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Breast Imaging

E2496. What to Expect When Your Patient Is Expecting: Imaging the Pregnant or Lactating Patient

Davis M,  Owen W. University of Kentucky, Lexington, KY

Address correspondence to M. Davis (davis.megan17@gmail.com)

Background Information: There are several barriers to performing breast imaging in the pregnant or lactating patient that can lead to a delay in diagnosis of pregnancy-associated breast cancer (PABC). The breasts undergo extensive changes resulting from the hormonal influences of pregnancy and lactation. These changes make image interpretation difficult in this population, as it is challenging to detect abnormalities and to differentiate normal from abnormal findings. Additionally, there is often hesitance to image the pregnant patient due to concerns about harm to the fetus, which can exacerbate the delay in diagnosis. Knowledge of the normal changes of pregnancy and lactation and the appropriate use of imaging can lead to a more rapid diagnosis. The hormonal changes of pregnancy and lactation also result in the growth of hormone-sensitive tumors in the breast and the development of certain tumors that occur only during pregnancy or lactation. Recognizing key features and directing appropriate management of these masses is an important role for the radiologist. Becoming more familiar with normal or benign findings in the breast during pregnancy and lactation is part of achieving the ultimate goal, which is to detect and diagnose breast cancer at an earlier stage. PABC is the leading cause of malignancy-related deaths in pregnancy, is known to have a poorer prognosis, and has a high emotional impact given the context of pregnancy. We will review the features of PABC and present challenging cases that demonstrate some key issues involved in the delay in diagnosis.

Educational Goals/Teaching Points: The goals of this exhibit are to review the imaging findings associated with normal changes that occur in the breast during pregnancy and lactation and discuss the limitations, safety, and utility of each imaging modality during pregnancy and lactation. Also, we will review common benign masses during pregnancy and lactation with attention to key imaging findings and appropriate management using a case-based approach. Finally, we will discuss imaging and clinical features of pregnancy-associated breast cancers.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Imaging findings associated with changes in the breast during pregnancy and lactation, including proliferation of the terminal ductal lobular units, fibrofatty stromal regression, increased vascularity, and increased secretions and water volume content of the breast will be reviewed. The limitations, safety, and appropriate use of mammography, ultrasound, MRI, and core needle biopsy in this special population will be discussed. We will review common benign masses, including galactoceles, fibroadenomas, and lactating adenomas, and discuss unique features of PABC.

Conclusion: Imaging the pregnant patient is difficult due to the normal changes of pregnancy and lactation. These difficulties often lead to a delay in diagnosis of PABC, which can have very negative consequences given the potentially aggressive nature of the disease. This delay can be avoided or decreased when the radiologist knows what imaging is appropriate during pregnancy and lactation and can differentiate normal and abnormal changes and recognize the features of benign and malignant breast lesions.