Breast ultrasound in a women’s general check-up

What breast ultrasound adds to a general check-up

Breast ultrasound uses sound waves to examine breast tissue and the lymph nodes of the armpit. It uses no ionizing radiation, so it can be repeated without limit and is also suitable for young women. It distinguishes reliably a cystic formation, that is, one containing fluid, from a solid one, which is often the first question when a woman feels a lump.

In a general check-up, ultrasound is used according to age, the structure of the breast and risk factors. It is not a test to be done “for every case” independently of context: its value relates to the question to be clarified and to the clinical examination that precedes it.

Ultrasound and mammography are different examinations

Mammography is the examination that has been shown to reduce mortality from breast cancer when performed as screening within programs, usually from age 45–50 onward and at regular intervals. Ultrasound does not replace mammography at this age: it does not detect some early changes well, especially microcalcifications.

Ultrasound is the main examination in women under 40, in women with symptoms and as a complement to mammography when the breast is dense. Mammography is not performed at the clinic; when needed, the woman is directed to a center that performs it and the result is interpreted in the consultation together with the ultrasound.

When it is recommended

The doctor recommends ultrasound when a lump or thickening is felt, when there is pain limited to one area, nipple discharge, a skin change or enlargement of the armpit nodes. It is also used to follow a known finding, such as a cyst or a fibroadenoma.

Women with a family history of breast or ovarian cancer, or with a known genetic mutation, need an individual plan that may start earlier and include other methods. Even without symptoms, a regular visit with clinical breast examination is part of the general check-up.

How it is done and when

The examination lasts a few minutes. You lie down, the breast is exposed and the doctor moves the probe with gel over the skin, including the armpit area. There is no pain, apart from light pressure over a tender area. No fasting or special preparation is needed.

For women who still menstruate, the best time is after menstruation has ended, when the breast is less swollen and less tender. Bring previous breast examinations for comparison and say if you have had an operation, an implant or hormonal therapy.

How the report is read: the BI-RADS system

The report is usually classified by the BI-RADS system, which summarizes the finding in categories. Category 1 is an examination without findings, category 2 indicates a benign finding, while category 3 indicates a finding with a very low probability of being malignant, which is followed with a short-interval check. Categories 4 and 5 indicate suspicion of malignancy and call for a sample.

When a sample is needed, it is taken with a needle under ultrasound guidance, and the tissue obtained is sent for anatomopathological analysis. A benign result must agree with the ultrasound appearance; when it does not, the decision is reviewed. The report should state clearly what was seen and which step is recommended.

Frequently asked questions

Is breast ultrasound enough if I am over 45? Not as screening. After this age mammography is the basic examination, while ultrasound complements it, especially when the breast is dense or there is a lump. Mammography is not performed at the clinic; we direct you and interpret the result together with the ultrasound.

What does a dense breast mean? It means that on mammography there is more glandular and connective tissue than fat, which makes reading harder and slightly increases risk. It is a normal feature found in many women. Ultrasound may be added at the doctor’s discretion, but it does not replace mammography.

Is a breast cyst dangerous? A simple cyst is benign and usually needs no treatment; ultrasound distinguishes it reliably. When it is very painful it may be drained with a needle. A cyst with a complex appearance or with solid parts is assessed further, according to its BI-RADS category.

What does BI-RADS 3 mean? It is a finding with a very low probability of being malignant, usually a benign nodule with characteristic features. A short-interval check, often after a few months, is chosen instead of a biopsy. If the finding changes, it is reassessed.

Can ultrasound be done during pregnancy or breastfeeding? Yes. Ultrasound uses no radiation and is the preferred method during pregnancy and lactation for any lump or concern, with no consequences for the mother or the baby.

How often should I have a breast ultrasound? There is no single interval. It is usually done when there are symptoms, to follow a finding or as a complement according to the doctor. Clinical check is recommended every 6 months to one year according to risk, and sooner when the doctor sees it as reasonable.

Self-awareness and follow-up

Knowing the usual appearance of the breast is useful: any new lump, skin change, nipple retraction or bloody discharge calls for a consultation, even when the latest mammogram or ultrasound was normal. A normal examination does not exclude changes that appear later.

Clinical check and follow-up are recommended every 6 months to one year according to risk and the finding, and sooner when the doctor sees it as reasonable or when a change occurs. Benign findings such as simple cysts usually do not need frequent follow-up.

Care at Tirana Polyclinic: We perform breast and armpit ultrasound and link the result to the clinical examination. When indicated, we perform the ultrasound-guided sampling and the anatomopathological analysis. Mammography is not performed at the clinic; the woman is directed to the relevant service and the result is interpreted in the consultation.