Emerging research suggests that mammography may play a viable role in detecting pregnancy-related breast cancer (PABC), even among women with extremely dense breasts.
For a retrospective study, recently published in Clinical Imaging, researchers reviewed mediolateral oblique and craniocaudal mammogram views for 167 women (mean age of 37) with newly diagnosed PABC as well as ultrasound imaging for 146 women in the cohort. The study authors noted use of different mammography techniques, including full-field digital mammography (78 patients) and digital breast tomosynthesis (DBT) (89 patients).
The researchers also pointed out that 97.6 percent of the cohort had dense breasts with 77 percent having extremely dense breasts. Eighty-two percent of the women were lactating, and 18 percent of the cohort were pregnant.
The study authors found that 82 percent of PABCs (137/167) were detected with mammography, and 69 percent of those PABCs had calcifications. Calcifications presented as sole finding in 55 cases and with a mass in 30 cases, according to the study.
“Given this increased density (in the cohort) and the reduced compression force, a decrease in mammographic sensitivity was anticipated. However, our results showed that in most patients, PABC was visible on mammography, primarily due to the high incidence of calcifications, which are less affected by mammographic density,” wrote lead study author Noam Nissan, M.D., Ph.D., an attending radiologist in the Department of Radiology at Sheba Medical Center, Tel Hashomer in Ramat Gan, Israel, and colleagues.
Three Key Takeaways
- Mammography effectively detects PABC despite dense breasts.
In a cohort where 97.6 percent had dense breasts and 77 percent had extremely dense breasts, mammography still detected 82 percent of PABCs, largely due to the presence of calcifications, which are less impacted by density. - Mammography adds diagnostic value over ultrasound. While both modalities detected measurable disease, mammography showed a greater extent of disease (mean 4.9 cm vs. 3.6 cm on ultrasound) and provided clinically relevant additional information in 38 percent of cases, including T-stage alterations in 27 percent.
- Calcifications are key imaging features. Among mammographically detected PABCs, 69 percent had calcifications — either alone or with a mass — supporting their diagnostic utility even in dense, lactating, or pregnant breasts.
Noting that mammography and ultrasound both detected measurable disease in 118 patients, the researchers pointed out a greater mean extent of disease (4.9 cm) in comparison to ultrasound (3.6 cm). When factoring in additional positive biopsy results, lesion size changes and T-stage alteration, the study authors determined that mammography added value for 38 percent of the cohort.
“In 45/167 (27%) PABCs, the mammographic measurement either exceeded the (ultrasound) measurement by ≥1 cm, which was previously suggested as a large margin for surgical control, or altered the T-stage, which may impact the medical management. Overall, the fact that mammography provided clinically relevant information in 64/167 (38 %) PABCs underscores the crucial importance of this modality in the diagnostic workup of this challenging disease,” emphasized Nissan and colleagues.
(Editor’s note: For related content, see “Mammography Study: AI Facilitates Greater Accuracy and Longer Fixation Time on Suspicious Areas,” “Expanded Breast Cancer Screening in Missouri Led to 45 Percent Higher Likelihood of Mammography Screening for Women on Medicaid” and “Reducing the Interval Breast Cancer Rate of Screening DBT: Can AI Have an Impact?”)
Beyond the inherent limitations of a single-center retrospective study, the authors conceded a lack of assessment for the specificity of the imaging modalities utilized in the research. They also acknowledged the possible impact of different imaging protocols and scanners with many of the patients having diagnostic workup at other facilities.
