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Chu ECP, Yun SMH. Metastatic Breast Cancer Presenting As Neck Pain in a Pregnant Patient. Cureus 2024; 16:e51444. [PMID: 38298289 PMCID: PMC10828743 DOI: 10.7759/cureus.51444] [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] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Breast cancer metastasizing to the spine during pregnancy is a rare occurrence. A 36-year-old woman experienced persistent neck pain during the third trimester of pregnancy. The pain continued until the postpartum period, severely affecting quality of life (QOL). Physical examination revealed a restricted cervical range of motion. Spinal lesions were detected on magnetic resonance imaging. Metastatic breast cancer was confirmed through a biopsy. The patient underwent radiation therapy for spinal metastasis, chemotherapy for breast cancer, and nonsteroidal anti-inflammatory drug therapy for pain. She was referred for chiropractic care and physical rehabilitation. After six weeks of collaborative treatment, the patient experienced significant pain relief and improvement in strength, mobility, and QOL. This case report highlights the need to evaluate unexplained symptoms in pregnant and postpartum women to exclude sinister pathologies. It demonstrates the need for a multidisciplinary approach that combines oncological, chiropractic, and rehabilitative care to optimize the outcomes in patients with complex presentations.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Steve Ming Hei Yun
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
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2
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Pyle C, Hill M, Sharafi S, Forton C, Sohaey R. Pregnancy-associated Breast Cancer: Why Breast Imaging During Pregnancy and Lactation Matters. JOURNAL OF BREAST IMAGING 2023; 5:732-743. [PMID: 38141239 DOI: 10.1093/jbi/wbad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 12/25/2023]
Abstract
Pregnancy-associated breast cancer is characterized as breast cancer diagnosed during pregnancy, within the first postpartum year, or during lactation. It usually presents as a palpable mass, although the large majority of palpable masses during pregnancy are benign. Breast cancer is the most common invasive malignancy diagnosed during pregnancy and lactation, and its incidence is increasing as more women delay childbearing. Understanding the appropriate methods for screening and diagnostic workup of breast findings in this population is imperative for radiologists to promptly diagnose pregnancy-associated breast cancer. Use of available imaging modalities should be tailored to patient-specific factors, with US typically the first-line modality due to patient age and decreased sensitivity of mammography in the setting of lactational changes. This article illustrates the spectrum of imaging appearances of pregnancy-associated breast cancer, the appropriate diagnostic imaging workup, and the unique challenges encountered in evaluation of this patient population.
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Affiliation(s)
- Chelsea Pyle
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Molly Hill
- University of Kansas Medical Center, Department of Radiology/Breast Imaging, Kansas City, KS, USA
| | - Shahrzad Sharafi
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Camelia Forton
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
| | - Roya Sohaey
- Oregon Health & Science University, Diagnostic Radiology/Women's Imaging, Portland, OR, USA
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3
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Chung HL, Joiner J, Ferreira Dalla Pria HR, Jean S, Vishwanath V, De Jesus C, Elhatw A, Guirguis MS, Patel MM, Moseley TW. Breast Imaging Considerations in Symptomatic Young, Pregnant, and Lactating Women. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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4
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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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Fazeli S, Sakala M, Rakow-Penner R, Ojeda-Fournier H. Cancer in pregnancy: breast cancer. Abdom Radiol (NY) 2023; 48:1645-1662. [PMID: 36750478 DOI: 10.1007/s00261-023-03824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/09/2023]
Abstract
Breast cancer is the most common malignancy in women, and for women under 40, it is the leading cause of cancer-related deaths. A specific type of breast cancer is pregnancy-associated breast cancer, which is diagnosed during pregnancy, the first-year postpartum, or during lactation. Pregnancy-associated breast cancer is seen in 3/1000 pregnancies and is increasing in incidence as women delay pregnancy. This type of breast cancer is more aggressive, and not infrequently, there is a delay in diagnosis attributed to physiologic changes that occur during pregnancy and a lack of awareness among physicians. In this review, we discuss the demographics of pregnancy-associated breast cancer, provide differential considerations, and illustrate the multimodality imaging features to bring attention to the radiologist about this aggressive form of breast cancer.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA
| | | | - Rebecca Rakow-Penner
- Department of Radiology, Division of Breast Imaging and Body Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, USA
| | - Haydee Ojeda-Fournier
- Department of Radiology, Division of Breast Imaging, UC San Diego Health, 9400 Campus Point Dr., La Jolla, CA, 92037, USA.
