Breast ultrasound description: uneven echo and duct dilatation, what is the problem?

Author: Chen Wen, Chief Physician, Peking University Third Hospital

Reviewer: Liang Zhen, Chief Physician, Peking University Cancer Hospital

Ultrasound examination is a very common examination method that we come into contact with during hospital visits. Compared with many other examination items, ultrasound examination is very convenient and non-invasive, so it is favored by many doctors and patients.

For example, breast ultrasound is a very good method for breast examination. However, many patients always have various questions when they receive the breast ultrasound examination report:

Is it a problem if the breast structure is slightly disordered or the echo is uneven? What is breast duct dilatation? Do I need to do other tests after doing breast ultrasound?

Do you know the answers to these questions?

1. Does the description of “slightly disordered structure and uneven echo” on breast ultrasound mean there is a problem?

The mammary glands of women are affected by both individual differences and genetic factors, so each person's breasts appear different on ultrasound.

To distinguish the different glands, ultrasound doctors will roughly divide them into three categories:

If the glandular tissue is relatively thick and the surrounding fat tissue is relatively thin, it is called glandular-predominant breast; if the glandular tissue is very thin and the surrounding fat tissue is relatively abundant, it is called fat-predominant breast; if the glandular tissue and fat tissue are mixed together, resulting in a relatively messy breast echo on ultrasound, it is called inhomogeneous breast, which is reflected in the ultrasound report as "uneven glandular echo."

At the same time, each person's gland echo will have different ultrasound manifestations due to the influence of hormones during different menstrual cycles. For example, the echo in the early stage of menstruation is often lower or more chaotic than that in the late stage of menstruation, which is reflected in the ultrasound report as "the gland echo is uneven and the structure is slightly disordered". These descriptions do not mean that there is a problem with the gland, but only represent the ultrasound manifestation of the breast in a certain state of the human body.

Figure 1 Original copyright image, no permission to reprint

2. What does “mammary duct dilatation” described by breast ultrasound mean?

A normal mammary gland contains a large number of ducts, which are important channels for transporting milk during lactation. Therefore, the ducts during lactation must be dilated. The degree of dilation is related to the amount of milk contained in them. This is a common phenomenon during lactation and there is no need to worry.

However, some women do experience partial duct dilation in their breasts when they are not breastfeeding. At this time, the ultrasound doctor first observes the degree of duct dilation. If the inner diameter of the duct does not exceed 2mm, the fluid in the dilated duct is very clear, and the inner wall of the duct is relatively smooth, it is generally considered to be a basically normal physiological manifestation.

When the catheter is dilated to more than 2mm, the ultrasound doctor will further observe whether the fluid in the catheter is clear, whether it contains debris or solid nodules, etc., and then further determine whether the dilated catheter is benign or has a risk of malignancy.

Figure 2 Original copyright image, no permission to reprint

3. After an ultrasound examination, do I no longer need a breast X-ray examination?

Breast ultrasound is simple and non-invasive, without radiation, and has a relatively good resolution, so even very small nodules can be detected. It is indeed a very good breast examination method. However, breast ultrasound also has its shortcomings. For example, breast ultrasound is not as sensitive as breast X-ray in detecting tiny calcifications that often appear in malignant nodules.

Therefore, if a clinician suspects that a breast nodule has a malignant risk, in addition to recommending ultrasound examination, a breast X-ray examination will also be recommended. If the ultrasound doctor finds dot-shaped or block-shaped calcification foci in the breast during the examination, in order to further clarify the nature, the patient will also be recommended to undergo a breast X-ray examination.

Although breast X-ray examination has a certain degree of radioactivity, in many cases combining it with ultrasound examination can achieve the effect of "1+1>2".