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Sorin V, Bufman H, Bernstein-Molho R, Faermann R, Friedman E, Raskin D, Balint Lahat N, Sklair-Levy M. Breast cancer screening in BRCA1/2 pathogenic sequence variant carriers during pregnancy and lactation. Clin Imaging 2024; 111:110189. [PMID: 38759599 DOI: 10.1016/j.clinimag.2024.110189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women harboring germline BRCA1/BRCA2 pathogenic sequence variants (PSVs) are at an increased risk for breast cancer. There are no established guidelines for screening during pregnancy and lactation in BRCA carriers. The aim of this study was to evaluate the utility of whole-breast ultrasound (US) screening in pregnant and lactating BRCA PSV carriers. METHODS Data were retrospectively collected from medical records of BRCA PSV carriers between 2014 and 2020, with follow-up until 2021. Associations between imaging intervals, number of examinations performed and pregnancy-associated breast cancers (PABCs) were examined. PABCs and cancers diagnosed at follow-up were evaluated and characteristics were compared between the two groups. RESULTS Overall 212 BRCA PSV carriers were included. Mean age was 33.6 years (SD 3.93, range 25-43 years). During 274 screening periods at pregnancy and lactation, eight (2.9 %) PABCs were diagnosed. An additional eight cancers were diagnosed at follow-up. Three out of eight (37.5 %) PABCs were diagnosed by US, whereas clinical breast examination (n = 3), mammography (n = 1) and MRI (n = 1) accounted for the other PACB diagnoses. One PABC was missed by US. The interval from negative imaging to cancer diagnosis was significantly shorter for PABCs compared with cancers diagnosed at follow-up (3.96 ± 2.14 vs. 11.2 ± 4.46 months, P = 0.002). CONCLUSION In conclusion, pregnant BRCA PSV carriers should not delay screening despite challenges like altered breast tissue and hesitancy towards mammography. If no alternatives exist, whole-breast ultrasound can be used. For lactating and postpartum women, a regular screening routine alternating between mammography and MRI is recommended.
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Affiliation(s)
- Vera Sorin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel.
| | - Hila Bufman
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Rinat Bernstein-Molho
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Renata Faermann
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Eitan Friedman
- The Faculty of Medicine, Tel-Aviv University, Israel; Oncogenetics Unit, Institute of Human Genetics, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel Raskin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
| | - Nora Balint Lahat
- The Faculty of Medicine, Tel-Aviv University, Israel; Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel-Aviv University, Israel
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Xu K, Chung M, Hayward JH, Kelil T, Lee AY, Ray KM. MRI of the Lactating Breast. Radiographics 2024; 44:e230129. [PMID: 38300813 DOI: 10.1148/rg.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The breasts undergo marked physiologic changes during lactation that can make conventional imaging evaluation with mammography and US challenging. MRI can be a valuable diagnostic aid to differentiate physiologic and benign processes from malignancy in patients who are lactating. In addition, MRI may allow more accurate delineation of disease involvement than does conventional imaging and assists in locoregional staging, screening of the contralateral breast, assessment of response to neoadjuvant chemotherapy, and surgical planning. Although the American College of Radiology recommends against patients undergoing contrast-enhanced MRI during pregnancy because of fetal safety concerns, contrast-enhanced MRI is safe during lactation. As more women delay childbearing, the incidence of pregnancy-associated breast cancer (PABC) and breast cancer in lactating women beyond the 1st year after pregnancy is increasing. Thus, MRI is increasingly being performed in lactating women for diagnostic evaluation and screening of patients at high risk. PABC is associated with a worse prognosis than that of non-PABCs, with delays in diagnosis contributing to an increased likelihood of advanced-stage disease at diagnosis. Familiarity with the MRI features of the lactating breast and the appearance of various pathologic conditions is essential to avoid diagnostic pitfalls and prevent delays in cancer diagnosis and treatment. The authors review clinical indications for breast MRI during lactation, describe characteristic features of the lactating breast at MRI, and compare MRI features of a spectrum of benign and malignant breast abnormalities. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chikarmane in this issue.
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Affiliation(s)
- Kali Xu
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Maggie Chung
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Jessica H Hayward
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Tatiana Kelil
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Amie Y Lee
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
| | - Kimberly M Ray
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S-261, San Francisco, CA 94143
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3
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Peterson MS, Gegios AR, Elezaby MA, Salkowski LR, Woods RW, Narayan AK, Strigel RM, Roy M, Fowler AM. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics 2023; 43:e230014. [PMID: 37708073 PMCID: PMC10560982 DOI: 10.1148/rg.230014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 09/16/2023]
Abstract
Physiologic changes that occur in the breast during pregnancy and lactation create challenges for breast cancer screening and diagnosis. Despite these challenges, imaging evaluation should not be deferred, because delayed diagnosis of pregnancy-associated breast cancer contributes to poor outcomes. Both screening and diagnostic imaging can be safely performed using protocols based on age, breast cancer risk, and whether the patient is pregnant or lactating. US is the preferred initial imaging modality for the evaluation of clinical symptoms in pregnant women, followed by mammography if the US findings are suspicious for malignancy or do not show the cause of the clinical symptom. Breast MRI is not recommended during pregnancy because of the use of intravenous gadolinium-based contrast agents. Diagnostic imaging for lactating women is the same as that for nonpregnant nonlactating individuals, beginning with US for patients younger than 30 years old and mammography followed by US for patients aged 30 years and older. MRI can be performed for high-risk screening and local-regional staging in lactating women. The radiologist may encounter a wide variety of breast abnormalities, some specific to pregnancy and lactation, including normal physiologic changes, benign disorders, and malignant neoplasms. Although most masses encountered are benign, biopsy should be performed if the imaging characteristics are suspicious for cancer or if the finding does not resolve after a short period of clinical follow-up. Knowledge of the expected imaging appearance of physiologic changes and common benign conditions of pregnancy and lactation is critical for differentiating these findings from pregnancy-associated breast cancer. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Molly S. Peterson
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Alison R. Gegios
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Mai A. Elezaby
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Lonie R. Salkowski
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Ryan W. Woods
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Anand K. Narayan
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Roberta M. Strigel
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Madhuchhanda Roy
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Amy M. Fowler
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
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Aschen SZ, Paik KC, Swistel AS, Talmor M. Pregnancy-Associated Breast Changes after Nipple-Sparing Mastectomy. Plast Reconstr Surg 2023; 152:492-500. [PMID: 36727812 DOI: 10.1097/prs.0000000000010199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Women of reproductive age are chronically underrepresented in breast cancer studies. Recent studies suggest that almost 40% of patients diagnosed with breast cancer who are of reproductive age want to have children after completing treatment. In this study, the authors evaluated patients of reproductive age who had undergone nipple-sparing mastectomy (NSM) and implant-based reconstruction. The authors compared those who became pregnant with those who did not with respect to clinical and radiologic changes that are reported at follow-up. METHODS Any patient 45 years of age or younger at the time of NSM was determined to be of reproductive age, selected for evaluation, and followed prospectively. The presence or absence of breast examination changes in the setting of pregnancy after NSM was recorded. RESULTS A total of 36 patients became pregnant after NSM, and 158 patients did not become pregnant after NSM. Of those who became pregnant, nearly half reported some clinical change just before or immediately after delivery. These changes included color change and discharge at the residual nipple-areola complex and palpable nodularity elsewhere. For those with palpable changes, an ultrasound was performed and hypoechoic lesions with variable vascularity were identified. For those who went on to excision, lactational hyperplasia was the most common diagnosis. CONCLUSIONS Ultrasound is an appropriate first-line investigation of breast changes, which can include hyperplasia of remaining ductal and glandular tissue. Patients who became pregnant after NSM commonly had clinical breast examination changes, but the majority of these changes were found to be benign on further evaluation. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Seth Z Aschen
- From the Divisions of Plastic and Reconstructive Surgery
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5
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Callaway MK, Dos Santos CO. Gestational Breast Cancer - a Review of Outcomes, Pathophysiology, and Model Systems. J Mammary Gland Biol Neoplasia 2023; 28:16. [PMID: 37450228 PMCID: PMC10348943 DOI: 10.1007/s10911-023-09546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
The onset of pregnancy marks the start of offspring development, and represents the key physiological event that induces re-organization and specialization of breast tissue. Such drastic tissue remodeling has also been linked to epithelial cell transformation and the establishment of breast cancer (BC). While patient outcomes for BC overall continue to improve across subtypes, prognosis remains dismal for patients with gestational breast cancer (GBC) and post-partum breast cancer (PPBC), as pregnancy and lactation pose additional complications and barriers to several gold standard clinical approaches. Moreover, delayed diagnosis and treatment, coupled with the aggressive time-scale in which GBC metastasizes, inevitably contributes to the higher incidence of disease recurrence and patient mortality. Therefore, there is an urgent and evident need to better understand the factors contributing to the establishment and spreading of BC during pregnancy. In this review, we provide a literature-based overview of the diagnostics and treatments available to patients with BC more broadly, and highlight the treatment deficit patients face due to gestational status. Further, we review the current understanding of the molecular and cellular mechanisms driving GBC, and discuss recent advances in model systems that may support the identification of targetable approaches to block BC development and dissemination during pregnancy. Our goal is to provide an updated perspective on GBC, and to inform critical areas needing further exploration to improve disease outcome.
