When pre-existing lesions enlarge because of hormonal stimulation, they may appear atypical secondary to infarction or proliferative and lactational changes within the lesion [9,10,13]. These changes may lead to concerning imaging features and warrant further evaluation with biopsy. Some benign palpable masses are definitively benign on imaging evaluation (ie, cysts), whereas other masses may have benign imaging characteristics that allow for close follow- up. Given the challenge of clinical examination in pregnant and lactating patients, diagnostic breast imaging, particularly breast ultrasound (US), plays a crucial role in characterizing the features of palpable lesions and in determining appropriate management. US has the highest sensitivity for the diagnosis of PABC [24-28]. Furthermore, because of the predominantly young patient age and the decreased sensitivity of mammography in the setting of dense breast tissue, breast US is the first-line imaging examination in pregnant and lactating patients. If breast US is negative, or if there are suspicious sonographic findings, additional imaging with mammography or digital breast tomosynthesis (DBT) may be indicated. There is a limited role for advanced breast imaging techniques in pregnant women. The ACR does not recommend the intravenous (IV) administration of gadolinium during pregnancy [33]. The physiologic increased breast vascularity of pregnancy and lactation may limit the sensitivity of dynamic contrast-enhanced (DCE) breast MRI [12,33-35]. Biopsy should be recommended for any suspicious imaging findings, and patients should be informed regarding the possibility of milk fistula and increased risk of bleeding. Discussion of Procedures by Variant Variant 1: Breast cancer screening during lactation. Initial imaging. There is limited evidence on breast cancer screening in lactating women.
Breast Imaging of Pregnant and Lactating Women. When pre-existing lesions enlarge because of hormonal stimulation, they may appear atypical secondary to infarction or proliferative and lactational changes within the lesion [9,10,13]. These changes may lead to concerning imaging features and warrant further evaluation with biopsy. Some benign palpable masses are definitively benign on imaging evaluation (ie, cysts), whereas other masses may have benign imaging characteristics that allow for close follow- up. Given the challenge of clinical examination in pregnant and lactating patients, diagnostic breast imaging, particularly breast ultrasound (US), plays a crucial role in characterizing the features of palpable lesions and in determining appropriate management. US has the highest sensitivity for the diagnosis of PABC [24-28]. Furthermore, because of the predominantly young patient age and the decreased sensitivity of mammography in the setting of dense breast tissue, breast US is the first-line imaging examination in pregnant and lactating patients. If breast US is negative, or if there are suspicious sonographic findings, additional imaging with mammography or digital breast tomosynthesis (DBT) may be indicated. There is a limited role for advanced breast imaging techniques in pregnant women. The ACR does not recommend the intravenous (IV) administration of gadolinium during pregnancy [33]. The physiologic increased breast vascularity of pregnancy and lactation may limit the sensitivity of dynamic contrast-enhanced (DCE) breast MRI [12,33-35]. Biopsy should be recommended for any suspicious imaging findings, and patients should be informed regarding the possibility of milk fistula and increased risk of bleeding. Discussion of Procedures by Variant Variant 1: Breast cancer screening during lactation. Initial imaging. There is limited evidence on breast cancer screening in lactating women.