Diagnosis Of Pregnancy-associated Breast Cancer Research Articles

Breast Imaging and Intervention during Pregnancy and Lactation.

Physiologic changes that occur in the breast during pregnancy and lactation create challenges for breast cancer screening and diagnosis. Despite these challenges, imaging evaluation should not be deferred, because delayed diagnosis of pregnancy-associated breast cancer contributes to poor outcomes. Both screening and diagnostic imaging can be safely performed using protocols based on age, breast cancer risk, and whether the patient is pregnant or lactating. US is the preferred initial imaging modality for the evaluation of clinical symptoms in pregnant women, followed by mammography if the US findings are suspicious for malignancy or do not show the cause of the clinical symptom. Breast MRI is not recommended during pregnancy because of the use of intravenous gadolinium-based contrast agents. Diagnostic imaging for lactating women is the same as that for nonpregnant nonlactating individuals, beginning with US for patients younger than 30 years old and mammography followed by US for patients aged 30 years and older. MRI can be performed for high-risk screening and local-regional staging in lactating women. The radiologist may encounter a wide variety of breast abnormalities, some specific to pregnancy and lactation, including normal physiologic changes, benign disorders, and malignant neoplasms. Although most masses encountered are benign, biopsy should be performed if the imaging characteristics are suspicious for cancer or if the finding does not resolve after a short period of clinical follow-up. Knowledge of the expected imaging appearance of physiologic changes and common benign conditions of pregnancy and lactation is critical for differentiating these findings from pregnancy-associated breast cancer. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Pregnancy-associated breast cancer as a screening and diagnostic challenge: a case report

Pregnancy-associated breast cancer (PABC) is the most common malignancy of pregnancy, affecting 1 in 3000 women. Due to the increased size and density of the breast tissue during pregnancy and lactation, diagnosis and treatment are commonly delayed. A 37-year-old woman, gravida 1 para 0, at the 27th week of gestation presented with two tumors of approximately 2 cm in the right breast with ipsilateral lymph node involvement on the ultrasonography. HER2–, ER+, PR+, a poorly differentiated ductal carcinoma was identified by the core biopsy and immunohistochemistry. The diagnosis of PABC was made, the tumor’s clinical stage was cT2, N1, Mx. She underwent a total mastectomy with axillary node dissection on the right side and was started on adjuvant therapy with paclitaxel. Our report highlights the importance of proper breast oncology surveillance during pregnancy, using safe and inexpensive methods including ultrasonography and biopsy of suspicious masses, to avoid cancer development and progression.

Pregnancy-Associated Breast Cancer: What Radiologists Must Know.

Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy, in the first year postpartum, or during breastfeeding. Imaging techniques play a significant role in the diagnosis of PABC. It is a challenging diagnosis since physiological changes seen in pregnancy and breastfeeding may limit clinical suspicion and imaging utility. The patient's well-being and the fetus must be taken into consideration for diagnosis and treatment.

Identification of core genes and clinical roles in pregnancy-associated breast cancer based on integrated analysis of different microarray profile datasets

More women are delaying child-birth. Thus, the diagnosis of pregnancy-associated breast cancer (PABC) will continue to increase. The aim of this study was to identify core candidate genes of PABC, and the relevance of the genes on the prognosis of PABC. GSE31192 and GSE53031 microarray profile datasets were downloaded from the Gene Expression Omnibus database and differentially expressed genes were analyzed using the R package and GEO2R tool. Then, Gene Ontology and Kyoto Encyclopedia of Gene and Genome pathway enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery. Moreover, the Search Tool for the Retrieval of Interacting Genes and the Molecular Complex Detection Cytoscape software plug-in were utilized to visualize protein–protein interactions and to screen candidate genes. A total of 239 DEGs were identified in PABC, including 101 up-regulated genes mainly enriched in fatty acid activation and the fibroblast growth factor signaling pathway, while 138 down-regulated genes particularly involved in activation of DNA fragmentation factor and apoptosis-induced DNA fragmentation. Fourteen hub genes with a high degree of connectivity were selected, including CREB1, ARF3, UBA5, SIAH1, KLHL3, HECTD1, MMP9, TRIM69, MEX3C, ASB6, UBE2Q2, FBXO22, EIF4A3, and PXN. Overall survival (OS) analysis of core candidate genes was performed using the Gene Expression Profiling Interactive Analysis and UALCAN websites. High ASB6 expression was associated with worse OS of PABC patients. Molecular subtypes and menopause status were also associated with worse OS for PABC patients. In conclusion, ASB6 could be a potential predictor and therapeutic target in patient with PABC.

