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Ultrasonographic Findings of Breast Diseases During Pregnancy and Lactating Period1

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Ultrasonographic Findings of Breast Diseases During Pregnancy and Lactating Period1 Journ al of the Korean Radiol ogica l Society 1995 : 33(3) : 443- 447 Ultrasonographic Findings of Breast Diseases During Pregnancy and Lactating Period1 Yeon Hee Lee, M.D2., Yong Hyun Park, M.D., Tae Hee Kwon, M.D. Purpose: To evaluate ultrasonographic findingsand usefulness in the diagnosis of breast diseases during pregnancy and lactating period. Methods and Materials: The authors evaluated the ultrasonographic findings of 18 breast diseases during pregnancy and lactation retrospectively. The ultr­ asonographic examinations were performed with linear-array 5 MHz transducer (AT 니. Final diagnoses were obtained by the excisional biopsy, fine needle aspir­ ation and clinical follow-up. Results: Total 18 cases of breast diseases were consisted of 8 cases of gala­ ctocele, 4 cases of fibroadenoma, 3 cases ofaxillary accessory breast, 2 cases of lactating adenoma, and 1 case of phylloidestumor. The ultrasonographic findings of the above breast diseases were valuable in the diagnosis and therapeutic plan­ nlng. Conclusion: Ultrasonography is the initial and useful method of diagnosing breast diseases during pregnancy and lactating period. Index Words: Breast. US Breast neoplasms, US INTROCUCTION MATERIALS and METHODS During pregnancy, patients complain of breast dis­ The authors reviewed the ultrasonographic findings comfort, pain or mass but mammography cannot be of 18 breast lesions of 17 female patients retrospe­ taken due to possible radiation hazard to the fetus ctively. Mean age ofthe patients was 29.5 years and the After delivery, mammography of lactating breast is lim­ age range was 24 - 35 years. Five patients were preg­ ited in detecting a mass lesion due to hypertrophied, nant and 13 patients were postpartum within one year dense breast parencymal tissue which can mask the at the time of examination. The most common symptom mass density. was palpable breast mass(72.2 % ) (Table 1). Ultrasonogram has no radiation hazard(1) and is ef­ The exam inations were performed with a hand - held, fective in the detection of the mass especially in dense linear -array 5 MHz transducer( ATL Ultramark 9, 80- breasts, so it is of great use in the exam ination of breast thell , Washington , U.S.A) and a sonopad was used wh­ diseases during pregnancy and lactating period. enever a lesion is located superficially. The authors have experienced various breast dis­ Final diagnoses wer e obtained by means of surgical eases during pregnancy and lactation and these tried excision in 11 cases, fine needle aspiration in 4 cases to find the usefulness of ultrasonography in these pa­ of galactoceles, and combination of clinical and sono­ patients graphic findings in 3 cases ofaxillary accessory bre­ asts. In five pregnancies, the excision was performed after del ivery. ' D epart m e nt 이 D i a gn ostic Radiology , ChaWo men’ s Hospi tal olSeoul RESULTS 2Department ofDiagnostic Radio logy , Dan kook Uni versityCo llege 01 Medi cine Rece ived October 14, 1994; AcceptedAugu st28 , 1995 Address reprint requests to :Yeon Hee Lee , M.D. , Department 01 Radi ology Total of 18 breast lesions were examined by ultra­ Dankook Un iversityH ospital sonography due to subjective symptoms. The final di ­ ~ 29 Anseodong Chonan Choong nam 330-714 Korea agnoses were 8 cases of galactoceles, 4 cases of Tel. 82-417- 550-6921 Fax. 82-417- 552-9674 fibroadenomas, 3 cases ofaxillary accessory breà. sts, - 443 - Journal of the Korean Radiological Society 1995 ; 33(3) : 443 - 447 2 cases of lactating adenomas, 1 case of benign phy­ (25%) but which was not confirmed by pathology (Fig. Iloides tumor. 2b). In 4 cases, after aspiration of mildly greenish fluid, Patients with accessory breast of axilla (3 cases) the masses disappeared in palpation. In the other 4 complained swelling of the axillary area with or without cases, the excision of the masses was performed pain. Ultrasonographic findings showed brease paren­ In 2 cases of lactating adenoma, roughly 3 cm sized chymal echoes in axillary area without a definite mass isoechoic mass was noted with ill defined border, mim­ or Iymphadenopathy. After delivery, swelling of both icking breast parencymal echogenicity adjacent to it. axillary area disappeared and so did the symptoms. There was no characterirstic findings such as posterior Three patients with fibroadenomas showed a well de­ enhancement, posterior shadowing, and calcification fined, low echogenic, oval shaped mass lesions, but (Fig. 3) the lateral shadowing was not seen(Fig. 1). One case One patient with phylloides tumor(1 case) showed showed a well defined mass which had a lobulated bor­ hypoech 이 c oval shaped mass (13.5 X 10 X 6.5cm) der and dense central calcification. The diameter ofthe with well defined border but definite clefts or cysts fibroadenomas were less than 2 cm in all cases. Micro­ were not seen (Fig. 4). scopic findings showed variable parenchymatous du­ ctal hyperplasia corresponding to those of the sur­ DISCUSSION rounding breast. Ultrasonographic findings of galactoceles(8 cases) In the evaluation of breast diseases, combined mo­ were cystic masses with variable internal echoes In 5 dalities are used such as mammography, ultrasono­ cases, well defined, single chambered, purely cystic graphy, xeromammography, galactography and re­ mass lesions were noted. One case showed 3.1 X 1.2 cently MRI(2 -4). cm sized purely cystic mass with multilocular cham­ The usefulness of mammography in women less bers and the pathology showed multiple ductectasias then 35 years of age is controversial. Mammography is without inflammatory changes (Fig. 2a). Two, relatively apparently less effective in the evaluation of the radio­ large (3.5 X 2.1 cm and 2.8 X 2.0 cm in size in each) dense breasts of younger women than of the less ra­ cystic masses contained highly echogenic. nodular diodense breasts of older women. According to Ba­ densities with posterior shadowing suggesting curds ssett et al(5) , in women less than 35 years of age, at Table 1. Summary of 18 Breast Diseases During Pregnancy and Lactation Period Diagnosis Age Symptom onset Symptom Physical Exam Axillary 30 IUP24wk pai nl ess 1eft axi 11 ary left axiliary sweliing accessory breast mass 27 IUP 19 wk painless bilateral bilateral axillary axillary mass swelling 24 IUP 8wk painfulleft axillary left axillary swelling mass Fibroadenoma 30 IUP 6wk breast discomfort nodular breast *35 P.P. 12m breast mass tender mass 29 P.P. 3m breastmass firm movable mass 27 P.P. 3m breastmass firm movable mass Gal actocel e 30 P.P. 3m left breast mass semifirm mass 25 P.P. 3m 1eft breast mass cysticmass 34 P.P. 1 m leftbreastpain firm πlO vable πlass 32 P.P .12 m left breast mass firm movable mass 26 P.P. 1 m ri ght breast mass soft movable mass 30 P.P. 4m right breast mass firm movable mass *35 P.P. 12 m breastmass tender mass 30 P.P.12m ri ght breast mass nodular mass Lactating adenoma 28 P.P. 1 m right breast mass solidmass 33 P.P. 1 m 1eft breast mass firm movable mass Pylioides tumor 31 IUP28wk rapidly growing solidmass painf비 mass IUP : Intrauterine pregnancy, P.P. : Postpartum , wk: weeks , m : months *T he same patient showed both a fibroadenoma and a galactocele 444- Yeon Hee Lee, et al: Ultrasonographic Findin gs of Breast Di seases During Pregnancy and La ctating Period 2a 2b Fig . 1. fibroadenomas A homogenous hypoechoic mass is well identified just beneath the skin . Fig. 2. galactoceles a. Multiseptated cystic mass is demonstrated and confirmed as multipl e ductectasias b. 111 defined hypoechoic mass with posterior enhancement is defined on ultrasonography that represents cystic mass. Multiple echogenic nodules with posterior shadowing are demonstrated at posterior wall ofthe mass suggesting curds Fig. 3. Lactating adenoma Ultrasonography reveal s an ill- defined and oval shaped isoechogenic mass that inter­ mingled with normal parenchymal echoge­ nicities Fig. 4. phylloides tumors Ultrasonogram shows large, re latively well defined hypoechoic mass without charac­ teristic internal cl efts or cysts 3 4 leasttwothirds ofthe breastwas radiodense. the mass. Therefore, the ultrasonography is recommended as During pregnancy and lactating period, striking ch­ a primary imaging technique for the young women with anges take place in the mammary gland. The ductal ­ breast pro 비 ems. The rationale for this approach in lobular- alveolar system undergoes considerable hy­ younger women includes the lower prevalence of br­ pertrophy and prominent lobules are formed. Estrogen east cancer, the great likelihood that the breasts will be and progesterone secretion from the placenta is elev­ dense and poorly suited for mammography(6). Ultra­ ated and these are considered to be the major hor­ sonography may be also the initial mode of examin­ mones responsible for full breast development(7, 8). ation in lactation or pregnant women, because the T,herefore on ultrasonography, the glandular compo­ increased breast parenchymal density may obscure nent dominates, giving a finely granular pattern and -445 ./ Journ al of th e Korean Radiological Society 1995; 33(3) : 443-447 highly reflective appearance with extreme compre­ eves et al. (18) suggest phylloides tumors are related ssion of the subcutaneous and retromammary fat. The with pregnancy and lactation. In our case, the mass lactiferous ducts are also dilated and may reach a di­ was rapidly growing during pregnancy. ameter of 7 -8 mm during lactation and are seen as The axillary accessary breasts were the cause of cystic spaces(9). These changes are also noted within swelling and pain ofaxillary area in the pregnant wo­ the tumor mass corresponding to those of breast pa­ men and were easily recognized by ultrasonogrphy renchyme. Moran (8) reported that fibroadenomas are without any further work - up. After delivery, the symp­ histologically modified at pregnancy and lactation.
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