The fetal radiation dose from a 4-view mammogram is <0.03 mGy, and no teratogenic effects have been demonstrated below 50 mGy [43]. Complete mammographic evaluation is recommended as a component of locoregional staging in pregnant women with newly diagnosed breast cancer. Microcalcifications due to ductal carcinoma in situ adjacent to the index cancer may not be seen by US. Therefore, mammography is recommended for evaluating extent of disease. Multifocal or multicentric disease presenting as microcalcifications due to sonographically occult ductal carcinoma in situ may similarly be identified with adjunctive mammographic breast cancer staging. These findings would affect surgical management and aid in obtaining clear margins and improved patient outcomes. Breast Imaging of Pregnant and Lactating Women There are no studies specifically evaluating DBT during pregnancy. DBT may improve visualization of breast masses in pregnant women. The increased breast density seen in younger women and in the hormonally altered breast of pregnant women is more likely to conceal small masses because of the masking effect of dense breast tissue. US Breast Whole-breast US, including US of the nodal basins, is a staging modality with no known adverse effects on the fetus. In a single study by Yang et al [50], preoperative breast US was performed in 23 pregnant patients for the purpose of evaluating response to neoadjuvant chemotherapy during pregnancy. In this small study, 15 of 18 axillary metastases were correctly diagnosed with sonographic staging of the axilla, and all breast masses were identified by breast US. Whole-breast US staging has been evaluated in nonpregnant patients with reported incremental cancer detection rates similar to those of staging breast MRI [51]. Several additional studies in nonpregnant women support the use of whole-breast US staging [25,52,53].
Breast Imaging of Pregnant and Lactating Women. The fetal radiation dose from a 4-view mammogram is <0.03 mGy, and no teratogenic effects have been demonstrated below 50 mGy [43]. Complete mammographic evaluation is recommended as a component of locoregional staging in pregnant women with newly diagnosed breast cancer. Microcalcifications due to ductal carcinoma in situ adjacent to the index cancer may not be seen by US. Therefore, mammography is recommended for evaluating extent of disease. Multifocal or multicentric disease presenting as microcalcifications due to sonographically occult ductal carcinoma in situ may similarly be identified with adjunctive mammographic breast cancer staging. These findings would affect surgical management and aid in obtaining clear margins and improved patient outcomes. Breast Imaging of Pregnant and Lactating Women There are no studies specifically evaluating DBT during pregnancy. DBT may improve visualization of breast masses in pregnant women. The increased breast density seen in younger women and in the hormonally altered breast of pregnant women is more likely to conceal small masses because of the masking effect of dense breast tissue. US Breast Whole-breast US, including US of the nodal basins, is a staging modality with no known adverse effects on the fetus. In a single study by Yang et al [50], preoperative breast US was performed in 23 pregnant patients for the purpose of evaluating response to neoadjuvant chemotherapy during pregnancy. In this small study, 15 of 18 axillary metastases were correctly diagnosed with sonographic staging of the axilla, and all breast masses were identified by breast US. Whole-breast US staging has been evaluated in nonpregnant patients with reported incremental cancer detection rates similar to those of staging breast MRI [51]. Several additional studies in nonpregnant women support the use of whole-breast US staging [25,52,53].