The Role of Sonography during Pregnancy and Lactation in Diagnosis of Breast Lesions

Abstract Background: During pregnancy and lactation, the breast changes due to different hormonal effects. These changes are parenchymal & vascular which affects accurate radiological evaluation of breast lesions. Most breast lesions during preg-nancy and lactation are benign in nature; however, malignancy couldn’t be excluded. Aim of Study: Our aim was to review ultrasound findings of benign and malignant lesions common during pregnancy and lactation and differentiate between them by ultrasound and biopsy in suspected cases. Patients and Methods: This was a prospective study included 70 pregnant & lactating women with breast findings on ultrasound. All women subjected to full history taking, clinical examination, ultrasonography and pathological exam-ination results for some cases. Lesions had been assessed according to ultrasound BIRADS system as follows: (1) BIRADS 2 lesions had been considered benign, large painful cyst had been aspirated. (2) BIRADS 3 lesions had been followed-up for 6 months: If they are stationary or resolved, they had been considered benign lesions, If they show increased in size or changed in appearance, they had been biopsied. (3) BIRADS 4 and 5 lesions had been biopsied. Results: Our study results revealed that one patient (1.4%) had an accessory breast. 9 patients (12.9%) confirmed to have galactoceles by aspiration from cystic lesions that contained milky secretions. Two of the lactating women confirmed to have lactational adenoma by histopathology. 30 patients (42.8%) was diagnosed to have mastitis clinically & radiolog-ically, 14 patients (20%) resolved after medical treatment, 15 patients (21.4%) complicated by abscess formation & treated by surgical drainage & medical treatment, one patient (1.4%) was diagnosed granulmatous mastitis by histopathology and resolved after corticosteroids treatment. Two patients (2.9%) were diagnosed to have fat necrosis that decreased in size in their follow-up. Also, 16 patients (21.5%) were suspected to have benign lesions by US features, 6 patients (8.6%) were diagnosed as fibrocystic disease, 6 patients (8.5%) had few cystic lesions and diagnosed as simple cysts, 1 patient (1.4%) was diagnosed as fibromatosis after surgical excision & histopathological examination and 3 (4.3%) patients were diagnosed as fibroademonas after biopsy & stationary course in their follow-up after 6 months. However, 10 patients (13.13%) were suspected to have malignant lesions by US features, 9 patients (12.9%) was invasive ductal carcinoma and one patient (1.4%) was mucinous carcinoma after surgical excision and histopathology. The present study showed that regarding validity of US in the diagnosis of benign and malignant lesions; the sensitivity was 100%. The specificity was 98.3%. PPV was 90.9% and NPV was 100%. AUC was 0.99 or 99%. Conclusion: Substantial physiological changes during pregnancy and lactation make it challenging to evaluate patients presenting with a breast problem. Most findings in pregnant and lactating patients are benign. Ultrasound is the first-line imaging modality for all pregnant women and for lactating women less than 30 years of age and for guiding interventional breast procedures.