ACR Appropriateness Criteria® Breast Imaging During Pregnancy

Area of Science:

• Radiology
• Oncology
• Obstetrics

Background:

• Physiologic and structural breast changes during pregnancy complicate clinical examination and imaging.
• Pregnancy-associated breast cancer (PABC) is uncommon but rising due to delayed childbearing.
• PABC symptoms include palpable lumps, pain, nipple discharge, or breast enlargement.

Purpose of the Study:

• To provide evidence-based guidelines for breast imaging during pregnancy.
• To outline appropriate imaging modalities for PABC diagnosis and staging.
• To address the safety and efficacy of different imaging techniques in pregnant patients.

Main Methods:

• Systematic analysis of peer-reviewed medical literature.
• Application of evidence-based methodology (e.g., GRADE).
• Utilizing the RAND/UCLA Appropriateness Method for procedure evaluation.

Main Results:

• Mammography is safe and recommended for both screening and diagnostic purposes during pregnancy.
• Ultrasound is a valuable tool for evaluating PABC symptoms and staging.
• Breast MRI is not recommended due to unknown fetal safety of gadolinium contrast.

Conclusions:

• Routine screening mammography should continue during pregnancy for high- and normal-risk women.
• Diagnostic mammography and ultrasound are tailored for PABC evaluation and staging.
• Expert consensus and established guidelines inform recommendations when literature is limited.