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Insights Imaging. 2018 Aug;9(4):449-461. doi: 10.1007/s13244-018-0636-z. Epub 2018 Aug 9.

Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging.

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Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK.
PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy.
Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece.
Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria.
Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany.
Department of Radiology, University Hospital of La Ribera, Carretera de Corbera, Km 1, 46600, Alzira, Valencia, Spain.
Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France.
Thirlestaine Breast Centre, Cheltenham General Hospital, Thirlestaine Road, Cheltenham, GL53 7AP, UK.
Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria.
Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK.
Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224, Chêne-Bougeries, Genève, Switzerland.
Referenzzentrum Mammographie München and FFB gGmbH München, Sonnenstraße 29, 80331, Munich, Germany.
University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Unità Operativa Radiodiagnostica, Candiolo Cancer Institute - FPO, IRCCS, Str. Prov. 142, km 3.95, 10060, Candiolo, Turin, Italy.
Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.
Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Viale Regina Elena, 324, 00161, Rome, Italy.
Department of Imaging, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden.
Department of Radiology, Duna Medical Center, Budapest, Hungary.
Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.


This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40-74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered.


• US is an established tool for suspected cancers at all ages and also the method of choice under 40. • For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings. • High-risk women can be screened with US, especially when MRI cannot be performed. • Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams. • Breast US is inappropriate as a stand-alone screening method.


Automated whole breast ultrasound; BI-RADS; Breast cancer; Breast ultrasound (US); Colour-Doppler; Elastography

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