Breast Imaging of the Pregnant and Lactating Patient: Physiologic Changes and Common Benign Entities

Vashi, Reena; Hooley, Regina J.; Butler, Reni; Geisel, Jaime; Philpotts, Liane E.

doi:10.2214/ajr.12.9845

Cited by 103 publications

(114 citation statements)

References 17 publications

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“…Galactoceles are the most common palpable masses in lactating patients. These are cystic masses with posterior acoustic shadowing and variable internal echonicity depending on their fat, protein, and water content, but vascularity should never be present within a galactocele [2,8]. Lactating adenomas are fibroadenoma-like masses on US scan; however, microlobulations are more frequent and hypervascularity is usually seen on Doppler US.…”

Section: Discussionmentioning

confidence: 99%

“…Lactating adenomas also differ from fibroadenomas with their unique histologic features. US-guided biopsy is usually encouraged despite the benign US features [2,9]. …”

Section: Discussionmentioning

confidence: 99%

“…It is a clinical diagnosis, and US should be saved for patients with poor response to antibiotic therapy or if an abscess is suspected. US features of mastitis can be limited to skin thickening and parenchymal edema, but sometimes mass-like hypoechoic lesions with indistinct borders and peripheral hypervascularity can be seen [2]. These lesions may appear stiff on elastography studies mimicking malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Any new solid or complex cystic palpable mass identified on US during lactation that does not resolve within 2 weeks warrants biopsy even if it has a benign US appearance. Biopsy-proven benign lesions can be followed-up carefully during and after lactation as performed in non-lactating women [2,15,17]. …”

Section: Discussionmentioning

confidence: 99%

“…Alterations in serum estrogen, progesterone, and prolactin levels are mainly responsible for these structural changes [1,2]. Due to the increased size, nodularity, and sensitivity of the breasts during lactation, physical examination is usually a challenge.…”

Section: Introductionmentioning

confidence: 99%

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Breast Ultrasound during Lactation: Benign and Malignant Lesions

2018

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Background: Structural changes during lactation make breast physical examination difficult. When breast problems occur, patients are often referred for an ultrasound (US) scan. Most breast lesions diagnosed in these patients are benign, but the diagnosis of breast cancer is a challenge. We aim to demonstrate the spectrum of US imaging findings in lactating women. Methods: 77 breastfeeding patients who underwent breast US in our department between February 2012 and March 2017 were evaluated. Patients' electronic medical records were reviewed for the presenting complaint, US reports, pathology results if available, and clinical/radiologic follow-up. All examinations were performed by 2 radiologists. Results: 28 of the 77 patients had normal US findings. Cysts were seen in 16 patients. 4 patients had stable fibroadenomas. 6 patients had US imaging findings suggestive of mastitis, 5 patients had galactoceles, 1 patient had an abscess, and 1 patient had unilateral hypertrophy without any accompanying lesion. In 13 patients, BI-RADS 3 solid masses were diagnosed. Invasive breast cancer was diagnosed in 3 patients. Conclusion: US can demonstrate or exclude a true mass against the background of a nodular breast parenchyma. Radiologists must be aware of malignant US features to avoid delays in the diagnosis of pregnancy-associated breast cancer.

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Section: Discussionmentioning

confidence: 99%

“…Lactating adenomas also differ from fibroadenomas with their unique histologic features. US-guided biopsy is usually encouraged despite the benign US features [2,9]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Breast Ultrasound during Lactation: Benign and Malignant Lesions

2018

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Breast Cancer Diagnosed During Pregnancy

et al. 2015

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Breast cancer during pregnancy (BCP), although rare, is becoming more common and treatment should be as similar as possible to that for nonpregnant young patients with breast cancer. A group of specialists convened to review current guidelines and provide guidance on how recent advances in breast cancer diagnosis and treatment can be adapted for pregnant patients. The majority of patients with BCP will be considered for treatment during the pregnancy. Premature delivery should be avoided whenever possible. Most treatments, including sentinel lymph node biopsy, systemic therapy with taxanes, platinum agents, or dose-dense treatment can be safely given during pregnancy, after careful risk/benefit assessment for mother and child. Chemotherapy is contraindicated during the first trimester because of a higher risk of fetal malformations but is feasible in the second and third trimesters. Other treatments such as radiation therapy or anti-human epidermal growth receptor 2 treatment are in general not indicated during pregnancy but might be considered in some instances. Patient data should be collected in a systematic way whenever possible.

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Cancer and Pregnancy

Litton

2019

Holland‐Frei Cancer Medicine

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Overview The diagnosis of cancer during pregnancy is a clinical and emotional challenge for both the patient and the caregivers. A multidisciplinary approach including medical oncologists, surgeons, radiation oncologists, and obstetrics is vital to coordinate the treatment of the mother and the monitoring of the fetus. The available data regarding the treatment of cancer during pregnancy, including staging, surgery, radiation, and systemic therapy as well as outcomes for the patients and the children exposed to chemotherapy in utero is reviewed.

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Breast Imaging of the Pregnant and Lactating Patient: Physiologic Changes and Common Benign Entities

Abstract: A thorough understanding of expected physiologic changes and common benign breast abnormalities of pregnancy and lactation is required to differentiate these entities from pregnancy-associated breast cancer and to appropriately guide patient management.

Cited by 103 publications

References 17 publications

Breast Ultrasound during Lactation: Benign and Malignant Lesions

Breast Ultrasound during Lactation: Benign and Malignant Lesions

Breast Cancer Diagnosed During Pregnancy

Cancer and Pregnancy

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