More than 90 percent of gravidas with breast cancer have a palpable mass, and greater than 80 percent of cases are selfreported (Brewer, 2011). In pregnancy, clinical assessment, diagnostic procedures, and treatment of women with breast tumors are often slightly delayed (Berry, 1999). his can be partially attributed to pregnancy-induced breast tissue that obscures masses.
The evaluation of pregnant women with a breast mass does not difer from that for nonpregnant women (Loibl, 2015). hus, any suspicious breast mass should be pursued to diagnosis. Pragmatically, a palpable discrete mass can be biopsied or excised. If imaging is desirable to distinguish between a solid mass and a cystic lesion, sonography has high sensitivity and specificity (Navrozoglou, 2008). Mammography is appropriate if indicated, and the fetal radiation risk is negligible-0.04 mGywith appropriate shielding (rishna, 2013). But, because breast tissue is denser in pregnancy, mammography has a false-negative rate of 35 to 40 percent (Woo, 2003). If the decision to biopsy is uncertain, then MR imaging may be used. With such techniques, masses can usually be described as either solid or cystic.
Cystic breast lesions are simple, complicated, or complex (Berg, 2003). Simple cysts do not require special management or monitoring, but they may be aspirated if symptomatic. Complicated cysts show internal echoes during sonography, and they sometimes are indistinguishable from solid masses. These are typically aspirated, and if the sonographic abnormality does not resolve completely, a core-needle biopsy is usually performed. Complex cysts have septa or intracystic masses seen sonographically. Because some breast cancer may form complex cysts, excision is usually recommended.
For solid breast masses, evaluation is with the triple test, that is, clinical examination, imaging, and core needle biopsy. If all three suggest a benign lesion or if all three suggest a breast cancer, the test is said to be concordant. A concordant benign triple test is �99-percent accurate, and breast lumps in this category can be followed by clinical examination alone. Fortunately, most masses in pregnancy have these three reassuring features. In contrast, if any of the three assessments suggests malignancy, the mass should be excised.
Once breast cancer is diagnosed, a limited search of the most common metastatic sites is completed. For most women, this includes a chest radiograph, liver sonography, and skeletal MR imaging (Becker, 2016; Krishna, 2013).
Treatment of breast cancer is multidisciplinary and includes an obstetrician, breast surgeon, and medical oncologist. Ini tially, desires for pregnancy continuation are addressed, and data indicate that pregnancy interruption does not influence the course or prognosis of breast cancer (Cardonick, 2010). With pregnancy continuation, treatment in general mirrors that for nonpregnant women. Important caveats are that chemotherapy and surgery are postponed to the second trimester, and adjuvant radiotherapy is withheld until after delivery (Brewer, 2011).
Surgical treatment may be definitive. In the absence of metastatic disease, either a wide excision or a modified or total mastectomy-each with axillary node staging-can be performed (Rosenkranz, 2006). Staging by sentinel lymph node biopsy and lymphoscintigraphy with technetium-99m is safe. Breast reconstruction, if desired, is typically delayed until after delivery (Viswanathan, 2011). hat said, Caragacianu and coworkers (2016) described good results in 10 pregnant women who underwent immediate reconstruction after mastectomy.