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Pregnancy-Associated Breast Cancer: A Diagnostic and Therapeutic Challenge. Diagnostics (Basel) 2023; 13:diagnostics13040604. [PMID: 36832092 PMCID: PMC9955856 DOI: 10.3390/diagnostics13040604] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Pregnancy-associated breast cancer (PABC) is commonly defined as a breast cancer occurring during pregnancy, throughout 1 year postpartum, or during lactation. Despite being a rare circumstance, PABC is one of the most common types of malignancies occurring during pregnancy and lactation, with growing incidence in developed countries, due both to decreasing age at onset of breast cancer and to increasing maternal age. Diagnosis and management of malignancy in the prenatal and postnatal settings are challenging for practitioners, as the structural and functional changes that the breast undergoes may be misleading for both the radiologist and the clinician. Furthermore, safety concerns for the mother and child, as well as psychological aspects in this unique and delicate condition, need to be constantly considered. In this comprehensive review, clinical, diagnostic, and therapeutic aspects of PABC (including surgery, chemotherapy and other systemic treatments, and radiotherapy) are presented and fully discussed, based on medical literature, current international clinical guidelines, and systematic practice.
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7
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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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8
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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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9
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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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10
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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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11
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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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12
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Hajji A, Mhabrech HE, Daldoul A, Toumia N, Hajjaji A, Njima M, Jebali F, Faleh R. [Breast cancer and pregnancy: about 15 cases collected at the maternity center Monastir, Tunisia]. Pan Afr Med J 2021; 38:180. [PMID: 33995786 PMCID: PMC8077675 DOI: 10.11604/pamj.2021.38.180.23108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022] Open
Abstract
Le but de cette étude était de décrire les caractéristiques cliniques, radiologiques, histologiques et thérapeutiques du cancer du sein diagnostiqué au cours de la grossesse. Nous avons effectué la revue de tous les cancers du sein diagnostiqués au cours de la grossesse dans le centre Maternité et de Néonatologie de Monastir -Tunisie, sur une période allant de 2004 à 2019. Nous avons ainsi colligé 15 cas. L'âge moyen des patientes était de 34 ans. La plupart des cancers du sein associés à la grossesse (CSAG) était diagnostiquée en post-partum. Le carcinome canalaire infiltrant était le type histologique majeur (93% de cas), un cas rare de carcinome sécrétoire a été observé. Le stade clinique était dominé par les formes T2 et T4. Les récepteurs hormonaux étaient négatifs dans 40% des cas, le récepteur HER2 était positif dans 26,6% des cas. Le traitement incluait la chirurgie, radiothérapie, chimiothérapie et palliative. La moyenne de survie est de 32,2 mois. Le cancer du sein associé à la grossesse est une entité rare. Son pronostic est globalement mauvais en raison de l'âge jeune de survenue et d´un diagnostic souvent tardif. La décision thérapeutique constitue une contrainte difficile, par nécessité, multidisciplinaire à laquelle participera la patiente. La thérapie ciblée reste le grand espoir des nouvelles thérapies.
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Affiliation(s)
- Ahmed Hajji
- Service de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Monastir, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Houda El Mhabrech
- Service d´Imagerie Médicale, Hôpital Hadj Ali Soua, Ksar Hellal, Université de Monastir, Monastir, Tunisie
| | - Amira Daldoul
- Service de Carcinologie, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Nada Toumia
- Service de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Monastir, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Awatef Hajjaji
- Service de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Monastir, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Manel Njima
- Service d´Anatomopathologie, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Fethi Jebali
- Service d´Anesthésie-réanimation B, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
| | - Raja Faleh
- Service de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Monastir, Centre Hospitalier Universitaire Fattouma Bourguiba Monastir, Université de Monastir, Monastir, Tunisie
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13
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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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Nsaful J, Vanderpuye V, Scott AA, Dedey F, Oppong SA, Appiah-Danquah R, Damale N, Fenu B, Wordui T, Yarney J, Clegg-Lamptey JN. Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases. Ecancermedicalscience 2020; 14:1140. [PMID: 33281932 PMCID: PMC7685764 DOI: 10.3332/ecancer.2020.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the commonest female cancer worldwide and the most common malignancy during pregnancy. The current management of breast cancer is based on patient and tumour characteristics, preferences and disease stage. In pregnancy-associated breast cancer, the gestational age influences treatment options. Sequencing of therapies is guided by safe imaging options, timing of delivery and prognosis. Systemic therapy options in the neoadjuvant, adjuvant and palliative settings are limited due to safety concerns of the unborn foetus. In resource-constrained regions, the application of safe options may be challenging. This paper reports four of such cases managed in Ghana using a multidisciplinary approach and local resource-appropriate evidence-based practices. Maternal and foetal outcomes were acceptable with none resulting in termination of pregnancy.
