Dense breast tissue presents a well-recognised challenge in breast imaging, as it can obscure lesions on conventional mammography and reduce diagnostic sensitivity. This has led to increased emphasis on both understanding breast density and adopting complementary imaging approaches to improve cancer detection.

This presentation will provide a broad overview of breast density and its impact on imaging, with a focus on emerging innovations. In particular, it will introduce contrast-enhanced mammography as a technique that improves lesion visibility by highlighting areas of increased vascularity. Practical examples will also include contrast-guided biopsy, where areas of enhancement can be targeted to support more accurate tissue sampling.

Aimed at sonographers, this session will place these developments in a multimodality context, highlighting their role alongside ultrasound in the assessment of patients with dense breast tissue.

The male breast ultrasound is a poorly understood examination for many Sonographers.
Initially you need to understand the time frame of development and changes of the male breast from neonatal period through childhood to puberty and up until old age.
This knowledge then needs to be applied to the normal male breast ultrasound anatomy and possible pathologies during these stages.
To accurately diagnose pathology of the male breast, a thorough clinical history including symptoms, family history and medications taken needs to be acquired. Certain treatments and medications can deeply influence how the male breast reacts. Some diseases raise the risk of breast cancer.
90% of all male breast conditions are benign. 65% breast lesions seen on ultrasound are gynaecomastia, 25% carcinoma and 10% other lesions /conditions. Lesions and conditions of the male breast seen on ultrasound include:
Gynaecomastia, Pseudo gynaecomastia, Papilloma, Adenoma, Myofibroblastoma, Granular cell tumour, Fibrocystic change, Hamartoma, Lymphoma, Diabetic mastopathy, Epithelial/epidermoid inclusion cyst, Cystic lymphangioma, Pleomorphic hyalinising angioectatic tumour, Varix or thrombosis, Leiomyoma, Lipoma, PASH, Mastitis and Cancer
These pathologies will be discussed and examples demonstrated on ultrasound in this presentation.

Non-mass (grey) breast cancers present as subtle parenchymal pattern changes rather than discrete masses, making them challenging to detect on ultrasound and potentially mammographically occult. While ultrasound is often considered an adjunct to mammography, it plays a critical role in evaluating dense breast tissue and identifying atypical presentations. This presentation explores four cases of mammographically occult, non-mass breast cancers suspected on ultrasound due to their clinical presentation, highlighting their varied sonographic appearances, clinical symptoms, radiological assessment, pathological outcomes, and subsequent management. Through these case studies, we aim to increase awareness of non-mass breast cancer patterns and emphasise the importance of careful grey-scale assessment in conjunction with clinical assessment in daily practice. This session will provide practical insights for sonographers and clinicians to improve recognition of subtle malignant features and support earlier diagnosis and improved patient outcomes.

Non-mass (grey) breast cancers present as subtle parenchymal pattern changes rather than discrete masses, making them challenging to detect on ultrasound and potentially mammographically occult. While ultrasound is often considered an adjunct to mammography, it plays a critical role in evaluating dense breast tissue and identifying atypical presentations. This presentation explores four cases of mammographically occult, non-mass breast cancers suspected on ultrasound due to their clinical presentation, highlighting their varied sonographic appearances, clinical symptoms, radiological assessment, pathological outcomes, and subsequent management. Through these case studies, we aim to increase awareness of non-mass breast cancer patterns and emphasise the importance of careful grey-scale assessment in conjunction with clinical assessment in daily practice. This session will provide practical insights for sonographers and clinicians to improve recognition of subtle malignant features and support earlier diagnosis and improved patient outcomes.

This presentation will explore both the typical and the uncommon, subtle characteristics in the categorisation of benign versus malignant breast lesions. Drawing upon literature and experience, specific characteristics will be explored using examples, as well as strategies for discerning these features. This presentation aims to provide the audience with knowledge and strategies for more discerning categorisation of breast lesions, and for viewing breast malignancy screening through a fresh lens.

Introduction: Mammography test-sets from the BREAST program have been widely used to evaluate educational impact on cancer detection performance, however evidence in the modality of breast ultrasound remains limited. This study reports findings from the ULTRA_BREAST: Enhancing Diagnostic Proficiency in Breast Ultrasound project, which aimed to explore the diagnostic performance of sonographers and radiologists in interpreting breast ultrasound images.
Method: Readers reviewed all cases in a breast ultrasound test-set of 35 cases (10 biopsy-proven cancers, 25 benign) and localised any abnormalities, scoring them from 1 (normal) to 5 (highly suggestive of malignancy). Performance metrics included case sensitivity, specificity, and lesion sensitivity. Group comparisons were conducted using the Mann–Whitney U-test. Institutional ethics approval was granted.
Results: Radiologists (n=22) demonstrated slightly higher mean performance in most metrics except specificity, although no statistically significant differences were observed. Radiologists achieved a mean case sensitivity of 97.73%, 73.27% specificity, and 96.82% lesion sensitivity. Sonographers (n=20) achieved a mean case sensitivity of 91.0%, 79.2% specificity, and 91.0% lesion sensitivity. Among sonographers, those who routinely practice using either comprehensive or targeted ultrasound images alone demonstrated significantly higher sensitivity compared with those who routinely work with both comprehensive and targeted image sets (98.57% vs 85.45%, p=0.04).
Conclusion: Radiologists and sonographers demonstrated comparable diagnostic performance in breast ultrasound interpretation. For sonographers, consistent practice was associated with higher cancer lesion detection sensitivity. Further results are expected as the project continues.
Take home message: Sonographers’ workflow consistency emerged as a key factor in lesion detection.