Screening mammography remains the standard. In high-risk women, supplemental screening with MRI is being considered, and further study is warranted. In women of average risk with dense breast tissue, single-center studies support elective supplemental screening with ultrasound, and further study is both needed and ongoing.
At this time, indications for ultrasound include the following:
Initial evaluation of a breast lump in a woman less than 30 years of age. (Note: Mammography should also be performed if the sonogram is suspicious or if there is strong clinical suspicion and the sonogram is negative.)
Evaluation and biopsy guidance of a clinically suspicious lump in a woman of any age.
Evaluation and biopsy guidance of lesions manifest as highly suspicious microcalcifications over a large (greater than 2 cm) area, to identify any associated mass that may represent an invasive component.
Evaluation of bloody or spontaneous clear nipple discharge.
Evaluation of both breasts in women with newly diagnosed breast cancer and dense breast tissue.
Indications for contrast-enhanced breast MRI include the following:
Evaluation of the local extent of breast cancer bilaterally, particularly if the breasts are dense, tumor is invasive lobular, or there is suspicion for extensive intraductal component.
Positive margins after lumpectomy.
Initial sizing and assessment of response to neoadjuvant chemotherapy
Suspicious abnormality on mammography, one view only, not able to be localized for biopsy after full workup with additional views and ultrasound.139
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