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Affiliation(s)
- Josephine Nsaful
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Aba Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Florence Dedey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Rita Appiah-Danquah
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Nelson Damale
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Benjamin Fenu
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Theodore Wordui
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joe Nat Clegg-Lamptey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
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15
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Local Complications of Breast Surgery during Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:101-105. [PMID: 32816268 DOI: 10.1007/978-3-030-41596-9_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.
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16
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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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17
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Soto-Trujillo D, Santos Aragón LN, Kimura Y. Pregnancy-Associated Breast Cancer: What Radiologists Must Know. Cureus 2020; 12:e10343. [PMID: 33062467 PMCID: PMC7549862 DOI: 10.7759/cureus.10343] [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] [Indexed: 11/12/2022] Open
Abstract
Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy, in the first year postpartum, or during breastfeeding. Imaging techniques play a significant role in the diagnosis of PABC. It is a challenging diagnosis since physiological changes seen in pregnancy and breastfeeding may limit clinical suspicion and imaging utility. The patient's well-being and the fetus must be taken into consideration for diagnosis and treatment.
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Affiliation(s)
| | | | - Yukiyoshi Kimura
- Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, MEX
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18
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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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19
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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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20
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A Systematic Review of Milk Fistula in Nursing Mothers: Modifying the Perspective Toward Maintenance of Breastfeeding. CLINICAL LACTATION 2020. [DOI: 10.1891/clinlact-d-20-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionMilk fistula is rare, and cessation of nursing has been recommended for treatment. We performed a comprehensive review of all existing literature to explore the causes of milk fistulae and the necessity of discontinuing breastfeeding, and mention our recommendations given our present practice.MethodGoogle Scholar, Pubmed, Ovid Medline, and Scopus were thoroughly investigated by using relevant keywords. After screening by reading titles, abstracts, and full texts of returned studies, pertinent articles were included and data extracted.ResultsSeventeen studies including 27 cases were included. Lactation ceased in 16 patients, but this was generally done without awaiting results of conservative management.ConclusionWe recommend measures for preventing milk fistulae, conservative measures for treatment, and continuation of breastfeeding throughout the process until healing occurs.
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Reyes E, Xercavins N, Saura C, Espinosa-Bravo M, Gil-Moreno A, Cordoba O. Breast cancer during pregnancy: matched study of diagnostic approach, tumor characteristics, and prognostic factors. TUMORI JOURNAL 2020; 106:378-387. [PMID: 32623975 DOI: 10.1177/0300891620925158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Breast cancer is one of the most frequently occurring cancers during pregnancy and its incidence is increasing. Many studies have shown poor outcomes, the causes of which remain unclear. OBJECTIVES To analyze radiologic characteristics, histology, and prognosis factors of breast cancer during pregnancy. METHODS A total of 42 patients with breast cancer diagnosed during pregnancy (BCP) were matched with 84 patients with breast cancer of similar age who were not pregnant. Sensitivity of radiology, tumor characteristics, prognosis factors, disease-free survival, and overall survival were analyzed. RESULTS The sensitivity of breast ultrasound was higher than that of mammography for both groups. Ultrasound sensitivity for cancer was 95.7% in patients with BCP versus 98% in the not pregnant group, with non-statistically significant differences. Mammography sensitivity for cancer was 56.5% in patients with BCP versus 61% in the not pregnant group, with non-statistically significant differences. The stage at diagnosis according to the TNM staging system was significantly higher in patients with BCP with stage IV cancer: 16.7% in patients with BCP versus 3.7% in the not pregnant group (p = 0.03). No statistically significant differences were observed in histologic grade, Ki-67 index, or molecular subtype. Disease-free survival and overall survival were significantly lower in patients with BCP (p = 0.002 and p = 0.04). Multivariate analysis showed no difference when adjusting for stage and surrogate molecular subtype. CONCLUSION Breast ultrasound shows a high sensitivity to detect breast cancer during pregnancy. BCP is diagnosed at a higher stage than in nonpregnant women. In our series, patients with BCP had poorer outcomes than the not pregnant group. These results were not observed when adjusting for stage.
