Ultrasound and mammography both useful in breast cancer during pregnancy

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Performing both ultrasonography and mammography in pregnant women diagnosed with breast cancer yields clinically important information, report physicians at the University of Texas, MD Anderson Cancer Center in Houston.

Increased breast volume and firmness during pregnancy can make breast cancer diagnosis difficult, Dr. Wei Tse Yang and colleagues note. These women may also have more locally advanced cancer at presentation than do nonpregnant patients, making chemotherapy a reasonable option. However, most previous studies included women whose breast cancer was diagnosed after delivery.

Dr. Yang's group evaluated imaging studies of 23 patients with 24 cases of breast cancer diagnosed during pregnancy between 1989 and 2003. As reported in the April issue of Radiology, mammography was the sole imaging modality for three cases, as was sonography for four cases. The other 17 cases underwent both ultrasonography and mammography.

Mammograms identified malignancy in 18 of 20 cases. Sonography findings were positive for all 21 malignancies in 20 women who underwent breast and nodal basin studies. Moreover, sonography correctly depicted axillary metastasis in 15 of 18 women assessed.

In the two women who had false-negative results with mammography, ultrasound identified a 3.0-cm and a 1.6-cm cancerous breast mass.

Sixteen of the women underwent neoadjuvant anthracycline-based chemotherapy while pregnant and additional non-anthracycline-based chemotherapy after delivery. The authors observed that ultrasound evaluation was useful in following patient response to chemotherapy.

"We believe that mammography and sonography have a complementary role in imaging the pregnant patients," the authors write, "and suggest that sonography be used as the initial imaging modality in symptomatic pregnant women."

They also recommend that mammography, performed on both breasts, should be done on pregnant women with a diagnosis of invasive or in situ malignancy.

Radiology 2006;239:52-60.