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Affiliation(s)
| | - Camila O Dos Santos
- , Cold Spring Harbor Laboratory, Cancer Center, Cold Spring Harbor, NY, USA.
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6
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Nissan N, Massasa EEM, Bauer E, Halshtok-Neiman O, Shalmon A, Gotlieb M, Faermann R, Samoocha D, Yagil Y, Ziv-Baran T, Anaby D, Sklair-Levy M. MRI can accurately diagnose breast cancer during lactation. Eur Radiol 2023; 33:2935-2944. [PMID: 36348090 DOI: 10.1007/s00330-022-09234-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/27/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the diagnostic performance of breast dynamic contrast-enhanced (DCE) MRI during lactation. MATERIALS AND METHODS Datasets of 198 lactating patients, including 66 pregnancy-associated breast cancer (PABC) patients and 132 controls, who were scanned by DCE on 1.5-T MRI, were retrospectively evaluated. Six blinded, expert radiologists independently read a single DCE maximal intensity projection (MIP) image for each case and were asked to determine whether malignancy was suspected and the background-parenchymal-enhancement (BPE) grade. Likewise, computer-aided diagnosis CAD MIP images were independently read by the readers. Contrast-to-noise ratio (CNR) analysis was measured and compared among four consecutive acquisitions of DCE subtraction images. RESULTS For MIP-DCE images, the readers achieved the following means: sensitivity 93.3%, specificity 80.3%, positive-predictive-value 70.4, negative-predictive-value 96.2, and diagnostic accuracy of 84.6%, with a substantial inter-rater agreement (Kappa = 0.673, p value < 0.001). Most false-positive interpretations were attributed to either the MIP presentation, an underlying benign lesion, or an asymmetric appearance due to prior treatments. CAD's derived diagnostic accuracy was similar (p = 0.41). BPE grades were significantly increased in the healthy controls compared to the PABC cohort (p < 0.001). CNR significantly decreased by 11-13% in each of the four post-contrast images (p < 0.001). CONCLUSION Breast DCE MRI maintains its high efficiency among the lactating population, probably due to a vascular-steal phenomenon, which causes a significant reduction of BPE in cancer cases. Upon validation by prospective, multicenter trials, this study could open up the opportunity for breast MRI to be indicated in the screening and diagnosis of lactating patients, with the aim of facilitating an earlier diagnosis of PABC. KEY POINTS • A single DCE MIP image was sufficient to reach a mean sensitivity of 93.3% and NPV of 96.2%, to stress the high efficiency of breast MRI during lactation. • Reduction in BPE among PABC patients compared to the lactating controls suggests that several factors, including a possible vascular steal phenomenon, may affect cancer patients. • Reduction in CNR along four consecutive post-contrast acquisitions highlights the differences in breast carcinoma and BPE kinetics and explains the sufficient conspicuity on the first subtracted image.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efi Efraim Moss Massasa
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
| | - Ethan Bauer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Halshtok-Neiman
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shalmon
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gotlieb
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renata Faermann
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Samoocha
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagil
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Maia AF, Solinho M, Vicente Costa R, Alves O, Nogueira M. The Importance of Carefully Evaluating Breast Masses During Pregnancy. ACTA MEDICA PORT 2023; 36:143-144. [PMID: 36738183 DOI: 10.20344/amp.19118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ana Filipa Maia
- Serviço de Ginecologia/Obstetrícia. Hospital Distrital de Santarém. Santarém. Portugal
| | - Mariana Solinho
- Serviço de Ginecologia/Obstetrícia. Hospital Distrital de Santarém. Santarém. Portugal
| | - Rita Vicente Costa
- Serviço de Ginecologia/Obstetrícia. Hospital Distrital de Santarém. Santarém. Portugal
| | - Olga Alves
- Serviço de Ginecologia/Obstetrícia. Hospital Distrital de Santarém. Santarém.. Portugal
| | - Madalena Nogueira
- Serviço de Ginecologia/Obstetrícia. Hospital Distrital de Santarém. Santarém. Portugal
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Polic A, Eutsler KM, Patel SS. Breastfeeding and the patient's perspective. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1629-1636. [PMID: 36625897 DOI: 10.1007/s00261-022-03791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this article is to summarize available data on breastfeeding in patients with a cancer diagnosis. MATERIALS AND METHODS A review of available literature in the MEDLINE database was performed and the data summarized. In addition, two patient interviews were conducted to gain insight into the patient perspective. RESULTS Breastmilk is the nutritional standard for human infants and understanding the implications of a cancer diagnosis on lactation is important in optimizing maternal and infant outcomes. Though limited, available data suggest that breastfeeding may be a safe and appropriate option for some patients undergoing treatment of a malignancy. CONCLUSIONS Patient experiences with breastfeeding in the setting of a cancer diagnosis vary widely, and depend on the type of malignancy, the timing of the diagnosis, and the indicated treatment. Breastfeeding may be an appropriate option for certain patients after multidisciplinary counseling. Alternatives to breastfeeding exist for patients who are unable to or do not desire to breastfeed.