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Affiliation(s)
- Eduardo Reyes
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Natalia Xercavins
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Saura
- Vall d'Hebron Breast Cancer Center, Service of Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martin Espinosa-Bravo
- Vall d'Hebron Breast Cancer Center, Service of Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Gil-Moreno
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Octavi Cordoba
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
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22
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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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23
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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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24
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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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25
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Haliloglu N, Ustuner E, Ozkavukcu E. Breast Ultrasound during Lactation: Benign and Malignant Lesions. Breast Care (Basel) 2019; 14:30-34. [PMID: 31019440 DOI: 10.1159/000491781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Structural changes during lactation make breast physical examination difficult. When breast problems occur, patients are often referred for an ultrasound (US) scan. Most breast lesions diagnosed in these patients are benign, but the diagnosis of breast cancer is a challenge. We aim to demonstrate the spectrum of US imaging findings in lactating women. Methods 77 breastfeeding patients who underwent breast US in our department between February 2012 and March 2017 were evaluated. Patients' electronic medical records were reviewed for the presenting complaint, US reports, pathology results if available, and clinical/radiologic follow-up. All examinations were performed by 2 radiologists. Results 28 of the 77 patients had normal US findings. Cysts were seen in 16 patients. 4 patients had stable fibroadenomas. 6 patients had US imaging findings suggestive of mastitis, 5 patients had galactoceles, 1 patient had an abscess, and 1 patient had unilateral hypertrophy without any accompanying lesion. In 13 patients, BI-RADS 3 solid masses were diagnosed. Invasive breast cancer was diagnosed in 3 patients. Conclusion US can demonstrate or exclude a true mass against the background of a nodular breast parenchyma. Radiologists must be aware of malignant US features to avoid delays in the diagnosis of pregnancy-associated breast cancer.
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Affiliation(s)
- Nuray Haliloglu
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Evren Ustuner
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Esra Ozkavukcu
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
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26
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ACR Appropriateness Criteria ® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol 2019; 15:S263-S275. [PMID: 30392595 DOI: 10.1016/j.jacr.2018.09.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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27
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Wang B, Yang Y, Jiang Z, Zhao J, Mao Y, Liu J, Zhang J. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer. Thorac Cancer 2019; 10:1060-1068. [PMID: 30920126 PMCID: PMC6500985 DOI: 10.1111/1759-7714.13045] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to evaluate the characteristics, diagnosis, prognosis, and effective treatment modalities of pregnancy‐associated breast cancer (PABC). Methods From 1 January 2005 to 31 December 2015, 142 patients with PABC were identified in the Cancer Institute and Hospital of Tianjin Medical University database. The clinicopathological features, treatment methods, and outcomes were retrospectively evaluated. Results The median age at diagnosis was 30 years. All patients presented with a palpable mass in the breast. The sensitivity of ultrasound and mammography in PABC diagnosis was 86% and 83.3%, respectively, which increased to 91.3% when a combination of mammography and ultrasound was used. The median tumor size was 5.5 cm, and 63.1% of patients had associated axillary lymph node metastases. The proportions of ER negative, PR negative and HER2 positive were 45.7%, 45.7% and 30%, respectively. The five‐year overall survival (OS) and disease‐free survival (DFS) rates were 76.8% and 63.5%, respectively. According to univariate analysis, T stage, N stage, and HER2 status were significant prognostic factors for OS and DFS. The time interval between the onset of the first symptom and the first meeting with a health professional was also significant for OS. Multivariate analysis showed that T stage and HER2 status were independent prognostic risk factors for OS and DFS. Conclusion PABC is an aggressive form of breast cancer associated with advanced stage at diagnosis. Despite the existing difficulties in diagnosis, imaging examinations are indispensable. Early diagnosis and multidisciplinary therapy, including anti‐HER2 targeted therapy, may be important to improve prognosis.
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Affiliation(s)
- Bin Wang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Yanfang Yang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Zhansheng Jiang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Integrative Oncology
| | - Jing Zhao
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Ultrasound Diagnosis & Treatment
| | - Yiran Mao
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Department of Ultrasound Diagnosis & Treatment
| | - Jun Liu
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Second Department of Breast Cancer
| | - Jin Zhang
- Key Laboratory of Cancer, Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin, China.,Third Department of Breast Cancer
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28
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Untanas A, Grigaitė I, Briedienė R. Imaging in pregnancy-associated breast cancer: a case report. Acta Med Litu 2019; 26:134-139. [PMID: 31632188 PMCID: PMC6779471 DOI: 10.6001/actamedica.v26i2.4034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND PABC (pregnancy-associated breast cancer) is a rare condition that appears as a malignancy in 1 per 3000 pregnant women and is one of the most common cancers diagnosed during pregnancy or the postpartum period. If a woman who is pregnant or within a year after delivery has complaints of a palpable breast mass, it could undeniably be a malignant mass of the breast. That is why an ultrasound should be performed for all pregnant or lactating women who detect a palpable breast mass that persists for two or more weeks. CASE REPORT Our case report presents a pregnant 40-year-old previously healthy female at 36 weeks gestational age with a complaint of a palpable left breast mass for two months period. The initial ultrasound showed a breast tumour of irregular shape, solid and hypervascular mass. CONCLUSIONS Early diagnostics of PABC is of crucial importance in order to offer the best possible outcomes for the patient and foetus.