Breast Ultrasound during Lactation: Benign and Malignant Lesions

Background: Structural changes during lactation make breast physical examination difficult. When breast problems occur, patients are often referred for an ultrasound (US) scan. Most breast lesions diagnosed in these patients are benign, but the diagnosis of breast cancer is a challenge. We aim to demonstrate the spectrum of US imaging findings in lactating women. Methods: 77 breastfeeding patients who underwent breast US in our department between February 2012 and March 2017 were evaluated. Patients' electronic medical records were reviewed for the presenting complaint, US reports, pathology results if available, and clinical/radiologic follow-up. All examinations were performed by 2 radiologists. Results: 28 of the 77 patients had normal US findings. Cysts were seen in 16 patients. 4 patients had stable fibroadenomas. 6 patients had US imaging findings suggestive of mastitis, 5 patients had galactoceles, 1 patient had an abscess, and 1 patient had unilateral hypertrophy without any accompanying lesion. In 13 patients, BI-RADS 3 solid masses were diagnosed. Invasive breast cancer was diagnosed in 3 patients. Conclusion: US can demonstrate or exclude a true mass against the background of a nodular breast parenchyma. Radiologists must be aware of malignant US features to avoid delays in the diagnosis of pregnancy-associated breast cancer.

Importance of a Multidisciplinary Approach to Breast Cancer Treatment in Pregnancy: Case Report of New Diagnosis of Pregnancy-Associated Breast Cancer

Pregnancy-Associated Breast Cancer (PABC) is a rare diagnosis and includes new diagnoses of cancer both during pregnancy as well as within the first year post-delivery. Due to its rarity, there is of yet no gold standard treatment nor is there a standardized regimen of treatment during pregnancy according to the American College of Obstetrics and Gynecology (ACOG). We report a case involving a 35-year-old gravida 2 para 1-0-0-1 who was diagnosed with clinical stage II (T2 N1) breast cancer in the early third trimester of pregnancy after physical examination revealed a palpable mass. Ultrasound-guided biopsy revealed poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, with micropapillary features, estrogen receptor (ER 90%), progesterone receptor (PR 25%) positive, HER2 positive 3+ with Ki67 index 75%. After extensive counseling and discussion between Obstetrics, Maternal Fetal Medicine, Breast Surgery, Neonatal ICU, and Oncology, a decision was made to initiate neoadjuvant chemotherapy (NAC) with adriamycin and cyclophosphamide. Our patient completed 4 total NAC treatments prior to delivery followed by a regimen of weekly taxol plus herceptin and perjeta postpartum. This patient strongly desired to carry the pregnancy to term and began treatment prior to delivery, making this case unique in comparison to other publications in which treatment was delayed until after delivery, or the pregnancy was terminated prior to beginning treatment. Our case highlights the importance of a multi-disciplinary approach to counseling patients in this unique situation to allow them the autonomy to choose the treatment best for them and their baby.

Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer

Pregnancy-associated breast cancer (PABC) may be defined as breast cancer diagnosed during pregnancy or within 1 year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of breast cancer. A single-institution retrospective chart review was performed of 99 patients identified with PABC between 1992 and 2007. Non-PABC controls were matched 2:1 to PABC cases by year of diagnosis and age. The differences in clinical features were compared between cases and controls using chi-square tests. Univariate and multivariate analyses were performed to assess the effect of PABC on survival. Of the 99 PABC cases, breast cancer was diagnosed during pregnancy in 36 patients, and after delivery in 63. PABC cases were more likely than controls to be negative for estrogen receptor (59% vs 31%, P < .0001) and negative for progesterone receptor (72% vs 40%, P < .0001). Cases were also more likely to have advanced T class (P = .0271) and N class (P = .0104) and higher grade tumors (P = .0115). With a median follow-up of 6.3 years for cases and 4.7 years for controls, overall survival did not differ between cases and controls (P = .0787). On multivariate analysis, the independent prognostic factors for overall survival were estrogen receptor status (P = .0031) and N class (P = .0003). The diagnosis of PABC was not an independent prognostic factor (P = .1317). PABC is associated with more adverse tumor features than non-PABC matched for age and year of diagnosis. After correcting for pathologic features, the diagnosis of PABC is not in itself an adverse prognostic factor for survival.

Pathologic features and outcomes of pregnancy-associated breast cancer (PABC): A case control study.

1589 Background: PABC may be defined as breast cancer (BC) diagnosed during pregnancy or within one year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of BC. Methods: We performed a single institution retrospective chart review of 99 patients (pts) diagnosed with PABC between 1992 and 2007, identified through our institutional database. Pts with non-invasive BC, prior BC or metastases at diagnosis were excluded. Non-PABC controls were matched 2:1 to PABC cases by year of diagnosis and age at diagnosis. Tumor features including T stage, N stage, grade, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status were recorded. Details of obstetric history, treatment and outcomes were also recorded. Results: The median age at diagnosis for cases was 35 (range 24-48) and for controls was 36 (range 25-48). Of the PABC pts, the diagnosis was made during pregnancy in 36, and after delivery in 63. 9 pts received chemotherapy during pregnancy, consisting of doxorubicin with or without cyclophosphamide. PABC cases were more likely than controls to be ER negative (59% vs. 31%, p < 0.0001) and PR negative (72% vs. 40%, p < 0.0001). Cases were also more likely to have advanced T stage (p = 0.0496) and N stage (p = 0.017) and higher grade tumors (p = 0.0137). Overall survival (OS) did not differ between cases and controls (p = 0.9584). The median follow-up for cases was 6.3 years and for controls was 4.7 years. After adjustment for ER, PR, HER2, T stage, N stage or grade, the presence of PABC vs non-PABC was not prognostic for survival. ER status, T stage and N stage were prognostic for OS after adjustment for PABC vs. non-PABC. On multivariate analysis, independent prognostic factors for OS were ER status (p = 0.0019) and N stage (p = 0.0001). The diagnosis of PABC was not an independent prognostic factor (p = 0.0999). Conclusions: PABC is associated with a higher incidence of ER and PR negative tumors, higher grade tumors and a more advanced disease stage at diagnosis than controls matched for age and year of diagnosis. While PABC is associated with less favorable tumor features, the diagnosis of PABC in itself is not an adverse prognostic factor for survival. No significant financial relationships to disclose.

Pregnancy-associated breast cancer: spectrum of imaging appearances

Delay in diagnosis of pregnancy-associated breast cancer (PABC) is common, often attributed to the difficulty in evaluating tumours in the gravid breast, low awareness among physicians and reluctance of patients and physicians to perform imaging or invasive procedures during pregnancy. Familiarity with imaging features of PABC is crucial for prompt diagnosis. This article illustrates imaging findings of PABC and provides an approach for the evaluation of pregnant and lactating women with palpable abnormalities.

