GESTATIONAL BREAST-CANCER

Objective: To study the problems of breast imaging in gestational brea st cancer. Patients and method: Retrospective review of the charts of 19 patients with breast cancer detected during pregnancy or lactation or within 1 year of delivery, who were referred to a tertiary centre f or adjuvant therapy between 1986 and 1996. For 10 patients who underwe nt breast imaging, mammograms and breast ultrasonograms or reports wer e requested from outside facilities. Results: The patients ranged in a ge from 23 to 41 years (mean 31 years). Ah 19 patients presented with palpable tumours; in 7 patients, the tumours were stage T2 or higher; in 11 patients, the tumours were at an advanced stage with positive ax illary nodes. In 11 of the patients there was a delay in diagnosis, wh ich ranged from 2 to 16 months. Of the 8 mammograms that could be revi ewed, 5 showed infiltrating ductal carcinomas with typical features, w hich were detected as a mass [in 1 case), a mass with microcalcificati ons tin 1 case), microcalcifications tin 2 cases) and asymmetry tin 1 case). Three mammograms were negative, including 1 obtained from a pat ient with extensive comedocarcinoma. Breast ultrasonograms obtained fr om 4 patients (2 of whom also had mammograms) showed solid hypoechoic masses; in 2 of the ultrasonograms, the masses simulated a benign lesi on. Conclusions: Although breast cancer during pregnancy and lactation is rare, this study suggests that radiologists should include it in t he differential diagnosis of a solid breast mass seen during pregnancy or lactation. Clinicians appear to be reluctant to use breast imaging in these patients; however, this can lead to a delay in diagnosis. Ul trasonography is the modality of choice for initial analysis of such a mass in this age group. Mammography with shielding of the abdomen is recommended if there is suspicion of cancer. Clinical, mammographic an d sonographic findings should be integrated for optimum interpretation .