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Affiliation(s)
| | - Indrė Grigaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Briedienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- National Cancer Institute, Vilnius, Lithuania
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29
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Abstract
The incidence of cancer in pregnancy is increasing. The most frequent malignancies include breast and cervical cancers. Diagnosis may be complicated by late presentation. Imaging during pregnancy should consider risks to the fetus. Diagnostic work-up, including tumor markers, can be influenced by the physiology of pregnancy. Treatment of cancer can often be safely administered with good maternal and fetal outcomes. Chemotherapy, radiotherapy, and surgery must be adapted to the pregnancy state. Counselling and emotional support are an essential part of management.
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Affiliation(s)
- Matthys H Botha
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Stellenbosch, South Africa
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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30
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Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis? Eur Radiol 2018; 29:1187-1193. [DOI: 10.1007/s00330-018-5721-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/28/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
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31
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Nissan N, Furman-Haran E, Allweis T, Menes T, Golan O, Kent V, Barsuk D, Paluch-Shimon S, Haas I, Brodsky M, Bordsky A, Granot LF, Halshtok-Neiman O, Faermann R, Shalmon A, Gotlieb M, Konen E, Sklair-Levy M. Noncontrast Breast MRI During Pregnancy Using Diffusion Tensor Imaging: A Feasibility Study. J Magn Reson Imaging 2018; 49:508-517. [DOI: 10.1002/jmri.26228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/01/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Noam Nissan
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Edna Furman-Haran
- Department of Biological Services; Weizmann Institute of Science; Israel
| | - Tanir Allweis
- Department of General Surgery; Kaplan Medical Center; Israel
| | - Tehillah Menes
- Department of General Surgery; Souraski Medical Center; Israel
| | - Orit Golan
- Department of Radiology; Souraski Medical Center; Israel
| | - Varda Kent
- Department of Radiology; Assaf Harofeh Medical Center; Israel
| | - Daphna Barsuk
- Department of General Surgery; Assuta Medical Center; Israel
| | | | - Ilana Haas
- Department of General Surgery; Meir Medical Center; Israel
| | - Malka Brodsky
- Meirav Center of Breast Care, Sheba Medical Center; Israel
| | - Asia Bordsky
- Department of General Surgery; Bnai Zion Medical Center; Israel
| | | | - Osnat Halshtok-Neiman
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Renata Faermann
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Anat Shalmon
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Michael Gotlieb
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Eli Konen
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Miri Sklair-Levy
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
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32
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Simoes E, Graf J, Sokolov AN, Grischke EM, Hartkopf AD, Hahn M, Weiss M, Abele H, Seeger H, Brucker SY. Pregnancy-associated breast cancer: maternal breast cancer survival over 10 years and obstetrical outcome at a university centre of women's health. Arch Gynecol Obstet 2018; 298:363-372. [PMID: 29931523 DOI: 10.1007/s00404-018-4822-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/13/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is considered the second most common malignancy affecting pregnancy. The limited knowledge as to long-term survival is nonuniform. This retrospective study aims to contribute by a follow-up of pregnancies of breast cancer patients treated at a single university centre with focus on maternal long-term survival in relation to time point of diagnosis (before, during, and after pregnancy). METHODS Data of 25 patients were reviewed for the period between 2000 and 2009 in relation to their neonatal and maternal outcome parameters as well as their maternal breast cancer outcomes by assessing maternal mortality at annual intervals up to a maximum of 10 years follow-up. RESULTS Median age at diagnosis was 33 years. Maternal survival rate of the total collective came to 76% after 5 years and to 68% after 10 years. The newborns were healthy, 22% of them presented with a 1'Apgar score 5-7. Preterm delivery occurred in 53%. PABC significantly affected maternal survival compared to the national breast cancer cohort at 5 years and barely significantly at 10 years, with highly significant (p < 0.003) to significant (p < 0.01) effects at 5 and 10 years, respectively, for PABC diagnosed during and after pregnancy. CONCLUSIONS The present findings on survival rates suggest that maternal medical assessment at the beginning of and during further course of pregnancy should include a scrutinized thorough breast examination. Conveying/delivering special competences to monitor these high-risk pregnancies at the interface of oncological care should be considered an obligatory part of academic medical education, obstetrical training and interprofessional midwifery education.
