Background: The breasts undergo many changes during pregnancy and in preparation for lactation, some of which include gland maturation, alveolar development, increase in size and number of secondary and tertiary ducts, increase in the fluid content of the breasts, and involution of stromal adipose tissue. These changes often result in increased radiodensity on mammography, which can pose a challenge to breast imaging interpretation during pregnancy and lactation. Pregnancy associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy, within the first postpartum year, or during lactation. It usually presents as a palpable mass, although greater than 80% of palpable masses during pregnancy are benign. Incidence of cancer during pregnancy is on the rise, as more women delay child bearing into the fourth decade of life, with breast cancer being the most common. Understanding the best approach for appropriate screening and workup of breast findings during pregnancy is imperative for radiologists to accurately diagnose pregnancy related breast cancer. Use of mammography or ultrasound should be tailored to patient specific factors, with ultrasound being the typical first line due to patient age and decreased sensitivity of mammography in the setting of dense breast tissue.
Learning Objectives: 1. Review current recommendations for breast cancer screening in pregnant/lactating patients and incidence of breast cancer in this population
2. Understand normal breast tissue changes during pregnancy and associated imaging findings
3. Review multi-modality case series from our institution ranging from benign to malignant, with teaching points
4. Review imaging recommendation for workup, diagnosis and follow-up in pregnancy when patients present with suspicious findings
Abstract Content/Results: We will highlight concepts key to caring for pregnant patients in a breast clinic based on current standard of care - appropriate screening and diagnostic imaging including most up to date radiation safety, next steps, biopsy recommendations, and follow-up care. Breast anatomy and physiology and expected changes during pregnancy will be briefly reviewed with corresponding example images. An image-rich series of approximately 10 cases will demonstrate normal changes seen during pregnancy, common benign entities, pregnancy associated breast cancer, and breast cancer mimics.
Conclusion: A clear understanding of the expected imaging appearance of breast tissue in pregnant patients and how it effects imaging findings is imperative to appropriate assessment and recommendations for this population. While ultrasound is generally the first step in analyzing a palpable finding, additional work-up and care should be tailored to patient’s age, risk factors, and initial imaging findings.
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