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Affiliation(s)
- Aleksandra Polic
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
| | - Kaitlin M Eutsler
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Soha S Patel
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
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Harper LK, Simmons CL, Woodard GA, Solanki MH, Bhatt AA. Pictorial Review of Common and Uncommon Pediatric Breast Lesions. Radiographics 2023; 43:e220117. [DOI: 10.1148/rg.220117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura K. Harper
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Curtis L. Simmons
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Genevieve A. Woodard
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Malvika H. Solanki
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Asha A. Bhatt
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
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10
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Management of Pregnancy Associated Breast Cancer: a Review. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Long Standing Giant Galactocele and Its Surgical Management. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jha P, Pōder L, Glanc P, Patel-Lippmann K, McGettigan M, Moshiri M, Nougaret S, Revzin MV, Javitt MC. Imaging Cancer in Pregnancy. Radiographics 2022; 42:1494-1513. [PMID: 35839139 DOI: 10.1148/rg.220005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (~1:1000 pregnancies), PAC is increasing owing to postponed childbearing and advanced maternal age at conception. Cancer-related symptoms masked by physiologic gestational changes may delay diagnosis. Imaging, clinical management, and treatment require a carefully choreographed multidisciplinary team approach. The risk-benefit of every imaging modality, the strategies to balance the safety of mother and fetus, and the support of the patient and family at every step are crucial. US and MRI are preferred imaging modalities that lack ionizing radiation. Radiation dose concerns should be addressed, noting that most imaging examinations (including mammography, radiography, CT, and technetium 99m-labeled sulfur colloid sentinel lymph node staging) are performed at radiation levels below thresholds at which deterministic side effects are seen. Dose estimates should be provided after each examination. The use of iodinated intravenous contrast material is safe during pregnancy, but gadolinium-based contrast material should be avoided. Accurate diagnosis and staging combined with gestational age affect decisions about surgery and chemotherapy. Whole-body MRI with diffusion-weighted sequences is ideal to screen for primary and metastatic sites, determine disease stage, identify biopsy targets, and guide further cancer site-specific imaging. The authors provide an update of the imaging triage, safety considerations, cancer-specific imaging, and treatment options for cancer in pregnancy. An invited commentary by Silverstein and Van Loon is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Priyanka Jha
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Liina Pōder
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Phyllis Glanc
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Krupa Patel-Lippmann
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Melissa McGettigan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Stephanie Nougaret
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Marcia C Javitt
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
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Jafari M, Abbasvandi F, Nazeri E, Olfatbakhsh A, Kaviani A, Esmaeili R. Ultrasound features of pregnancy-associated breast cancer: A retrospective observational analysis. Cancer Med 2022; 12:1189-1194. [PMID: 35748020 PMCID: PMC9883397 DOI: 10.1002/cam4.4974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
Pregnancy-associated breast cancer (PABC) is a poor prognosis in women, and the mortality rate is higher in this subgroup of patients than in non-PABC. This study aims to assess clinicopathological and ultrasound features of patients with PABC. Of 75 patients with breast cancer, 31 cases were in lactating, or pregnancy phase and 44 patients had no recent history of pregnancy/lactation at the time of cancer detection. The available pathological characteristics and ultrasound findings of the PABC and non-PABC groups were compared. The analysis of ultrasound findings demonstrated that the percentages of antiparallel orientation (p = 0.04) and heterogeneous internal echo pattern (p = 0.002) were higher in the PABC group. The final Breast Imaging Reporting and Data System (BI-RADS) assessment in the two groups was significantly different (p = 0.008). In this study, most PABCs were BI-RADS 4c or 5; compared with age-matched non-PABC cases. There were significant differences in ER (p = 0.03), receptor groups (p = 0.007), and tumor grade (p = 0.02) in PABC compared to non-PABC group. To conclude, radiologists should be careful about ultrasound findings of PABC and recommend core needle biopsy in suspected cases.
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Affiliation(s)
- Maryam Jafari
- Department of RadiologyAli Asghar Children Hospital, Iran University of Medical SciencesTehranIran,Genetics Department, Breast Cancer Research CenterMotamed Cancer Institute, ACECRTehranIran
| | - Fereshteh Abbasvandi
- ATMP Department, Breast Cancer Research CenterMotamed Cancer Institute, ACECRTehranIran
| | - Elahe Nazeri
- Genetics Department, Breast Cancer Research CenterMotamed Cancer Institute, ACECRTehranIran
| | - Asiie Olfatbakhsh
- Breast Diseases Department, Breast Cancer Research CenterMotamed Cancer Institute, ACECRTehranIran
| | - Ahmad Kaviani
- Department of SurgeryTehran University of Medical ScienceTehranIran
| | - Rezvan Esmaeili
- Genetics Department, Breast Cancer Research CenterMotamed Cancer Institute, ACECRTehranIran
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Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 2022; 17:360-376. [PMID: 35576513 DOI: 10.1089/bfm.2022.29207.kbm] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Katrina B Mitchell
- Department of Breast Surgery, Ridley-Tree Cancer Center, Sansum Clinic, Santa Barbara, California, USA
| | - Helen M Johnson
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Anne Eglash
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - Kyle Widmer Cash
- Department of Medicine, Tulane University School of Medicine, Southeast, Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
| | - Pamela Berens
- Department of Obstetrics and Gynecology, University of Texas, Houston, Texas, USA
| | - Brooke Miller
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Breast MRI during pregnancy and lactation: clinical challenges and technical advances. Insights Imaging 2022; 13:71. [PMID: 35397082 PMCID: PMC8994812 DOI: 10.1186/s13244-022-01214-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
The breast experiences substantial changes in morphology and function during pregnancy and lactation which affects its imaging properties and may reduce the visibility of a concurrent pathological process. The high incidence of benign gestational-related entities may further add complexity to the clinical and radiological evaluation of the breast during the period. Consequently, pregnancy-associated breast cancer (PABC) is often a delayed diagnosis and carries a poor prognosis. This state-of-the-art pictorial review illustrates how despite currently being underutilized, technical advances and new clinical evidence support the use of unenhanced breast MRI during pregnancy and both unenhanced and dynamic-contrast enhanced (DCE) during lactation, to serve as effective supplementary modalities in the diagnostic work-up of PABC.
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Affiliation(s)
- Noam Nissan
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel.
| | - Ethan Bauer
- Sackler Medicine School, New-York Program, Tel Aviv University, Tel Aviv, Israel
| | - Efi Efraim Moss Massasa
- Joint Medicine School Program of Sheba Medical Center, St. George's, University of London and the University of Nicosia, Sheba Medical Center, Tel Hashomer, Israel
| | - Miri Sklair-Levy
- Radiology Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
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Perez F, Bragg A, Whitman G. Pregnancy Associated Breast Cancer. J Clin Imaging Sci 2022; 11:49. [PMID: 35003831 PMCID: PMC8730537 DOI: 10.25259/jcis_81_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022] Open
Abstract
Pregnancy associated breast cancer (PABC) is a subset of cancer that is too often diagnosed at a more advanced stage due to physiologic changes of the breast and lack of awareness among patients and physicians, resulting in higher mortality rates. While PABC is rare, it is postulated that as women delay childbearing, the rate of PABC may increase. Therefore, it is important to discuss appropriate workup, safety of mammography during pregnancy, and biopsy techniques.
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Affiliation(s)
- Frances Perez
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ashley Bragg
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Gary Whitman
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
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17
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MRI of the Lactating Breast: Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features. Acad Radiol 2021; 29:1332-1341. [PMID: 34857455 DOI: 10.1016/j.acra.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. MATERIALS AND METHODS The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups' trends and differences between the lactating and cancer cohorts were statistically assessed. RESULTS CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001). CONCLUSION BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.
