Cytological Evaluation of Breast Masses during Pregnancy and Lactation: A Retrospective Analysis

Abstract

Background: Breast masses are a common problem encountered in pregnancy and lactation. Fine needle aspiration cytology (FNAC) is a rapid and cost-effective procedure in evaluating breast masses in these conditions. However, the cytological interpretation of these masses must be made with caution due to the atypia inherent to secretory changes in glandular epithelium seen in this period (pregnancy and lactation). Materials and Methods:A retrospective study for a period of 3 years (January 2014 to December 2016) was conducted for evaluating the role of cytology in interpretation of breast masses in pregnancy and lactation during this period. All available clinical and histo-pathological data was also retrieved and analyzed.Results: Forty five breast masses were identified during pregnancy and lactation. Benign lesions were the most common etiology seen. Among benign lesions, galactocele was the most common etiology identified. Fibroadenoma (FA) was the most common benign tumor seen during this period. Four cases were identified as pregnancy associated breast carcinoma (PABC) constituting 8.8% of all breast masses in this period. Conclusion:Cytology was an effective tool with minimal surgical intervention in identifying the etiology of breast masses in pregnancy and lactation. However, the cytopathologists must be aware of the characteristic patterns seen in breast FNAC smears during pregnancy and lactation and the associated atypia seen in glandular epithelium during this period. FNAC smears in these conditions must be interpreted with caution considering the associated clinical details and radiological findings. FNAC will provide a very rapid, easy and cost effective tool in identifying the etiology for breast masses. However, the patients must be followed up during pregnancy and postpartum period as majority of benign lesions regress without any intervention. Benign lesions are the most common etiology in breast masses in pregnancy and lactation. But PABC must always be considered in the differential diagnosis for the timely diagnosis and intervention.