Whole-body MRI useful in diagnosing breast cancer during pregnancy

As women diagnosed with breast cancer during pregnancy are presented with limited imaging options, a new study published in The Breast suggests whole-body MRI (WB-MRI) could potentially be the answer to staging concerns.

“The staging procedure for pregnant women with breast cancer is challenging,” the authors, led by Fedro Peccatori of the European Institute of Oncology, wrote. “Any imaging modality to be used in this condition should be carefully selected in order to limit the exposure of the fetus to ionizing x-rays. Ionizing radiations have been associated with abortion, stillbirth, malformations, growth retardation and carcinogenesis.”

In the retrospective study, 14 pregnant women with breast cancer underwent staging with WB-MRI. The average age of the patient at diagnosis was 35 years, the average gestational age at MRI was 30 weeks and average age at delivery was 38 weeks.

Fourteen infants were born, and no physical abnormalities were present. There was one case of perinatal jaundice and one case of respiratory distress syndrome. Thirteen of women received cancer treatment during pregnancy.

  • Two patients or 14.2 percent underwent chemotherapy.
  • Two patients or 14.2 percent underwent a mastectomy or breast conserving surgery.
  • Nine patients of 64.3 percent received both chemotherapy and surgery.
  • WB-MRI was performed before surgery in 10 patients.
  • WB-MRI was performed after surgery in four patients.
  • One patient underwent WB-MRI at week 31, was induced at week 32 and was given treatment after surgery.

WB-MRI shows good diagnostic performance for the detection of primary and metastatic malignancies and is a safe and accurate alternative to other imaging modalities during pregnancy.

The authors noted further studies will need to confirm their preliminary observations to represent an imaging choice for the staging of pregnant women diagnosed with breast cancer.

“We conclude that diffusion-weighted MRI is feasible accurate and safe for the mother and for the fetus,” the authors wrote. “It may present the staging technique of choice in pregnant women diagnosed with breast cancer after the first trimester of pregnancy.”