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Pollack EB, O’Keefe MC. Breast Imaging in Special Populations: Indications and Findings in Pregnant and Lactating, Male, and Transgender Patients. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hara Y, Yano H, Yamaguchi R, Iwasaki K. Surgical excision of a lactating adenoma with rapid enlargement: A case report. Int J Surg Case Rep 2021; 89:106544. [PMID: 34775327 PMCID: PMC8593456 DOI: 10.1016/j.ijscr.2021.106544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction and importance A lactating adenoma is a benign breast tumor occurring in young women during pregnancy or lactation. Its growth is usually slow but, occasionally, can become rapid, resulting in a giant mass. This case report outlines an example of the rapid growth of a lactating adenoma, which was surgically excised. In this case, malignancy could not be ruled out, and biopsy and surgical excision were considered. Case presentation We present the case of a 28-year-old woman referred to us owing to the presence of a left breast mass with progressive enlargement. She initially presented with a left breast mass of approximately 20-mm in size, which increased to an approximate size of 70 mm during pregnancy. The patient's mammogram showed an equal-density lobular mass in the left breast. Ultrasonography and magnetic resonance imaging revealed a circumscribed lobular mass with cystic regions in the upper lateral quadrant. The patient was diagnosed with adenosis using core needle biopsy. However, it did not shrink during follow-up, and resection was performed. Histologically, the proliferation of the cystic ducts containing eosinophilic secretions and dilated tubules consisting of cuboidal or hobnail-shaped cells were observed. Clinical discussion Lactating adenoma, phyllodes tumor, and breast cancer are essential differential diagnoses when the size of breast masses increases rapidly. Ultrasonography is the first choice to examine lactating adenomas. Echogenic bands and pseudocapsules are characteristics of lactating adenomas. Conclusion Surgical excision is a notable treatment option when a lactating adenoma exhibits rapid growth or increase in mass, as it could be malignant. A lactating adenoma is a benign breast tumor. It rarely grows rapidly resulting in a giant mass. When this occurs, differentiation from malignancy is important. If malignancy cannot be ruled out, surgical excision becomes a feasible alternative.
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Affiliation(s)
- Yuki Hara
- Department of Breast Surgery, Sasebo City General Hospital, Sasebo, Nagasaki 857-8511, Japan.
| | - Hiroshi Yano
- Department of Breast Surgery, Sasebo City General Hospital, Sasebo, Nagasaki 857-8511, Japan
| | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka 839-0863, Japan.
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General Hospital, Sasebo, Nagasaki 857-8511, Japan.
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20
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Dendl K, Koerber SA, Finck R, Mokoala KMG, Staudinger F, Schillings L, Heger U, Röhrich M, Kratochwil C, Sathekge M, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI-PET/CT in patients with various gynecological malignancies. Eur J Nucl Med Mol Imaging 2021; 48:4089-4100. [PMID: 34050777 PMCID: PMC8484099 DOI: 10.1007/s00259-021-05378-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE 68Ga-FAPI (fibroblast activation protein inhibitor) is a novel and highly promising radiotracer for PET/CT imaging. The aim of this retrospective analysis is to explore the potential of FAPI-PET/CT in gynecological malignancies. We assessed biodistribution, tumor uptake, and the influence of pre- or postmenopausal status on tracer accumulation in hormone-sensitive organs. Furthermore, a comparison with the current standard oncological tracer 18F-FDG was performed in selected cases. PATIENTS AND METHODS A total of 31 patients (median age 59.5) from two centers with several gynecological tumors (breast cancer; ovarian cancer; cervical cancer; endometrial cancer; leiomyosarcoma of the uterus; tubal cancer) underwent 68Ga-FAPI-PET/CT. Out of 31 patients, 10 received an additional 18F-FDG scan within a median time interval of 12.5 days (range 1-76). Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean, and tumor-to-background ratio (TBR) was calculated (SUVmax tumor/ SUVmean organ). Moreover, a second cohort of 167 female patients with different malignancies was analyzed regarding their FAPI uptake in normal hormone-responsive organs: endometrium (n = 128), ovary (n = 64), and breast (n = 147). These patients were categorized by age as premenopausal (<35 years; n = 12), postmenopausal (>65 years; n = 68), and unknown menstrual status (35-65 years; n = 87), followed by an analysis of FAPI uptake of the pre- and postmenopausal group. RESULTS In 8 out of 31 patients, the primary tumor was present, and all 31 patients showed lesions suspicious for metastasis (n = 81) demonstrating a high mean SUVmax in both the primary (SUVmax 11.6) and metastatic lesions (SUVmax 9.7). TBR was significantly higher in 68Ga-FAPI compared to 18F-FDG for distant metastases (13.0 vs. 5.7; p = 0.047) and by trend for regional lymph node metastases (31.9 vs 27.3; p = 0.6). Biodistribution of 68Ga-FAPI-PET/CT presented significantly lower uptake or no significant differences in 15 out of 16 organs, compared to 18F-FDG-PET/CT. The highest uptake of all primary lesions was obtained in endometrial carcinomas (mean SUVmax 18.4), followed by cervical carcinomas (mean SUVmax 15.22). In the second cohort, uptake in premenopausal patients differed significantly from postmenopausal patients in endometrium (11.7 vs 3.9; p < 0.0001) and breast (1.8 vs 1.0; p = 0.004), whereas no significant difference concerning ovaries (2.8 vs 1.6; p = 0.141) was observed. CONCLUSION Due to high tracer uptake resulting in sharp contrasts in primary and metastatic lesions and higher TBRs than 18F-FDG-PET/CT, 68Ga-FAPI-PET/CT presents a promising imaging method for staging and follow-up of gynecological tumors. The presence or absence of the menstrual cycle seems to correlate with FAPI accumulation in the normal endometrium and breast. This first investigation of FAP ligands in gynecological tumor entities supports clinical application and further research in this field.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Rebecca Finck
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Fabian Staudinger
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lisa Schillings
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Dirk Jäger
- Department of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany.
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany.
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Radiology–Pathology Correlation: Inflammatory Conditions of the Breast. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Apéré-Mocho G, Acko-Ohui E, Isart D, Majthoub A, Simionca G, Marchand C, Bravo-Tsri B, Lokossou A. Infarctus mammaire spontané : à propos d’un cas. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Cepeda Martins AR, Di Maria S, Afonso J, Pereira M, Pereira J, Vaz P. Assessment of the uterine dose in digital mammography and digital breast tomosynthesis. Radiography (Lond) 2021; 28:333-339. [PMID: 34565679 DOI: 10.1016/j.radi.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Digital Mammography (DM-2D) and more recently Digital Breast Tomosynthesis (DBT), are two of the most effective imaging modalities for breast cancer detection, often used in screening programmes. It may happen that exams using these two imaging modalities are inadvertently performed to pregnant women. The objective of this study is to assess the dose in the uterus due to DM-2D and DBT exams, according to two main irradiation scenarios: in the 1st scenario the exposure parameters were pre-selected directly by the imaging system, while in the 2nd scenario, the maximum exposure parameters were chosen. METHODS The mammography equipment used was a Siemens Mammomat Inspiration. A physical anthropomorphic phantom, PMMA plates (simulating a breast thickness of 6 cm) and thermoluminescent dosimeters (TLDs) were used to measure entrance air kerma values on the phantom's breast and abdomen in order to successively estimate the mean glandular dose (MGD) and the dose in the uterus. For the two irradiation scenarios chosen, two-breast imaging modalities were selected: 1) DBT in Cranio-Caudal (CC) view (with 28 kV and 160 mAs as exposure parameters), 2) DBT and DM in Medio Lateral-Oblique (MLO) and CC views (with 34 kV and 250 mAs as exposure parameters). RESULTS In the 1st scenario, the TLD measurements did not detect significant dose values in the abdomen whereas the MGD estimated using the D.R. Dance model was in close agreement with data available in the literature. In the 2nd scenario, there was no significant difference in MGD estimation between the different views, whereas the air kerma values in the abdomen (in DBT mode, CC and MLO) were 0.049 mGy and 0.004 mGy respectively. In CC DM-2D mode the abdomen air kerma value was 0.026 mGy, with no significant detected value in MLO view. CONCLUSIONS For the dose in the uterus, the obtained values seem to indicate that DM-2D and DBT examinations inadvertently performed during pregnancy do not pose a significant radiological risk, even considering the case of overexposure in both breasts. IMPLICATIONS FOR PRACTICE The accurate knowledge of the doses in DM-2D and DBT will contribute to raise the awareness among medical practitioners involved in breast imaging empowering them to provide accurate information about dose levels in the uterus, improving their radiation risk communication skills and consequently helping to reduce the anxiety of pregnant women undergoing this type of examinations.