Management of pregnancy associated breast cancer

Background: The peak age incidence for breast cancer in developing countries is 35-45 years, which is part of the reproductive years of our women. As women defer childbearing on account of education and careers, the incidence of pregnancy associated breast cancer is expected to increase. Aim: This study presents 4 cases of pregnancy associated breast cancer (PABC) to illustrate the challenges and dilemma in the management of these patients. Methods: The clinical features, stage of presentation of the disease, treatment and outcome of treatment of 4 patients with PABC are reviewed. Results: There were live births of normal babies by all 4 patients, but 100% mortality as all the 4 patients with PABC died within 18 months of delivery from metastatic breast cancer. Conclusion: Seventy to 80% of non-pregnant patients present with advanced breast cancer. PABC as illustrated by these 4 cases presented at worse stages of the advanced cancer. The late stage at diagnosis of PABC and the desire by the patients to have normal live birth at term have worsened prognosis for the PABC patients in our environment. Recommendation: Multidisciplinary team approach by midwives, obstetricians, surgeons and counselors using BSE, CBE and screening at ante-natal clinics for early detection and diagnosis. Counselors to assist patients take decision in the best interest of patient and unborn baby to reduce morbidity and mortality. Keywords: Pregnancy, Breast, CancerPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 37-41

Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings.

To evaluate the mammographic and sonographic findings of pregnancy-associated breast cancer. A total of 22 consecutive patients with breast cancer pathologically diagnosed during pregnancy (n = 10) or lactation (n = 12) were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and sonography were performed on 12 patients; sonography only was performed on 7 patients; and mammography only was performed on 3 patients. Mammographic and sonographic findings were evaluated retrospectively. Mammography revealed positive findings in 13 (86.7%) of 15 patients, even though all 15 patients had dense breasts. Mammographic findings included masses (n = 5), masses with calcifications (n = 2), calcifications with axillary lymphadenopathy (n = 2), a mass with axillary lymphadenopathy (n = 1), calcifications alone (n = 1), asymmetric density alone (n = 1), and diffuse skin and trabecular thickening alone (n = 1). Sonographic findings were positive and showed masses for all 19 patients (100%). The common sonographic findings of masses were irregular shapes (n = 15), irregular margins (n = 16), parallel orientation (n = 11), complex echo patterns (n = 14, including marked cystic [anechoic] components [n = 4]), and posterior acoustic enhancement (n = 12). Surrounding tissue effects could be seen in 5 patients, including ductal changes (n = 2), Cooper ligament thickening (n = 1), edema (n = 3), and skin thickening (n = 3). Calcifications within or outside a mass (n = 7) and axillary lymphadenopathy (n = 8) were also detected. Although a mass could not be discernible by mammography because of increased radiodensity during pregnancy or lactation, calcification, asymmetric density, axillary lymphadenopathy, and skin and trabecular thickening were helpful for diagnosis of pregnancy-associated breast cancer. Sonographic findings of a solid mass with posterior acoustic enhancement and a marked cystic component were somewhat different from the appearance of breast cancer in nonpregnant women, possibly because of the physiologic changes of pregnancy and lactation.

Imaging of pregnancy-associated breast cancer.

To assess the use of mammography in diagnosis of pregnancy-associated breast cancer (PABC). A retrospective review of medical records between 1973 and 1993 was performed in 85 women with breast cancer diagnosed during pregnancy or within 1 year after pregnancy. In 21 of these women, mammography was performed before biopsy; the mammographic findings in this study group, which had 23 cases of invasive carcinoma, were reviewed for signs of malignancy. Breast sonography was performed in six cases in five women; sonographic findings were also reviewed. Mammographic findings were present in 18 of 23 cases (78%), including mass (n = 13) (nine cases with calcification), suspicious calcifications (n = 4), and diffusely increased parenchymal density (n = 1). Breast sonography revealed focal solid mass in six of six cases. Axillary lymph node metastases occurred in 15 of 23 cases (65%). Although symptoms occurred before or during pregnancy in 12 cases (52%), PABC was diagnosed after pregnancy in 19 cases (83%). PABC is often advanced at diagnosis and associated with poor prognosis. Breast imaging studies usually demonstrate focal findings due to clinically evident PABC.