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Affiliation(s)
- Elisabeth Simoes
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany.,Staff Section Social Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Joachim Graf
- Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany. .,Medical Faculty Tübingen, Dean's Office for Students' Affairs, Tübingen, Germany.
| | - Alexander N Sokolov
- Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Eva-Maria Grischke
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Andreas D Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Martin Weiss
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Harald Abele
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Harald Seeger
- Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
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33
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Nissan N, Furman-Haran E, Shapiro-Feinberg M, Grobgeld D, Degani H. Monitoring In-Vivo the Mammary Gland Microstructure during Morphogenesis from Lactation to Post-Weaning Using Diffusion Tensor MRI. J Mammary Gland Biol Neoplasia 2017; 22:193-202. [PMID: 28707256 DOI: 10.1007/s10911-017-9383-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Lactation and the return to the pre-conception state during post-weaning are regulated by hormonal induced processes that modify the microstructure of the mammary gland, leading to changes in the features of the ductal / glandular tissue, the stroma and the fat tissue. These changes create a challenge in the radiological workup of breast disorder during lactation and early post-weaning. Here we present non-invasive MRI protocols designed to record in vivo high spatial resolution, T2-weighted images and diffusion tensor images of the entire mammary gland. Advanced imaging processing tools enabled tracking the changes in the anatomical and microstructural features of the mammary gland from the time of lactation to post-weaning. Specifically, by using diffusion tensor imaging (DTI) it was possible to quantitatively distinguish between the ductal / glandular tissue distention during lactation and the post-weaning involution. The application of the T2-weighted imaging and DTI is completely safe, non-invasive and uses intrinsic contrast based on differences in transverse relaxation rates and water diffusion rates in various directions, respectively. This study provides a basis for further in-vivo monitoring of changes during the mammary developmental stages, as well as identifying changes due to malignant transformation in patients with pregnancy associated breast cancer (PABC).
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Affiliation(s)
- Noam Nissan
- Department of Biological Regulation, Weizmann Institute of Science, P.O. Box 26, 7610001, Rehovot, Israel
- Diagnostic Imaging Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Edna Furman-Haran
- Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | | | - Dov Grobgeld
- Department of Biological Regulation, Weizmann Institute of Science, P.O. Box 26, 7610001, Rehovot, Israel
| | - Hadassa Degani
- Department of Biological Regulation, Weizmann Institute of Science, P.O. Box 26, 7610001, Rehovot, Israel.
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34
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Cordeiro CN, Gemignani ML. Breast Cancer in Pregnancy: Avoiding Fetal Harm When Maternal Treatment Is Necessary. Breast J 2017; 23:200-205. [PMID: 28191695 DOI: 10.1111/tbj.12780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The management of breast cancer during pregnancy poses unique challenges and requires a multi-disciplinary approach. In this review, we discuss the treatment of breast cancer in pregnancy and recent updates regarding the safety of surgical and chemotherapeutic treatments, including both oncologic and fetal outcomes. The treatment of breast cancer during pregnancy mirrors that outside of pregnancy, with a few important differences dictated by the balance of maternal versus fetal health. Overall, surgical treatment, neo-adjuvant chemotherapy, and/or adjuvant chemotherapy are feasible in most women during pregnancy. Further research to determine the safety of these therapies in pregnancy-associated breast cancer is warranted.
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Affiliation(s)
- Christina N Cordeiro
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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35
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Tirada N, Dreizin D, Khati NJ, Akin EA, Zeman RK. Imaging Pregnant and Lactating Patients. Radiographics 2016; 35:1751-65. [PMID: 26466183 DOI: 10.1148/rg.2015150031] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As use of imaging in the evaluation of pregnant and lactating patients continues to increase, misperceptions of radiation and safety risks have proliferated, which has led to often unwarranted concerns among patients and clinicians. When radiologic examinations are appropriately used, the benefits derived from the information gained usually outweigh the risks. This review describes appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation (ie, radiography, computed tomography, nuclear scintigraphy, and fluoroscopically guided interventional radiology), radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women. Maternal radiation risk must be weighed with the potential consequences of missing a life-threatening diagnosis such as pulmonary embolus. Fetal risks (ie, spontaneous abortion, teratogenesis, or carcinogenesis) vary with gestational age and imaging modality and should be considered in the context of the potential benefit of medically necessary diagnostic imaging. When feasible and medically indicated, modalities that do not use ionizing radiation (eg, magnetic resonance imaging) are preferred in pregnant and lactating patients. Radiologists should strive to minimize risks of radiation to the mother and fetus, counsel patients effectively, and promote a realistic understanding of risks related to imaging during pregnancy and lactation.