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Affiliation(s)
- A R Cepeda Martins
- Inspeção Geral da Agricultura, do Mar, do Ambiente, e do Ordenamento do Territorio (IGAMOT), Seção Radiações Ionizantes, Rua de O Seculo, N.51, 1200-433, Lisbon, Portugal
| | - S Di Maria
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066, Bobadela LRS, Portugal.
| | - J Afonso
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - M Pereira
- Agência Portuguesa do Ambiente, Departamento de Emergências e Proteção Radiológica, Divisão de Autorização e Segurança Nuclear, Rua da Murgueira 9 - Zambujal - Alfragide, 2610-124, Amadora, Portugal
| | - J Pereira
- Agência Portuguesa do Ambiente, Departamento de Emergências e Proteção Radiológica, Divisão de Autorização e Segurança Nuclear, Rua da Murgueira 9 - Zambujal - Alfragide, 2610-124, Amadora, Portugal
| | - P Vaz
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066, Bobadela LRS, Portugal
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24
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A new search pattern for emergency breast exams: the clinical picture. Emerg Radiol 2021; 29:207-213. [PMID: 34533665 DOI: 10.1007/s10140-021-01958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
Distinct breast diseases are readily diagnosed by clinical and ultrasound appearance that radiologists and sonographers may encounter in emergency room and urgent care patient presentations. While it may be impractical or impossible for the on-call emergency radiologist to examine a patient with breast complaints, radiologists can and should adopt the practice pattern to routinely seek out the clinical photographs in the patient's medical record while interpreting breast examinations. Imaging should be interpreted in the context of both the history and the physical findings. Sonographers play important roles in the documentation of visual inspection findings, in addition to performing high quality targeted ultrasound where applicable. This pictorial offers resources to emergency radiologists and sonographers that facilitate rapid accurate diagnosis of ten distinct breast diseases.
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Holtz JN, Woodard GA, Hayward JH, Ray KM, Kannan N, Greenwood HI, Joe BN, Lee AY. The Value of Targeted Ultrasound for the Primary Evaluation of Breast Symptoms in Pregnant Women of All Ages. JOURNAL OF BREAST IMAGING 2021; 3:556-563. [PMID: 38424949 DOI: 10.1093/jbi/wbab058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Data on breast imaging in symptomatic pregnant women are limited. Our aim was to assess the value of targeted breast US for the primary evaluation of breast symptoms in pregnant women of all ages. METHODS This IRB-approved retrospective study included all pregnant patients who underwent targeted US for focal breast symptoms at an academic imaging facility over an 18-year period (2000-2018). Clinical, imaging, and pathology results were reviewed. Malignant outcomes were determined by histology. Benign outcomes were confirmed by pathology or ≥2 years of follow-up. Descriptive statistics and 2 × 2 contingency table analyses were performed at the presentation level. RESULTS The study cohort comprised 178 presentations in 175 pregnant women. Mean age was 34.7 years (standard deviation, 5.2). The majority (153/178, 86.0%) were more than 30 years old. At presentation, 42.1% (75/178) were in the first trimester of pregnancy, 27.0% (48/178) in the second, and 29.8% (53/178) in the third. The most common presenting symptom was a palpable lump (162/178, 91.0%), followed by focal pain (7/178, 3.9%). The vast majority (174/178, 97.8%) of cases were non-malignant. However, targeted US detected all 4 malignancies (cancer detection rate, 22/1000; negative predictive value 136/136, 100%). Sensitivity and specificity were 100% (4/4) and 78.2% (136/174), respectively. CONCLUSION Benign causes of symptoms in pregnant women were far more common; malignancy was rare, accounting for only 2.2% (4/178) of cases. Targeted breast US detected all malignancies, supporting US as the primary imaging modality for evaluating symptomatic pregnant women, regardless of age.
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Affiliation(s)
- Jamie N Holtz
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | | | - Jessica H Hayward
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Kimberly M Ray
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Neeta Kannan
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Heather I Greenwood
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Bonnie N Joe
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Amie Y Lee
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
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Casinelli A, Malavolta G, Caruso G, Capri O, Ballesio L. Breast imaging screening in a BRCA1-mutated lactating patient: A potential pitfall mimicking malignancy. Radiol Case Rep 2021; 16:3104-3108. [PMID: 34429812 PMCID: PMC8367808 DOI: 10.1016/j.radcr.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/10/2021] [Indexed: 11/26/2022] Open
Abstract
Breast imaging screening during lactation poses a real clinical challenge, especially in high-risk patients. We presented the case of a 34-year-old BRCA1-mutated woman showing marked, asymmetric background parenchymal enhancement on the right breast suspicious for malignancy in the context of annual screening magnetic resonance imaging. The patient revealed that she was still occasionally breastfeeding her two-year-old child only from right side. Ultrasound evaluation reported typical benign lactational findings on the right enhancing breast. An in-depth understanding of expected/ physiologic breast changes during lactation and an accurate clinical-radiological correlation are required to appropriately guide patient management and avoid misdiagnosis.
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Affiliation(s)
- Alice Casinelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy
| | - Giulia Malavolta
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Oriana Capri
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Laura Ballesio
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Italy
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Faast A, Ikeda DM, Pittman S, DeMartini W, Kozlov A. FDG Avid Abnormalities in the Breast: Breast Cancer Mimics. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Maranhão N, Maranhão B. Practical considerations for evaluation of images of the breast during pregnancy and lactation. Radiol Bras 2021; 54:VII-VIII. [PMID: 33574635 PMCID: PMC7863715 DOI: 10.1590/0100-3984.2021.54.1e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Norma Maranhão
- Member of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Director of Lucilo Maranhão Diagnósticos, Recife, PE, Brazil. E-mail:
| | - Beatriz Maranhão
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Director of Lucilo Maranhão Diagnósticos, Recife, PE, Brazil. E-mail:
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Acuña J, Pierre CM, Sorenson J, Adhikari S. Point-of-care Ultrasound to Evaluate Breast Pathology in the Emergency Department. West J Emerg Med 2021; 22:284-290. [PMID: 33856313 PMCID: PMC7972395 DOI: 10.5811/westjem.2020.10.48008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction As physician-performed point-of-care ultrasound (POCUS) becomes more prevalent in the evaluation of patients presenting with various complaints in the emergency department (ED), one application that is significantly less used is breast ultrasound. This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED. Methods This was a retrospective review of ED patients presenting with breast symptoms who received a POCUS examination. An ED POCUS database was reviewed for breast POCUS examinations. We then reviewed electronic health records for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of the POCUS study on patient care and disposition. Results We included a total of 40 subjects (36 females, 4 males) in the final analysis. Most common presenting symptoms were breast pain (57.5%) and a palpable mass (37.5%). “Cobblestoning,” ie, dense bumpy appearance, was the most common finding on breast POCUS, seen in 50% of the patients. Simple fluid collections were found in 37.5% of patients. Conclusion Our study findings illustrate the utility of POCUS in the evaluation of a variety of breast complaints in the ED.
