When would breast Ultrasound be indicated without obtaining a mammogram first?
• In patients who are younger than 30 and in pregnant patients, it is recommended to start with breast US. For other patients presenting with palpable masses, mammography should be obtained first, with the following exceptions. At our institution, a mammogram is obtained first in women who are older than 30. To evaluate the palpable abnormality further, US follows mammography. If the patient is younger than 30, US is performed first. Age 30 is an arbitrary number; different institutions may have a different cutoff age.
• In patients who have had a mastectomy, there is not enough tissue to obtain a mammogram. If there is a palpable area, sonographic evaluation should be performed.
• In women who are lactating, sonography may be performed first.