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Affiliation(s)
- Nikki Tirada
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - David Dreizin
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Nadia J Khati
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Esma A Akin
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
| | - Robert K Zeman
- From the Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037 (N.T., N.J.K., E.A.A., R.K.Z.); and Department of Diagnostic Radiology, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, Md (D.D)
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36
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Fetal Implications of Diagnostic Radiation Exposure During Pregnancy: Evidence-based Recommendations. Clin Obstet Gynecol 2016; 59:412-8. [DOI: 10.1097/grf.0000000000000187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:19-32. [DOI: 10.1016/j.bpobgyn.2015.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022]
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38
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Solomon E, Liberman G, Nissan N, Frydman L. Robust diffusion tensor imaging by spatiotemporal encoding: Principles and in vivo demonstrations. Magn Reson Med 2016; 77:1124-1133. [PMID: 26968710 DOI: 10.1002/mrm.26197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Evaluate the usefulness of single-shot and of interleaved spatiotemporally encoded (SPEN) methods to perform diffusion tensor imaging (DTI) under various preclinical and clinical settings. METHODS A formalism for analyzing SPEN DTI data is presented, tailored to account for the spatially dependent b-matrix weightings introduced by the sequence's use of swept pulses acting while in the presence of field gradients. Using these b-matrix calculations, SPEN's ability to deliver DTI measurements was tested on phantoms as well as ex vivo and in vivo. In the latter case, DTI involved scans on mice brains and on human lactating breasts. RESULTS For both ex vivo and in vivo investigations, SPEN data proved less sensitive to distortions arising from Bo field inhomogeneities and from eddy currents, than conventional single-shot alternatives. Further resolution enhancement could be achieved using referenceless methods for interleaved SPEN data acquisitions. CONCLUSION The robustness of SPEN-based sequences vis-à-vis field instabilities and heterogeneities, enables the implementation of DTI experiments with good sensitivity and resolution even in challenging environments in both preclinical and clinical settings. Magn Reson Med 77:1124-1133, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Eddy Solomon
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel
| | - Gilad Liberman
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel
| | - Noam Nissan
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel.,Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Lucio Frydman
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel
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39
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Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D, Nekka I, Chérel P. Breast lumps in pregnant women. Diagn Interv Imaging 2015; 96:1077-87. [PMID: 26341843 DOI: 10.1016/j.diii.2015.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
Breast lumps detected during pregnancy are generally benign and reflect fibroadenoma, lactating adenoma, cysts, infarction of the breast or galactocele. Although rare, the possibility of breast cancer must also be considered to avoid any delays in diagnosis. After patient questioning and clinical examination, the first imaging modality to use is ultrasound. No further assessment is called for if lesions are categorized as BI-RADS 2 and no suspicious clinical signs are observed. Depending on the clinical setting, lesions classified BI-RADS 3 require monitoring and mammographic assessment (which can be helpful in diagnosing cancer and incurs no risk to the embryo or fetus). If the clinical signs are unclear and/or the lesion(s) are categorized as ≥ BI-RADS 4a, then mammography and often biopsy should be performed. Strict BI-RADS scoring (American College of Radiology) should be applied, bearing in mind that benign lesions can appear suspicious during pregnancy, and some cancers can exhibit what seem to be reassuring characteristics.
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Affiliation(s)
- A Langer
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France.
| | - M Mohallem
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - H Berment
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - F Ferreira
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - A Gog
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - D Khalifa
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - I Nekka
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
| | - P Chérel
- Service de radiodiagnostic, institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 St-Cloud, France
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Díaz García N, Cuadrado Rouco C, Vich P, Alvarez-Hernandez C, Brusint B, Redondo Margüello E. [Breast cancer update in primary care: (V/V)]. Semergen 2014; 41:76-88. [PMID: 25002350 DOI: 10.1016/j.semerg.2014.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.
