Type:
Educational Exhibit
Keywords:
Breast, Obstetrics (Pregnancy / birth / postnatal period), Ultrasound
Authors:
R. Scandiffio, C. Giaconi, A. Cilotti, C. Marini, D. Mazzotta, M. Moretti, D. Caramella; pisa/IT
DOI:
10.1594/ecr2011/C-1557
Imaging findings OR Procedure details
Gestational and secretory hyperplasia are normal findings during pregnancy and lactation; breast is characterized by ductal sprouting,
lobular growth and decrease of intraglandular fat.
At mammography,
breast parenchyma appears dense and confluent,
while fat tissue decreases; in lactating women,
mammography should be performed after breast- feeding.
At ultrasonography,
echogenity in lactating breast parenchyma becomes more marked as more milk is synthesised.
Milk ducts present hypoechoic and can contain flecks representing milk fat globules; echogenic wall can be visible; medium diameter is 2mm with a wide range (0,9-10mm).
During pregnancy mammary blood flow increases to double pre-pregnancy levels by 24 weeks and then remains constant during lactation.
Lactating adenoma is a relatively uncommon benign lesion in pregnancy and it is a tumor of secretory breast epithelium.
Normal mitotic figures and foci of necrosis may be present,
without cellular atypia.
Sonographical features can be suggestive of benignity: lactating adenoma is characterized by well- circumscribed margins,
long axis parallel with chest wall,
gentle lobulations and thin echogenic pseudocapsule; mass can be hypervasculized.
Galactocele is an inflammatory cyst containg fluid,
and is the most common benign lesion in lactating women.
US depicts a round,
echogenic lesion with posterior enhancement,
similar to a complicated cyst.
Mammography depicts a round lesion,
with shape margins and sometimes a fluid level.
Mastitis and abscess are infectious diseases due to nipple discharge and superinfections (usually Streptococcus spp.
and S.
Aureus); antibiotic therapy and eventually drainage are indicated.
Mastitis present with skin and trabecular thickening,
but imaging is not useful unless malignancy is suspected.
Abscess occurs in 3% of complicated mastitis and manifests as ill- defined,
inhomogeneous,
hypoechoic mass,
sometimes with fluid- debris level and posterior enhancement.
Granulomatous mastitis is an uncommon disease that affects young women,
usually in 5 years after pregnancy.
US shows multiple hypoechoic lesions,
while mammography depicts multiple opacities; these findings are similar to multifocal cancer,
so histological examination is mandatory.
Fibroadenomas are usually preesistent,
but hormonal changes can determine some modifications,
such as increasing volume,
infarction or lactational changes.
In our experience,
however,
no significant changes were registered.
Pregnancy associated breast carcinomas (PABC) is a well known entity and amounts 3% of all breast carcinomas: it arises during pregnancy or within 1 year of delivery and is characterised by advanced staging at diagnosis,
poor prognosis and high grade.
Radiological findings are similar to non- PABC.
Mammography sensitivity is lower because of glandular density,
so US can be used in diagnosis,
in assessing axillary nodes and in interventional procedures.
US findings include inhomogeneous mass,
with ill- defined margins and hypervascularity.
Axillary lymph nodes should be evaluated[1,2].
MR can be used in staging and in pre- surgical planning.