1 Department of Surgery, Mahdieh University Women Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Pediatric Surgery Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
The majority of cases are very young, less than 40 years old, which means they are out of the screening age range. For older pregnant women, screening is not done both due to possible radiation exposure of fetus and low accuracy of mammographyin pregnancy-induced highly dense breasts. Therefore, all the patients are symptomatic at presentation. Mass or ulcer in the breast, nipple or axilla; skin or nipple retraction, nipple scaling, unilateral uniduct spontaneous nipple discharge with any color, unilateral breast edema without or with redness (Peaud’orange) are the symptoms that bring the patient to her obstetrician. Thus, all pregnant women must be informed by their obstetricians about the possibility of breast cancer occurrence during pregnancy as well as all signs and symptoms of breast cancer. It should be noted that, stage by stage, the prognosis is the same as that of non-pregnant patients. Among the three breast imaging modalities, sonography is the first imaging procedure used for symptomatic pregnant women. It can safely be done during all trimesters of pregnancy. As always, sonography can differentiate solid tumors from cysts. Simple cysts are always benign, although they may present as large masses. Since there is no possibility for malignancy in these simple cysts, there would be no need for further follow-up because during the follow-up, their size and number can change or they may disappear spontaneously. These findings do not change our approach. In the case of large painful cysts, they can be aspirated using a needle either by surgeons or under the guide of sonography by a radiologist. On the other hand, if any solid mass is seen in the wall of a cyst, it is no longer a simple cyst and is considered as suspicious, thus classified as at least breast imaging reporting and data system (BIRADS) 4 needing immediate tissue diagnosis. Sonography, also, gives important information about solid tumors. By the evaluation of margins, vascularity, and elasticity, it can differentiate possibly benign tumor defined as BIRADS 3 from suspicious ones defined as BIRADS 4 or 5 that, again, need immediate tissue diagnosis. Well defined round or oval masses with fine margins without vascularity by Doppler evaluation and elastic, not rigid in elastography, are considered as possibly benign tumors or BIRADS 3 and can be followed by sonography instead of tissue diagnosis because the possibility of malignancy though not zero, is less than 2%. Sonography can, also, evaluate the lymp nodes in the breast and axilla; and diagnose the suspicious ones (thick cortex, round rather than kidney shape). If an LN is suspicious, tissue diagnosis is needed by needle biopsy which is usually done at the same time as the breast biopsy.