic screening checks, recommended from the age of 40;

– in symptomatic women, i.e. all those who present breast alterations, skin retractions, nipple retractions, serum secretions, palpable lumps;

– in operated women for follow-up examinations.

The test is performed using a mammograph, a device that uses ionising radiation, and usually involves the acquisition of 2 projections for each breast.

These 2 projections are obtained at different angles for a complete representation of the mammary gland.

Mammography is the reference test in breast diagnostics, as it has good sensitivity and specificity, rapidity of execution and is widely available.

This test makes it possible to assess mammographic signs indicative of lesions such as opacities, microcalcifications (sometimes the only sign of cancer), architectural distortions and density asymmetries.

However, in women with high-density breasts, the sensitivity of mammography is reduced due to overlapping fibro-ghiandular tissues.

This phenomenon can sometimes mask any lesions located in their context or result in false images.

In such cases, mammography is complemented with ultrasound, which has good sensitivity in dense breasts.

Mammary ultrasound

Mammary ultrasound is a fundamental part of breast diagnostics, is based on the use of ultrasound and is performed with high-frequency linear probes.

Its advantages are the absence of ionising radiation, wide availability and low cost.

It is the test of choice in young, pregnant or breastfeeding women, while it is performed as a complement to mammography in other cases.

Breast ultrasound is indicated

– in cases of doubtful or suspicious findings on mammography

– in symptomatic women

– in asymptomatic women with a high hereditary risk

– as a guide for interventional procedures.

Ultrasonographic imaging allows to differentiate between liquid and solid type lesions, to evaluate the characteristics of lesions in order to provide an appropriate degree of suspicion, to study loco-regional lymph nodes, surgical scars in operated women and periprosthetic tissues in case of prosthetic implants.

Mammary Ultrasound, however, is only occasionally able to identify microcalcifications

One of the limitations of this test is its poor reproducibility, as it is an operator-dependent test.

For this reason it must be performed in a systematic and reproducible manner, evaluating all sectors of both breasts and axillary cavities, according to multiple scans.

Our Advice and Tips / Vademecum:

Mammography and ultrasound are 2 complementary tests, the combination of which allows greater diagnostic accuracy in the assessment of breast lesions, especially in dense breasts.

– Asymptomatic women – carry out regular clinical and mammographic check-ups, possibly supplemented by ultrasound (from the age of 40).

– Women with symptoms – undergo a clinical test, ultrasound (for younger women) or mammography combined with ultrasound in good time to exclude or confirm the clinical suspicion.

Breast Cancer: For Every Woman And Every Age, The Right Prevention