Value of Breast Ultrasound in the Clinical Practice of the Surgeon

*María Eugenia Aponte-Rueda and María Isabel de Abreu*

### **Abstract**

In recent years, breast surgeons have been increasing the use of ultrasound as a reliable and useful tool in their practice to assist in managing patients and the operating room. An appropriate clinical and sonographic correlation can define diagnostic workup, provide immediate reassurance to the patients, and perform one-site diagnostic needle interventions. Particularly, it has a significant role in low-middle income countries, where imaging services are scarce due to its high cost, maintenance needs, and limited availability of trained personnel. Therefore, training and accreditation of surgeons who perform and interpret ultrasound are required interventions to influence the provider's knowledge, accomplish optimal practices, complete diagnostic examinations of the breast, and improve the patients' quality of care. This review aims to serve as an educational resource regarding the up-todate value of breast ultrasound for surgeons.

**Keywords:** Breast Ultrasound, Breast Imaging, Interventional Radiology, Breast Cancer, Intraoperative Ultrasound, Low and Middle Income Countries, Breast Surgeon

### **1. Introduction**

Ultrasound (US) is a reliable and helpful tool in evaluating, diagnosing, and managing breast disease improving the patients' quality of care. In recent years, with the increasing quality of the ultrasonography equipment, the surgeons have escalated its use, particularly by breast surgeons in their clinical practice and operating room, which has led to the enhanced provision of care for women with breast disease [1, 2].

Breast ultrasound allows immediate identification and characterization of localized breast symptoms, palpable abnormalities noted on physical breast examination; and nonpalpable abnormalities identified on other breast imaging modalities. Hence, an appropriate clinical and sonographic correlation can define diagnostic workup, provide immediate reassurance to the patients, and perform one-site diagnostic needle interventions. In addition, it has the advantages of being low-cost, more affordable, portable, safe, and requires minimal maintenance. It has a significant role in low-middle income countries, where imaging services are scarce due to its high cost and limited availability of trained personnel [3]. In these settings, capacities on local referral chains are minimal; therefore, the use of US by breast surgeons offers significant appropriateness to the patients by allowing them to obviate the high threshold needed to reach referral services.

Breast surgeons can acquire comprehensive skills and competence in US techniques and their indications in the outpatient setting under the supervision of a

US-experienced radiologist or surgeon, enhancing the multidisciplinary care of breast patients. Also, participation in training courses guided by local proficiency standards [1] allows the successful incorporation of breast ultrasound and ultrasound-guided breast procedures into clinical practice, which can then be translated into the operation room. Training and accreditation of surgeons who perform and interpret ultrasound is an intervention that influences providers' behavior for optimal patient outcomes. Hence, the surgeon who assists in managing breast patients has to design a rational plan of action based on their knowledge, available resources, and patient needs to ensure adequate and safe breast care [4–6].

The purpose of this review is to serve as an educational resource for the value of breast ultrasound in the clinical practice of the surgeon by providing the understanding of its applications for the evaluation, management, and monitoring of breast diseases; and the recognizing of its indications for interventional breast procedures in order to improve the decision-making process and enhance patient care.
