Atlas of breast cancer early detection

1. No special preparation is needed for breast ultrasound.
2. Greet the patient politely. Note the presenting problems (if any) and indication of the study. Review the findings of CBE.
3. Note the patient demographics, including age, menstrual history, parity, age of the youngest child, lactational history, risk factors for breast cancer, and earlier surgery.
4. Make the patient comfortable and ensure her privacy at all times.
5. Instruct the patient to undress from the waist up and give her a gown to wear during the procedure.
6. A female supporting staff nurse or a female attendant is mandatory while the test is performed.
7. Position the patient with support beneath the chest to elevate the breasts for optimal and complete evaluation. This also limits the movement of the breasts. A headrest pillow helps in positioning the patient.
8. Ask the patient to raise both arms above her head to expose the entire breasts and axillae for the test. If the patient has any comorbidities, such as frozen shoulder, spine surgery, or cervical spondylosis, and is unable to be ideally positioned, the best manageable position under the circumstances should be achieved.
9. Turn the patient to right decubitus position for examination of the left axilla and far lateral breast tissues along the left axillary line to complete the test. Repeat with the patient turned to left decubitus position for examination of the right axilla and lateral tissues of the right breast.

Patient in supine position for bilateral breast ultrasound
If both breasts are to be scanned, the right breast is usually scanned first, then the left. Raise the patient’s arm above her head and place a soft support beneath the shoulder to minimize movement of the breast during the examination. Move the patient’s gown to uncover the side under examination up to the axilla. Cover the other breast for comfort. Ask the patient to turn her head to the opposite side.

Patient in supine position for ultrasound of right breast

The step-by-step breast ultrasound examination checklist acts as a useful reminder of the steps to be taken in the clinic. The checklist can also be used to assess the trainee’s skill during a training programme.