Breast lumps detected during pregnancy are generally benign and reflect fibroadenoma, lactating adenoma, cysts, infarction of the breast or galactocele. Although rare, the possibility of breast cancer must also be considered to avoid any delays in diagnosis. After patient questioning and clinical examination, the first imaging modality to use is ultrasound. No further assessment is called for if lesions are categorized as BI-RADS 2 and no suspicious clinical signs are observed. Depending on the clinical setting, lesions classified BI-RADS 3 require monitoring and mammographic assessment (which can be helpful in diagnosing cancer and incurs no risk to the embryo or fetus). If the clinical signs are unclear and/or the lesion(s) are categorized as ≥ BI-RADS 4a, then mammography and often biopsy should be performed. Strict BI-RADS scoring (American College of Radiology) should be applied, bearing in mind that benign lesions can appear suspicious during pregnancy, and some cancers can exhibit what seem to be reassuring characteristics.
The semiological description of masses in mammography is based on the BI-RADS system provided by the American College of Radiology. The contour is the most discriminating morphological criterion between benign and malignant masses. Most circumscribed masses are benign. Nevertheless, due to specific histological characteristics, certain malignant lesions or lesions with a risk of malignancy may appear in the mammography in this falsely reassuring form. An indistinct contour in the mammography is suspicious and requires a tissue sample. The positive predictive value of malignancy varies according to the morphology of the contour. It is lower for microlobulated contours, increases for masked, then indistinct contours and reaches 96% for spiculated contours. However, in rare cases, certain benign lesions may appear in the form of spiculated masses. In these specific cases, a correlation between the histological results with the imaging data is essential in order to avoid failing to recognise an underlying malignant lesion that the biopsy may have underestimated.
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