The role of breast imaging during pregnancy and lactation in the diagnosis of breast malignancy

Abstract

Purpose: Imaging the pregnant or lactating breast can prove a challenge with malignancy either obscured or masquerading as a benign mass. Pregnancy related, or gestational breast cancer occurs in 24 of every 100,000 pregnancies. It is vital to exclude malignancy in women at any age, whether pregnant or not, who present with breast symptoms and imaging is an important part of this work up. Methods: This paper reviews the current world knowledge of how best to image the breast in women who are pregnant or lactating. It includes the authors' own case series of 22 women identified from the Western Australian Gestational Breast Cancer Project and cases diagnosed at Royal Perth Hospital up to the end of March 2007 for whom breast imaging studies were available for review. Results/discussion: We discuss the imaging characteristics of gestational breast cancer as described in the world literature. Results demonstrate that most, but not all, pregnant and lactating breasts have high density but there is up to 100% negative predictive value for mammography and ultrasound. Despite the increased density mammography and/or ultrasound reveal positive findings when cancer is present in up to 90% of cases. Image guided biopsy is important to confirm a diagnosis. Conclusion: Imaging the breasts during pregnancy or lactation adds valuable information in the work up of a breast symptom. We provide an algorithm for the investigation of pregnant and/or lactating women with a palpable breast mass.