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Affiliation(s)
- Josie Acuña
- The University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Cubby M Pierre
- The University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Jacob Sorenson
- The University of Arizona, College of Medicine, Tucson, Arizona
| | - Srikar Adhikari
- The University of Arizona, Department of Emergency Medicine, Tucson, Arizona
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False-Positive 18F-FDG PET/CT Uptake in Unilateral Lactation. Case Rep Radiol 2021; 2020:8850052. [PMID: 33489403 PMCID: PMC7803103 DOI: 10.1155/2020/8850052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
A 31-year-old woman (7 months postpartum and lactating) with multiple sclerotic bone lesions was referred for an 18F-FDG PET/CT scan for characterization. The scan demonstrated unilateral diffuse intense FDG uptake corresponding to dense soft tissue in the right breast, likely related to secretory hyperplasia. On further questioning, it was made apparent that she had only been breastfeeding from the right breast. While the left breast also demonstrated dense soft tissue to a lesser degree, no significant FDG uptake was seen. The sclerotic bone lesions were not FDG avid, likely due to a separate non-FDG avid benign condition or bony metastases from a non-FDG avid primary malignancy. This was reinforced by the fact that subsequent investigations including serial bilateral breast ultrasound and percutaneous biopsy demonstrated no definite evidence of malignancy in the bilateral breasts. The histopathology findings of an open surgical biopsy of sclerotic lesions in the left posterior ilium were also nonspecific, favouring bone dysplasia with no evidence of malignancy.
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31
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Woodard GA, Bhatt AA, Knavel EM, Hunt KN. Mastitis and More: A Pictorial Review of the Red, Swollen, and Painful Breast. JOURNAL OF BREAST IMAGING 2021; 3:113-123. [PMID: 38424840 DOI: 10.1093/jbi/wbaa098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
Clinically, acute mastitis presents as a red, swollen, and painful breast. Targeted ultrasound can be performed to evaluate the extent of infection and for an underlying abscess. Noncomplicated mastitis or a small fluid collection may respond to oral antibiotics without further intervention, but a larger or more complex abscess may require single or serial percutaneous aspiration. Breast infections, particularly those complicated by an abscess, can have a prolonged clinical course, and close follow-up is required. Since the clinical presentation and imaging features of acute infectious mastitis can overlap with other etiologies, such as inflammatory breast cancer and idiopathic granulomatous mastitis, a percutaneous biopsy may be indicated to accurately diagnose patients.
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Affiliation(s)
| | - Asha A Bhatt
- Mayo Clinic, Department of Radiology, Rochester, MN
| | | | - Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN
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Kanbayti IH, Rae WID, McEntee MF, Ekpo EU. Mammographic density changes following BC treatment. Clin Imaging 2021; 76:88-97. [PMID: 33578136 DOI: 10.1016/j.clinimag.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mammographic density (MD) reduction is associated with lower risk of breast cancer (BC) recurrence and may be used as a marker of treatment outcome; however, trends in MD following BC therapies and the factors associated with such trends are poorly understood. The aim of this study was to investigate MD changes following BC treatment and the factors associated with these changes. METHODS A total of 226 BC-affected patients who received BC treatments were examined. MD was assessed by the Laboratory for individualized Radiodensity Assessment (LIBRA) software. A Wilcoxon ranked signed test was used to investigate the differences in MD before and after treatment and median independent test to assess the associated factors. RESULTS Significant differences in MD between baseline and follow-up mammograms were observed for all MD measures: percent density (p ≤ 0.005), dense area (p ≤ 0.004), and nondense area (p ≤ 0.02). After adjustment, these differences were more pronounced among younger at BC diagnosis (p ≤ 0.001), premenopausal (p ≤ 0.003), and obese women (p ≤ 0.05). Changes in MD were evident regardless of the treatment regimen. MD reduction was observed among patients with high baseline MD (p < 0.001), younger at BC diagnosis (p ≤ 0.04), premenopausal (p < 0.001), and normal body mass index (p = 0.04). Patients who experienced an increase in nondense area had high percent density at baseline (p ≤ 0.001). CONCLUSION Two different MD changes were observed over time: MD increase and decrease. Baseline MD, menopausal status, age at BC diagnosis, and body mass index influenced these changes.
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Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Saudi Arabia; Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Australia.
| | - William I D Rae
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Australia
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Australia; Department of Medicine Roinn na Sláinte, UG 12 Áras Watson, Brookfield Health Sciences |T12 AK54, Ireland
| | - Ernest U Ekpo
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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Rosas CHDS, Góes ACDA, Saltão LM, Tanaka AMDS, Marques EF, Bitencourt AGV. Pregnancy-lactation cycle: how to use imaging methods for breast evaluation. Radiol Bras 2020; 53:405-412. [PMID: 33304009 PMCID: PMC7720671 DOI: 10.1590/0100-3984.2019.0071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy and lactation constitute states of intense hormonal variation with secretory and structural changes in the breast parenchyma. These changes translate into important features on breast imaging, as well as the emergence of specific benign and malignant lesions. This literature review aims to discuss the safety of the use of breast imaging methods (mammography, ultrasound, and magnetic resonance imaging) during the pregnancy-lactation cycle, and to present the expected physiological changes and imaging appearance of the main breast diseases that may occur in this period, such as galactocele, lactating adenoma, fibroadenoma, puerperal mastitis, and pregnancy-associated breast cancer.
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Langer AK. Breast Imaging in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:17-25. [PMID: 32816258 DOI: 10.1007/978-3-030-41596-9_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
All breast disorders found during pregnancy and lactation should be carefully evaluated. Most of them are benign, but it is essential to exclude pregnancy-associated breast cancer (PABC), which is too often diagnosed late. The first-line imaging technique is ultrasound (US), which must be completed by mammography if there is any clinical or US suspicious sign . In lactating patients with PABC , breast magnetic resonance imaging (MRI) can be useful for local assessment.Management depends on the precise analysis and BI-RADS classification of the lesion. During pregnancy and lactation, there is an overlap in imaging: many benign lesions can grow, infarct, become heterogeneous and thus suspicious, and on the other hand, PABC does not always present with typical malignant features. That is why biopsy must be performed if after the clinical and radiological evaluation the doubt persists, i.e. for all BI-RADS 4 and 5 lesions, and for some BI-RADS 3 lesions.
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Breast Cytology and Pathology in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32816259 DOI: 10.1007/978-3-030-41596-9_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.
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Chung M, Hayward JH, Woodard GA, Knobel A, Greenwood HI, Ray KM, Joe BN, Lee AY. US as the Primary Imaging Modality in the Evaluation of Palpable Breast Masses in Breastfeeding Women, Including Those of Advanced Maternal Age. Radiology 2020; 297:316-324. [PMID: 32870133 DOI: 10.1148/radiol.2020201036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Women are increasingly delaying childbearing, and thus lactation, into their 30s and 40s, when mammography would typically be the initial imaging modality to evaluate palpable masses in the general population. Current guidelines recommend US as the first-line imaging modality for palpable masses in pregnant and lactating women, but data regarding breastfeeding women age 30 years and older are near nonexistent. Purpose To evaluate the diagnostic performance of targeted US as the primary imaging modality for the evaluation of palpable masses in lactating women, including those of advanced maternal age. Materials and Methods Lactating women with palpable breast masses evaluated at targeted US over a 17-year period (January 2000 to July 2017) were retrospectively identified. All US evaluations were performed at diagnostic evaluation, and mammography was performed at the discretion of the interpreting radiologist. Breast Imaging Reporting and Data System assessments, imaging, and pathology results were collected. Descriptive statistics and 2 × 2 contingency tables were assessed at the patient level. Results There were 167 women (mean age, 35 years ± 5 [standard deviation]), 101 of whom (60%) were of advanced maternal age (≥35 years). All women underwent targeted US, and 98 (59%) underwent mammography in addition to US. The frequency of malignancy was five of 167 (3.0%). Targeted US demonstrated a sensitivity and specificity of five of five (100%; 95% confidence interval [CI]: 48%, 100%) and 114 of 162 (70%; 95% CI: 63%, 77%), respectively. Negative predictive value, positive predictive value of an abnormal examination, and positive predictive value of biopsy were 114 of 114 (100%; 95% CI: 97%, 100%), five of 53 (9.4%; 95% CI: 3%, 21%), and five of 50 (10%; 95% CI: 3%, 22%), respectively. In the subset of 98 women who underwent mammography in addition to US, mammography depicted seven incidental suspicious findings, which lowered the specificity from 62 of 93 (67%; 95% CI: 56%, 76%) to 57 of 93 (61%; 95% CI: 51%, 71%) (P = .02). Conclusion Targeted US depicted all malignancies in lactating women with palpable masses. Adding mammography increased false-positive findings without any additional cancer diagnoses. © RSNA, 2020 See also the editorial by Newell in this issue.
