ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women

Abstract

Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC.

Breast lesions during pregnancy and lactation: a pictorial essay

“…However, persistent unilateral bloody nipple discharge can be a pathological condition that occurs secondary to infection, papilloma, or breast cancer. A diagnostic imaging evaluation is recommended if pathological nipple discharge is suspected [1,4,7].…”

“…The evaluation of breast imaging studies during pregnancy and lactation is challenging because of physiological and structural changes in the breast, as well as the need to balance maternal and fetal well-being [7].…”

Mammakarzinom und Schwangerschaft

“…Die Strahlenbelastung beträgt für den Fetus 50 mrad, wobei die maximale Grenzdosis in der Schwangerschaft bei einer Dosierung von 10 rad liegt. Damit kann auch die Mammografie zu jedem Zeitpunkt der Schwangerschaft unter Berücksichtigung der entsprechenden Sicherheitskautelen durchgeführt werden [3]. Das 3.…”

ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman

“…If ultrasonography shows suspicious findings or is discordant with clinical examination, additional imaging with mammography or digital breast tomosynthesis (DBT, or ''3D mammography'') may be indicated. 1 This is related to the fact that mammogram or DBT can visualize architectural distortion and/or calcifications not seen on ultrasonography, as well as delineate extent of disease in the setting of malignancy 35…”

“…The American College of Radiology (ACR) released new guidelines in 2018 regarding breast imaging of pregnant and lactating women. 1 These guidelines state that all breast imaging studies and biopsies are safe for women to undergo while breastfeeding, and also provide recommendations for maximizing examination sensitivity and minimizing biopsy-related complications in this patient population.…”