What Is a Breast Cancer Ultrasound?

A breast ultrasound (sonogram) is an imaging test used to detect breast cancer. Unlike mammograms (which use X-rays to produce images), breast ultrasounds use sound waves to view breast tissue.

This article will discuss why you may need a breast ultrasound in addition to a mammogram. It will also explain what happens during a breast ultrasound and how your results will be interpreted.

Purpose of Test

Breast ultrasounds are used to detect cancerous tumors and changes in blood flow within the breast. If you feel a lump or a screening mammogram shows a suspicious mass, your healthcare provider may recommend this test.  

Fluid-filled cysts and solid tumors can look the same on a mammogram. Breast ultrasounds can better determine whether a lump is a cyst or a tumor.

A breast ultrasound may be recommended in addition to a mammogram if you have dense breasts. (Mammograms show the type of breast tissue you have.) Dense breasts have lots of glandular tissue, as opposed to fatty tissue. Glandular tissue and cancerous tissue both appear white on a mammogram.

Breast ultrasounds are better for spotting small white tumors in glandular tissue than mammograms. Dense breast tissue is common in young people, especially those with a low body mass index (BMI). For that reason, a healthcare provider may recommend a breast ultrasound for you if you're under age 30 and have a breast mass that is palpable (that you can feel).

If you need a biopsy (removal of tissue to analyze in the lab), a breast ultrasound may be used to help guide the needle into the suspicious area.

Breast ultrasounds are also used to assess blood flow within the breast. Increased blood flow within the breast can indicate changes, such as inflammation, which can be associated with a variety of conditions.

Since breast ultrasounds use sound waves instead of ionizing radiation, they're usually recommended as a diagnostic tool for pregnant people who may have breast cancer.

All of this may make you think breast ultrasounds are the only breast cancer screening test you need. However, this is not the case. Breast ultrasounds can miss early signs of breast cancer, such as microcalcifications (small calcium deposits that appear as white specks on a mammogram), that mammograms can pick up.

Risks and Contraindications

Since they miss small tumors, breast ultrasounds are not recommended in place of mammograms. Other than that, there are no specific risks associated with breast ultrasound. However, this test may be less effective in certain populations, such as:

• People with very large breasts
• People who have obesity

Before the Test

If you have a history of dense breasts, a screening ultrasound may be done at the same time as screening mammography. Or, you may find you need a breast ultrasound after you've had a screening mammogram. This may occur if the radiologist reading your mammography finds something that warrants further testing, such as a mass or dense area.

Getting called back for additional testing after mammography is common and doesn't mean you have breast cancer. Fewer than 1 in 10 people who need follow-up testing have malignancies (cancer).

Even so, it may be stressful to find out that more testing is needed. For that reason, let your healthcare provider know you would like to schedule the ultrasound as soon as possible. Breast ultrasounds typically require a healthcare provider's referral.

Timing

As with most medical tests, you can expect to fill out forms, including a consent form, upon arrival at the testing facility. In some instances, you may be able to save time by filling out forms online before your appointment. If not, expect to spend around 15 minutes filling out paperwork before taking the test.

Breast ultrasound tests can be administered in one of these two ways:

• Handheld transducer ultrasound
• Automated breast ultrasound (ABUS)

To prepare you for this test, you will disrobe from the waist up and put on an open hospital gown. Your breasts will be covered with a warm gel that helps transmit sound waves. Adding prep time, both types of ultrasound tests take between 20 and 30 minutes to complete.

After the test, you'll be given time to get dressed and comfortable. In some instances, you may then have the opportunity to discuss your test results with a healthcare provider onsite.

Location

Breast ultrasounds are typically done in outpatient imaging centers. Based on your healthcare provider's referral and recommendation, you may instead have this test done in a hospital setting.

Imaging tests take place in private rooms. The technician performing the test will be in the room with you. Unlike tests that emit radiation, ultrasounds are not potentially harmful to others, so protecting the healthcare staff is not necessary.

The test does not use any anesthesia, so you will be able to drive afterward if that is your preferred transportation.

What to Wear

Don't use lotion, cream, powder, or any other substance on your breasts on the exam day. You can wear deodorant if you're only getting a sonogram. If you are also getting a mammogram, do not use deodorant.

Most facilities require you to disrobe from the waist up for this test. You will also be asked to remove jewelry, such as necklaces or piercing jewelry. Comfortable clothing that is easy to put on and take off may make sense. You will be given a hospital gown to wear during testing.

The warm gel placed on your breasts during the test will be removed afterward. Any leftover residue will not stain your clothing once you put it back on. If you choose, you may bring moistened wipes for cleanliness and comfort after testing.

Food and Drink

No special prep is needed for a breast ultrasound. You can eat and drink as you normally do before the test. You can also take your prescribed medications.

Cost and Health Insurance

If you have health insurance, your insurer will be contacted by the testing facility for preapproval before your exam.

State laws vary in their health insurance coverage mandates for breast ultrasounds. The purpose of the test, either screening or diagnostic, may impact coverage. (Tests are considered diagnostic if required after a screening test indicates the need for further testing.) In some states, no co-pay or deductible will be needed for diagnostic tests.