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Affiliation(s)
| | | | - Pilar Vich
- Centro de Salud Los Alpes, Madrid, España
| | | | | | - Esther Redondo Margüello
- Centro de Salud Internacional, Madrid Salud, Grupo de Actividades Preventivas de SEMERGEN, España
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Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Chérel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging 2014; 95:435-41. [DOI: 10.1016/j.diii.2013.12.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nissan N, Furman-Haran E, Shapiro-Feinberg M, Grobgeld D, Degani H. Diffusion-tensor MR imaging of the breast: hormonal regulation. Radiology 2014; 271:672-80. [PMID: 24533873 DOI: 10.1148/radiol.14132084] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the parameters obtained with magnetic resonance (MR) diffusion-tensor imaging (DTI) of the breast throughout the menstrual cycle phases, during lactation, and after menopause, with and without hormone replacement therapy (HRT). MATERIALS AND METHODS All protocols were approved by the internal review board, and signed informed consent was obtained from all participants. Forty-five healthy volunteers underwent imaging by using T2-weighted and DTI MR sequences at 3 T. Premenopausal volunteers (n = 16) underwent imaging weekly, four times during one menstrual cycle. Postmenopausal volunteers (n = 19) and lactating volunteers (n = 10) underwent imaging once. The principal diffusion coefficients (λ1, λ2, and λ3), apparent diffusion coefficient (ADC), fractional anisotropy (FA), and maximal anisotropy (λ1-λ3) were calculated pixel by pixel for the fibroglandular tissue in the entire breast. RESULTS In all premenopausal volunteers, the DTI parameters exhibited high repeatability, remaining almost equal along the menstrual cycle, with a low mean within-subject coefficient of variance of λ1, λ2, λ3, and ADC (1%-2% for all) and FA (5%), as well as a high intraclass correlation of 0.92-0.98. The diffusion coefficients were significantly lower (a) in the group without HRT use as compared with the group with HRT use (P < .01) and premenopausal volunteers (P < .01) and (b) in the lactating volunteers as compared with the premenopausal volunteers (P < .005). No significant differences in DTI parameters were found between premenopausal volunteers free of oral contraceptives and those who used oral contraceptives (P = .28-0.82) and between premenopausal volunteers and postmenopausal volunteers who used HRT (P = .31-0.93). CONCLUSION DTI parameters are not sensitive to menstrual cycle changes, while menopause, long-term HRT, and presence of milk in lactating women affected the DTI parameters. Therefore, the timing for performing breast DTI is not restricted throughout the menstrual cycle, whereas the modulations in diffusion parameters due to HRT and lactation should be taken into account in DTI evaluation.
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Affiliation(s)
- Noam Nissan
- From the Department of Biological Regulation (N.N., D.G., H.D.) and Unit of Biological Services (E.F.H.), Weizmann Institute of Science, PO Box 26, Rehovot 76100, Israel; and Department of Radiology, Meir Medical Center, Kfar Saba, Israel (M.S.F.)
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Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: radiological-pathological correlation. Insights Imaging 2013; 4:527-38. [PMID: 23881348 PMCID: PMC3781252 DOI: 10.1007/s13244-012-0211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Substantial physiological changes occur during pregnancy and lactation, making breast evaluation challenging in these patients. This article reviews the imaging challenges of the breast during pregnancy and lactation. The normal imaging appearance, imaging protocols and the imaging features of each commonly encountered benign and malignant entity with pathological correlation and supporting examples is described. An awareness of the imaging features of the breast during these physiological states and of various benign and malignant diseases that occur permits optimal management. CONCLUSIONS Evaluation of the pregnant and lactating patients who present with a breast problem is challenging. Although ultrasound may characterise the finding in many cases, mammography and even MRI may have a role in the management of these patients. TEACHING POINTS • To review physiological changes of the breast during pregnancy and lactation • To review imaging protocols of the breast during pregnancy and lactation • Discuss imaging findings with pathological correlation of benign and malignant diseases in pregnancy and lactation • Discuss pathological correlation of imaging findings in pregnancy and lactation.
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Affiliation(s)
| | - Vandana Dialani
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jonathan Marotti
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Tejas S. Mehta
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Priscilla J. Slanetz
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
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Langer A, Mohallem M, Chérel P. Cancer du sein et grossesse : revue de la littérature. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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The Management of Breast Symptoms in the Pregnant and Lactating Patient. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-012-0037-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Canoy JM, Mitchell GS, Unold D, Miller V. A radiologic review of common breast disorders in pregnancy and the perinatal period. Semin Ultrasound CT MR 2012; 33:78-85. [PMID: 22264905 DOI: 10.1053/j.sult.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The imaging changes in the breast associated with pregnancy and the perinatal period may not only deviate from the baseline appearance for each patient, but may also mimic disease or confound evaluation of disease. The hormonal changes can influence a range of disorders, from benign or inflammatory changes to malignant tumors. Moreover, outcomes differ from those of similar pathologies in nonpregnant patients, owing to either physiological changes or delays in diagnosis and treatment. Ultrasonography is the preferred imaging modality for evaluation during pregnancy and lactation, as its sensitivity for carcinoma is nearly 100% (Sabate JM, Clotet M, Torrubia S, et al, 2007; Radiographics 27 suppl 1:S101-S124). Therefore, an understanding of the specific pregnancy-associated pathologies and their radiologic appearances is indispensable to the interpreting radiologist.
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Affiliation(s)
- James M Canoy
- Radiology Department, Tufts School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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