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Affiliation(s)
- Maggie Chung
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Jessica H Hayward
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Genevieve A Woodard
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Anna Knobel
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Heather I Greenwood
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Kimberly M Ray
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Bonnie N Joe
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
| | - Amie Y Lee
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1825 4th St, Room L3185, San Francisco, CA, 94107 (M.C., J.H.H., A.K., H.I.G., K.M.R., B.N.J., A.Y.L.); and Department of Radiology, Mayo Clinic, Rochester, Minn (G.A.W.)
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Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. AJR Am J Roentgenol 2020; 216:1462-1475. [PMID: 32755376 DOI: 10.2214/ajr.20.23905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During pregnancy and lactation, the breast undergoes unique changes that manifest as varied clinical and imaging findings. Understanding the expected physiologic changes of the breast as well as recognizing the best imaging modalities for a given clinical scenario can help the radiologist identify the abnormalities arising during this time. Discussion with the patient about the safety of breast imaging can reassure patients and improve management. This article reviews the physiologic changes of the breast during pregnancy and lactation; the safety and utility of various imaging modalities; upto-date consensus on screening guidelines; recommendations for diagnostic evaluation of breast pain, palpable abnormalities, and nipple discharge; and recommendations regarding advanced modalities such as breast MRI. In addition, the commonly encountered benign and malignant entities affecting these patients are discussed.
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Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Helen M Johnson
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Katrina B Mitchell
- Surgical Oncology, Ridley Tree Cancer Center at Sansum Clinic, Santa Barbara, California, USA
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Ngaserin S, Chua HW, Mipuri TM. FDG-PET/CT unilateral breast enlargement and diffuse hypermetabolism related to unilateral lactation in a patient with primary biliary cirrhosis. Breast J 2020; 26:2094-2095. [PMID: 32469088 DOI: 10.1111/tbj.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sabrina Ngaserin
- Department of Surgery, Sengkang General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
| | - Hui Wen Chua
- Department of Surgery, Sengkang General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
| | - Tarun Mohan Mipuri
- SingHealth Duke-NUS Breast Centre, Singapore, Singapore.,Department of Radiology, Sengkang General Hospital, Singapore, Singapore
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40
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Sivarajah R, Welkie J, Mack J, Casas RS, Paulishak M, Chetlen AL. A Review of Breast Pain: Causes, Imaging Recommendations, and Treatment. JOURNAL OF BREAST IMAGING 2020; 2:101-111. [PMID: 38424883 DOI: 10.1093/jbi/wbz082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Indexed: 03/02/2024]
Abstract
Over two-thirds of women will experience breast pain in their lifetime. As one of the leading breast symptoms for which women seek medical attention, breast pain is suspected to be underreported and under-studied. Cyclical breast pain is related to hormonal changes. Noncyclical breast pain is independent of the menstrual cycle and can be idiopathic and related to chronic pain syndromes, infections, ill-fitting bras, musculoskeletal abnormalities, pregnancy, perimenopause, and postsurgical causes. Breast pain can also present in transgender patients and may require additional considerations as to the underlying cause. Imaging of mastalgia depends upon the suspected etiology. Inappropriate imaging for breast pain is associated with significant utilization of health care resources. Cyclical breast pain does not require an imaging work-up. The work-up of focal, noncyclical breast pain includes ultrasound for women aged younger than 40 years, and mammography and ultrasound for women aged 40 years and older. Management of breast pain is often supportive, as most breast pain resolves spontaneously. If pain persists, imaging and management should follow a step-wise approach. If conservative measures fail, second-line therapy is topical nonsteroidal anti-inflammatory drugs. If breast pain is severe and resistant to conservative methods, additional third-line therapies can be added by breast care specialists with specific knowledge of the potential deleterious side effects of these medications. While the causes of mastalgia are overwhelmingly benign, breast pain can significantly impact quality of life, and the breast radiologist should be familiar with causes, management, and treatment recommendations from a multidisciplinary approach.
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Affiliation(s)
- Rebecca Sivarajah
- Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA
| | - Janelle Welkie
- Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA
- Penn State College of Medicine, Hershey, PA
| | - Julie Mack
- Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA
| | - Rachel S Casas
- Penn State Health-Hershey Medical Center, Department of General Internal Medicine, Hershey, PA
| | - Melody Paulishak
- Penn State Health-Hershey Medical Center, Department of Surgery, Hershey, PA
| | - Alison L Chetlen
- Penn State Health-Hershey Medical Center, Department of Radiology, Hershey, PA
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41
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Clark HR, Merchant KA, Omar LA, Compton LM, Hayes JC. Breast Lesions in Women Aged Younger than 30 Years: Clinical Presentation, Diagnosis, and Management. JOURNAL OF BREAST IMAGING 2020; 2:72-80. [PMID: 38425001 DOI: 10.1093/jbi/wbz086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/06/2019] [Indexed: 03/02/2024]
Abstract
Women aged younger than 30 years frequently present with palpable breast lesions, breast pain, and nipple discharge. Diagnostic work-up often results in benign findings, including a variety of benign solid masses, infectious or inflammatory conditions, pregnancy- or lactation-related abnormalities, and normal variants. While rare, breast cancer can occur within this demographic, and it is often more advanced and aggressive than in older women. Other rare tumors can present within this patient demographic, including primary sarcoma of the breast and granular cell tumors. A knowledge of the clinical presentation, diagnostic approach, and management of this spectrum of pathologic entities is crucial to ensure optimal and cost-effective care within this patient demographic.
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Affiliation(s)
- Haley R Clark
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Kanwal A Merchant
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Lena A Omar
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Lindsay M Compton
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Jody C Hayes
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
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Lee SE, Bae YK. Breast lesions during pregnancy and lactation: a pictorial essay. Ultrasonography 2020; 39:298-310. [PMID: 32114749 PMCID: PMC7315302 DOI: 10.14366/usg.19070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022] Open
Abstract
A wide range of breast lesions can arise during pregnancy and lactation, from benign or Epub ahead of print inflammatory diseases to malignant tumors. Hormone-influenced physiological changes of the breast make the radiological evaluation of breast lesions challenging. Knowledge of the imaging features of normal physiological changes and common breast lesions during this period can help radiologists accurately diagnose and appropriately manage conditions. As such, this pictorial essay illustrates normal physiological changes related to pregnancy and lactation, as well as common benign and malignant breast lesions encountered during those periods.
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Affiliation(s)
- Seung Eun Lee
- Department of Radiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
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43
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Abramson L, Massaro L, Alberty-Oller JJ, Melsaether A. Breast Imaging During Pregnancy and Lactation. JOURNAL OF BREAST IMAGING 2019; 1:342-351. [PMID: 38424810 DOI: 10.1093/jbi/wbz065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/18/2019] [Indexed: 03/02/2024]
Abstract
Breast imaging during pregnancy and lactation is important in order to avoid delays in the diagnosis and treatment of pregnancy-associated breast cancers. Radiologists have an opportunity to improve breast cancer detection by becoming familiar with appropriate breast imaging and providing recommendations to women and their referring physicians. Importantly, during pregnancy and lactation, both screening and diagnostic breast imaging can be safely performed. Here we describe when and how to screen, how to work up palpable masses, and evaluate bloody nipple discharge. The imaging features of common findings in the breasts of pregnant and lactating women are also reviewed. Finally, we address breast cancer staging and provide a brief primer on treatment options for pregnancy-associated breast cancers.
