Diagnostic accuracy of ultrasound in detection of pregnancy associated breast cancer

  • Zainab Mehmood Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
  • Rafia Shahzad Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
  • Ismat Fatima Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
  • Abubaker Shahid Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
Keywords: Diagnostic accuracy, ultrasonography, pregnancy associated breast cancer, histopathology

Abstract

Introduction: Some unique physiological changes occur in breast volume and water content during pregnancy which makes the radiological evaluation of the breast difficult.  As a result, diagnosis of Pregnancy Associated Breast Cancer.  is often delayed.

Objective: To find out the diagnostic accuracy of ultrasonography in detection of pregnancy associated breast cancer taking histopathology as gold standard.

Methodology: Present Cross-sectional study was carried out at INMOL Hospital, Lahore. Ultrasound of 200 women was performed. The patient was laid supine and then turned slightly in oblique position to scan the breast with high frequency linear probe (7.5-10 MHz). The contra-lateral breast and both axillae were also scanned in the same way. Findings were categorized on the basis of Breast Imaging Reporting and Data System (BI-RADS) assessment categories. Subsequently the breast tissue was sent to histopathology laboratory for tissue diagnosis. The pathologist was blinded of the results of ultrasonography.

Results: Mean age was 34 ± 11.36 years. Twenty-eight percent patients were primi-para while 72% patients were multi-para. Diagnostic accuracy of ultrasonography taking histopathology as gold standard was analyzed and ultrasonography had sensitivity 84.78%, specificity 98.05%, positive predictive value 92.85%, negative predictive value 95.56% and diagnostic accuracy was 95%. Invasive ductal carcinoma was most commonly observed (P<0.001) malignant histopathology. On the other hand, significantly high (P = 0.033) number of benign lesions were Fibroadenomas.

Conclusion: The high sensitivity and specificity along with easy availability, and non-invasive nature makes ultrasonography a very useful technique for the diagnosis of Pregnancy Associated Breast Cancer.

Downloads

Download data is not yet available.

Author Biographies

Zainab Mehmood, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Medical Officer, Department of Radiology, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Rafia Shahzad, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Consultant Radiologist, Department of Radiology, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Ismat Fatima, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Principal Scientist, Department of Clinical Pathology, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Abubaker Shahid, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

Consultant Oncologist, Chief Medical Officer, Department of Radiotherapy, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan

References

Rojas KE, Bilbro N, Manasseh DM, Borgen PI. A review of pregnancy-associated breast cancer: diagnosis, local and systemic treatment, and prognosis. J Women's Heal. 2019; 28(6):778-84.

DOI: https://doi.org/10.1089/jwh.2018.7264

Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol. 2013; 31(20):2532-9.

DOI: https://doi.org/10.1200/JCO.2012.45.6335

Loibl S, Schmidt A, Gentilini O, Kaufman B, Kuhl C, Denkert C, et al. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA oncology. 2015 ; 1(8):1145-53.

DOI: https://doi.org/10.1001/jamaoncol.2015.2413

Langer A, Mohallem M, Stevens D, Rouzier R, Lerebours F, Chérel P. A single-institution study of 117 pregnancy-associated breast cancers (PABC): presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014 ; 95(4):435-41.

DOI: https://doi.org/10.1016/j.diii.2013.12.021

DiFlorio-Alexander RM, Slanetz PJ, Moy L, Baron P, Didwania AD, Heller SL, Holbrook AI , et al. ACR Appropriateness Criteria-Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol 2018; 15: S263-75.

DOI: https://doi.org/10.1016/j.jacr.2018.09.013

Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. Cochrane database sys reviews. 2015(7).

DOI: https://doi.org/10.1002/14651858.CD007058.pub3

Beyer I, Mutschler N, Blum KS, Mohrmann S. Breast lesions during pregnancy-a diagnostic challenge: Case report. Breast Care. 2015;10(3):207-10.

DOI: https://doi.org/10.1159/000381823

Gharekhanloo F, Haseli MM, Torabian S. Value of ultrasound in the detection of benign and malignant breast diseases: a Diagnostic Accuracy Study. Oman Med J. 2018; 33(5):380-86.

DOI: https://doi.org/10.5001/omj.2018.71

Robbins J, Jeffries D, Roubidoux M, Helvie M. Accuracy of diagnostic mammography and breast ultrasound during pregnancy and lactation. AJR Am J Roentgenol 2011; 196:716-22.

DOI: https://doi.org/10.2214/AJR.09.3662.

Beyer I, Mutschler N, Blum KS, Mohrmann S. Breast lesions during pregnancy-a diagnostic challenge: Case report. Breast Care. 2015; 10(3):207-10.

DOI: https://doi.org/10.1159/000381823

Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology. 2006; 239(1):52-60.

DOI: https://doi.org/10.1148/radiol.2391050083

Kakoulidis I, Skagias L, Politi E. Pregnancy associated breast cancer (PABC): aspects in diagnosis. Breast disease. 2015; 35(3):157-66.

DOI: https://doi.org/10.3233/BD-150408

Bae SY, Jung SP, Jung ES, Park SM, Lee SK, Yu JH, et al. Clinical characteristics and prognosis of pregnancy-associated breast cancer: poor survival of luminal B subtype. Oncology. 2018; 95(3):163-9.

DOI: https://doi.org/10.1159/000488944

Kim YG, Jeon YW, Ko BK, Sohn G, Kim E-K, Moon B-I, et al. Clinicopathologic Characteristics of Pregnancy-Associated Breast Cancer: Results of Analysis of a Nationwide Breast Cancer Registry Database. J Breast Cancer 2017; 20(3): 264-69.

DOI: https://doi.org/10.4048/jbc.2017.20.3.264

Wang B, Yang Y, Jiang Z, Zhao J, Mao Y, Liu J, at el. Clinicopathological characteristics, diagnosis, and prognosis of pregnancy‐associated breast cancer. Thoracic cancer. 2019; 10(5):1060-8.

DOI: https://doi.org/10.1111/1759-7714.13045

Bitencourt AG, Gama RR, Graziano L, Negrão EM, Sabino SM, Watanabe AH, Guatelli CS, Souza JA, Mauad EC, Marques EF. Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol. 2017; 90(0):20170197.

DOI: https://doi.org/10.1259/bjr.20170197

Naz H, Sultana A, Baqai Z. Beneficial effect of cervical cerclage in preventing pregnancy loss. J Surg Pak. 2012; 17(3):112-5.

Khan Z, Khan R, Wazir AK. Success rate of cervical cerclage in preterm labour. J Preg Child Health. 2015; 2(4):1000176.

DOI: https://doi.org/10.4172/2376-127X.1000176

Published
2021-08-01
How to Cite
1.
Mehmood Z, Shahzad R, Fatima I, Shahid A. Diagnostic accuracy of ultrasound in detection of pregnancy associated breast cancer. JSTMU [Internet]. 1Aug.2021 [cited 28Mar.2024];4(1):3-. Available from: https://j.stmu.edu.pk/ojs/index.php/jstmu/article/view/113