Breast disease in the pregnant and lactating patient: radiological-pathological correlation

Abstract

ObjectiveSubstantial 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.ConclusionsEvaluation 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

Superficial Galactocelic Progression, Size-Variation and Assessment in a Patient

“…Marked proximity of ducts in this region (posterior to areola) galactocele formation is likely [8] [18]. Another justification for galactocelic examination with ultrasound is that the mammography of breastfeeding women is usually very dense and difficult to interpret irrespective of cystic presence or not [19]. These non-proliferative findings in this (breast cyst-case report) are not associated with carcinoma of the mammary glands, thus making it (galactocele) distinct from other breast masses with well circumscribed walls.…”

Prevention of Nipple Cracks of the Mammary Gland in the Early Postnatal Period

“…Снижение травматизации соска позволяет сущест-венно минимизировать риски его инфицирования во время лактации, предотвращает развитие лактостазов и, как следствие, отказ от грудного вскармливания [16][17][18][19]. Про лон гирование периода лактации в настоящее вре-мя рассматривается не только как профилактическая мера для снижения случаев онкологических заболева-ний у женщин в последующем (рак молочной железы, доброкачественные новообразования молочной желе-зы), но и как фактор существенного влияния на здоровье и дальнейшее развитие ребенка [20][21][22].…”

Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation

“…Ultrasound is considered the method of choice during pregnancy and lactation (2,6) , with a sensitivity of 86.7% and 100.0%, respectively (2,4) , considerably greater than the 30.0% reported for mammography (2,4,6,8) . Ultrasound also has the benefits of not exposing the fetus to radiation (2) , producing high-resolution images, and allowing a more effective assessment of the breast structures, making it excellent for diagnosing and differentiating between benign and malignant lesions (1) .…”

“…The diagnosis of breast cancer, which is difficult to elucidate and is less common among women who are pregnant or lactating than among those of the same age who are not, continues to be a challenge for clinicians (1) . In addition, the understanding of the various breast problems and of the characteristics of the corresponding images is essential to establishing an appropriate approach to such patients (2) .…”

“…The physiological changes during pregnancy and lactation increase breast density (2,4,6) , particularly in young women (4) , and make it technically difficult to evaluate breast imaging examinations (4,6) . Although an increase in breast density limits the use of mammography (4) , there is no consensus as to whether the evaluation of the image is so compromised during pregnancy and lactation that the use mammography should be avoided when it is clinically indicated (7) .…”