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Affiliation(s)
- Lisa Abramson
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
| | - Lindsey Massaro
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
| | | | - Amy Melsaether
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
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45
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Taşkın F, Polat Y, Erdoğdu İH, Soyder A. Pregnancy-associated breast cancer: A review of 47 women. Clin Imaging 2019; 58:182-186. [PMID: 31404824 DOI: 10.1016/j.clinimag.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is a rare disease. However, its expected incidence tends to be increased because of delayed maternal age. The purpose of this study was to describe the clinical, radiological, and histopathological characteristics of PABC cases diagnosed in our center. METHODS The clinical-radiological findings and histopathological characteristics of patients diagnosed and treated with PABC at our institution between January 2011 and January 2017 were retrospectively evaluated. RESULTS Mammography and ultrasonography were performed in all patients. MRI examination was performed in 18 patients. Nine (19.1%) out of 47 patients were diagnosed with breast cancer during pregnancy, and 38 (80.9%) were in their first year after delivery. The most frequent finding (95.7%) during imaging was one or more masses. Mammography-detected pure or accompanying microcalcifications were found in 12 (25.5%) patients. MRI detected additional multifocal and multicentric disease in 14 (29.8%) patients and contralateral cancer in one (2.1%) patient. CONCLUSIONS Pregnancy-related breast cancer tends to be diagnosed in an advanced stage with poor prognosis. Any breast abnormalities observed in this period should alert clinicians, and a meticulous radiological evaluation is mandatory. The early diagnosis of this disease would increase the chances of successful treatment.
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Affiliation(s)
- Füsun Taşkın
- Acibadem University School of Medicine, Department of Radiology, 34303 Istanbul, Turkey.
| | - Yasemin Polat
- Adnan Menderes University School of Medicine, Department of Radiology, 09010 Aydin, Turkey
| | - İbrahim H Erdoğdu
- Adnan Menderes University School of Medicine, Department of Pathology, 09010 Aydin, Turkey
| | - Aykut Soyder
- Adnan Menderes University School of Medicine, Department of General Surgery, 09010 Aydin, Turkey
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46
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Ravikanth R, Kamalasekar K. Imaging of Lactating Adenoma: Differential Diagnosis of Solid Mass Lesion in a Lactating Woman. J Med Ultrasound 2019; 27:208-210. [PMID: 31867197 PMCID: PMC6905250 DOI: 10.4103/jmu.jmu_3_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/26/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
Lactating adenoma is an uncommon palpable breast lesion occurring in the late pregnancy or lactation period and is commonly found in young primiparous women in the second or third decade of life. Although a benign condition, sometimes, core biopsy is required to exclude malignancy. Approximately 3% of all breast cancers occur in women who are pregnant; and hence, a breast mass in this group of women must be investigated. The main differential diagnosis for a palpable solid breast mass is lobular hyperplasia which is a normal physiological event, fibroadenoma, focal mastitis, lactating adenoma, tubular adenoma, phyllodes tumor, and breast carcinoma. Here, we present a case of lactating adenoma of the breast at 6 months’ postpartum in a 24-year-old primiparous woman.
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Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, Holy Family Hospital, Idukki, Kerala, India
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47
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Johnson HM, Mitchell KB. Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis. Ann Surg Oncol 2019; 26:3032-3039. [PMID: 31342385 DOI: 10.1245/s10434-019-07596-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Supporting breastfeeding is a global health priority, yet few clinical guidelines exist to guide surgical oncologists in managing lactation during or after breast cancer treatment. METHODS The literature was reviewed to identify evidence-based strategies for managing lactation during multidisciplinary breast cancer treatment or among breast cancer survivors. RESULTS The majority of the evidence is from observational studies, with some higher levels of evidence, including systematic reviews and meta-analyses. Several significant gaps in knowledge remain. CONCLUSIONS This review serves as a comprehensive resource of evidence-based recommendations for managing lactation in breast cancer survivors and breastfeeding women with a new breast cancer diagnosis.
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Affiliation(s)
- Helen M Johnson
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Katrina B Mitchell
- Breast Surgical Oncology, Presbyterian Healthcare Services - MD Anderson Cancer Network, Albuquerque, NM, USA.
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48
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Zha N, Alabousi M, Abdullah P, Freitas V, Linthorst R, Muhn N, Alabousi A. Breast Cancer Screening in High-Risk Patients during Pregnancy and Breastfeeding: A Systematic Review of the Literature. JOURNAL OF BREAST IMAGING 2019; 1:92-98. [PMID: 38424914 DOI: 10.1093/jbi/wby015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 03/02/2024]
Abstract
There are currently no clear guidelines for high-risk breast cancer screening during the pregnancy and breastfeeding periods. The objective of this systematic review (SR) was to assess the available evidence pertaining to breast cancer screening recommendations in this population with the aim of supporting future guidelines. We performed a SR of the literature using the electronic databases MEDLINE and Embase. Predetermined inclusion and exclusion criteria were used during the abstract screening and full-text data extraction phases. We retrieved 2,274 abstracts after removal of duplicates, from which 16 studies were included based on predetermined eligibility criteria. Most of the studies found were narrative reviews and expert opinions. Clinical breast exam (CBE) was recommended by 12 studies during pregnancy and by 6 studies in the breastfeeding period. Mammography was recommended in the breastfeeding period by 2 studies. Magnetic resonance imaging was recommended in the breastfeeding period by 2 studies. Ultrasound was considered not appropriate for screening in this population. The information extracted from this SR is based primarily on expert opinion and anecdotal evidence, which explains the lack of standardized guidelines for high-risk breast cancer screening in this population. However, expert opinion may be a surrogate outcome for high-risk breast cancer screening recommendations in this subset of patients, and as such, may justify the clinical management to be tailored accordingly. This SR summarizes the evidence pertaining to high-risk breast cancer screening during pregnancy and breastfeeding, which could serve as a catalyst for future research on the topic.
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Affiliation(s)
- Nanxi Zha
- McMaster University, Department of Radiology, Hamilton, ON, Canada
| | - Mostafa Alabousi
- McMaster University, Department of Radiology, Hamilton, ON, Canada
| | - Peri Abdullah
- York University, Department of Kinesiology & Health Science, Toronto, ON, Canada
| | - Vivianne Freitas
- University of Toronto, Joint Department of Medical Imaging, Toronto, ON, Canada
| | - Rhys Linthorst
- McMaster University, DeGroote School of Medicine, Hamilton, ON, Canada
| | - Narry Muhn
- McMaster University, Department of Radiology, Hamilton, ON, Canada
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49
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Mitchell KB, Fleming MM, Anderson PO, Giesbrandt JG, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Wight N, Winter L. ABM Clinical Protocol #30: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeed Med 2019; 14:290-294. [PMID: 31107104 DOI: 10.1089/bfm.2019.29128.kbm] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | | | - Philip O Anderson
- 3 Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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50
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Mitchell KB, Johnson HM, Eglash A, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Winter L, Weissman G, Wight N. ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeed Med 2019; 14:208-214. [PMID: 30892931 DOI: 10.1089/bfm.2019.29124.kjm] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Breast Surgical Oncology, Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | - Helen M Johnson
- 2 Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Anne Eglash
- 3 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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