Radiological Evaluation of Pregnancy Associated Breast Carcinoma: A Retrospective Study

Abstract

Introduction: Pregnancy-Associated Breast Cancer (PABC) is any breast cancer diagnosed during pregnancy or within 12 months after delivery. PABC is a rare, having an incidence of approximately 0.3/1000 pregnancies, however it’s incidence is increasing as more and more women are delaying childbearing. Aim: To evaluate the radiological features of pregnancy associated carcinoma and spread awareness of this entity, as knowledge of PABC will help in its early diagnosis and decrease mortality. Materials and Methods: This retrospective study was conducted in Integrated Breast Care Centre (IBCC) in All India Institute of Medical Sciences, Rishikesh, from 1st January 2019 to 30th June 2019. Pre designed proforma was used to collect all relevant information, which included patient data, clinical and examination finding and provisional diagnosis. Brief history regarding any risk factors was taken. All pregnant/lactating patients who presented with breast lump were evaluated by Ultrasonography (USG) and/or mammography and appropriate BIRADS was assigned. In selected patients CEMRI breasts was also done. The histopathologically proven malignant lesions were included in the study. Results: From 1st January 2019 to 30th June 2019, 196 cases of carcinoma breast came to IBCC, out of which seven cases were of PABC. Average age of presentation was 35 years. Most of the patients presented during lactation. It was found that most of the cases presented in advanced stage with large lump, involvement of skin and axillary lymph nodes. This was attributed to aggressive nature of these tumour, triple negative status on immunohistopathology, which was seen in all cases in our study and lack of awareness, un-education, low socio-economic status and reluctance of patients to perform imaging or invasive procedures during pregnancy, precluding timely management. On USG larger lesion showed cystic changes and smaller lesions parallel orientation with posterior acoustic enhancement, mimicking benign lesion. Mammography act as complimentary imaging modality and MRI helps in better evaluation of disease extent and multi-centricity. Conclusion: Incidence of PABC is increasing as more women are delaying child birth. USG is the imaging modality of choice for breast lumps presenting during pregnancy and lactation. Mammography act as a complimentary imaging modality. Imaging features of small lesions may mimic benign lesion, thus new palpable complex cystic masses or any mass persisting for more than two weeks during pregnancy and lactation warrant tissue sampling and should not be disregarded as a galactocele or an abscess. Most of the lesions are triple negative on immuno-histochemistry. Delay in diagnosis and aggressive nature of lesion attribute to most lesions presenting with large size, axillary lymph nodes and skin involvement. Thus, it is important to spread awareness of this entity and its radiological features, which will aid in its early diagnosis and management.

Keywords

• acoustic
• cancer
• enhancement
• negative
• posterior
• triple