Breast ultrasound screening tests are not typically covered by health insurance plans, although there are exceptions, including Medicare. If your insurer does pay, you may have a co-pay (a set amount you pay per procedure or service).

For example, Original Medicare (Parts A and B) covers screening ultrasounds under Part B, which requires an out-of-pocket co-pay of 20%.

You may also have to pay a deductible. Many plans require an annual deductible you must meet specifically for imaging tests before they will pay a portion of the bill. Check with your insurance provider, so you know what to expect.

If you don't have insurance or your insurer doesn't pay, your average out-of-pocket cost for a screening test will be around $250. If this poses a hardship, let your healthcare provider know. Do not forgo the test based on cost. You may have options.

What to Bring

Make sure to bring your healthcare provider's referral form with you. You will also need your insurance card, if you have one, and a photo ID.

If you anticipate a long wait in the waiting room, bring a book or something to occupy your time before the test.

During the Test

Anticipating any type of medical test can be stressful. Knowing what to expect may help.

Pre-Test

Medical prep is not needed for this test. You will not be given an intravenous (IV) line. You will not need to give a blood or urine sample.

A signed consent form may be required. You may be able to sign the form and other needed paperwork online before you go. If not, you will be given forms to fill out onsite. These will include information about health insurance, your healthcare provider's contact info, and your health history.

Throughout the Test

You will be lying down for either the handheld transducer or the ABUS test. You may also be asked to lie on your side. Ultrasounds take around 15 to 30 minutes.

Unlike mammograms, your breasts will not be compressed between two plates in a machine during the test. The technician will be with you for the entire procedure. If you feel discomfort or have questions, let them know.

Handheld Transducer

This is the most common type of ultrasound breast exam. After placing gel on your skin, the technician will place a wand called a transducer on your breasts. It may be used to view the entire breast or just the area of concern.

The technician may also pass the wand under your arms to view your lymph nodes. You may feel some pressure from the wand during a handheld transducer test.

The wand emits sound waves and picks up echoes as they bounce off breast tissue. The echoes generate pictures that are viewed on a computer screen.

In some instances, a Doppler probe may be added to the transducer. The probe lets the technician hear how fast blood is flowing through the blood vessels of the breast.

Automated Breast Ultrasound (ABUS)

This test uses a large transducer that scans the entire breast and takes hundreds of images. This test is useful for viewing the entire breast as a screening tool. In some instances, a wand transducer will be used to focus on specific areas after the ABUS test is completed.

Post-Test

There are no physical aftereffects from this test. Protocols vary at testing facilities. You may get your results at your appointment, or, you may have to wait until your report is read and sent to your healthcare provider. This may take several days or longer.

Once you have your results, you will be given the next steps, if any are needed.

Interpreting Results

Breast ultrasound results are analyzed with the Breast Imaging Reporting and Data System (BI-RADS). This is the same system used to analyze the results of other breast tests, including mammograms and magnetic resonance imaging (MRI) scans.

BI-RAD sorts ultrasound results into numerical categories from 0 to 6. A numbered category will be assigned to your test by the radiologist who analyzes it.

• 0—Incomplete, additional imaging needed: This category means the test was not clear, and more testing is needed.
• 1—Negative: Your breasts are normal. No signs of cancer were detected.
• 2—Benign: This is also a negative test result. No cancer was found. Another finding showed up that is not cancer, such as a benign calcification. This classification helps other professionals understand how to read your results.
• 3—Probably benign: Something can be seen that has a very low chance (2% or less) of being cancer. Since cancer is not ruled out definitively, follow-up is recommended within six to 12 months.
• 4—Suspicious abnormality: Cancer is suspected but cannot be confirmed. A biopsy is recommended as the next step.
• 5—Highly suggestive of malignancy: Findings look like cancer and have a significantly high (95%) chance of being cancer. A biopsy is strongly recommended as the next step.
• 6—Known biopsy-proven malignancy: Cancer has already been diagnosed. This category is used when ultrasounds are done to determine how well you are responding to treatment.

Follow-Up

In most instances, no signs of breast cancer will be found. Your healthcare provider will let you know when to schedule your next breast cancer screening test. These are usually done annually or every other year.

Ask if you should repeat the ultrasound test as a screening tool or only have another mammogram. If you are at high risk for breast cancer, an annual breast MRI may be recommended in addition to a mammogram.

Further testing, such as a breast biopsy, will be scheduled if anything suspicious is seen on your ultrasound.

Summary

Breast ultrasounds are noninvasive tests often done after a suspicious or unclear mammogram. They may also be done as screening tests in people with dense breasts.

Breast ultrasounds don't require any special type of preparation. The test itself takes around 30 minutes to complete.

You may receive your test results immediately, on-site. Sometimes, test results may be sent to your healthcare provider within several days.

A Word From Verywell

It can be scary and stressful to find out you need a breast ultrasound. Most tests don't uncover suspicious findings. However, if a malignancy is found or suspected, early treatment will be highly beneficial. Like mammograms, breast ultrasounds save lives.