Breast US: State of the Art

Breast US is an essential breast imaging tool that complements mammography and MRI. US is also often the primary imaging modality used to evaluate palpable breast masses and axillary lymph nodes and to guide percutaneous biopsy of breast masses and lymph nodes. Screening whole-breast US, with either handheld or automated technique, serves as a supplementary modality to screening mammography, particularly in women with dense breasts. Artificial intelligence (AI) has been adopted in US examinations to improve diagnostic accuracy and workflow. Analysis and quantification of background echotexture are emerging as a novel biomarker for breast cancer risk assessment. As US technology evolves and the scope of breast US widens, radiologists must understand the current and emerging US technology. They must also apply meticulous US scanning techniques to optimize image quality and ensure accurate diagnosis. This review provides a state-of-the-art summary of US technology and clinical applications as an adjuvant technique to mammography, MRI, and the clinical breast examination. The utility of breast US for screening, preoperative staging, and neoadjuvant treatment monitoring for breast cancer, breast intervention, and new techniques including AI, US tomography, optoacoustic imaging, and contrast-enhanced US will also be presented.