Lactational breast changes/lobular hyperplasia mimicking masses: how can we differentiate from true pathological masses?

Objective: The aim of this study was to evaluate the role of sonomammography in the characterization of clinically palpable breast masses during pregnancy and lactation with differentiation of true and false (lobular hyperplasia/lactational changes) masses. Materials and methods: One hundred patients with clinically palpable breast masses during pregnancy and lactation were evaluated by means of ultrasound (US). Mammography was performed only for 23 patients. Mammographic and sonographic findings were evaluated retrospectively. When US or mammography revealed a benign lesion, no further diagnostic evaluation was necessary. However, when US or mammography demonstrated a suspicious lesion, biopsy was performed. Results: US showed lobular hyperplasia/lactational breast changes categorized as Breast Imaging-Reporting and Data System 2 (BI-RADS 2) in 13 cases, a lesion with the criteria of benignity categorized as BI-RADS 2 in four cases, BI-RADS 3 in 68 cases, BI-RADS 4 in three cases, and BI-RADS 5 in 12 cases. Mammography showed normal dense breast categorized as BI-RADS 1 in four cases, lesions with criteria of benignity categorized as BI-RADS 3 in six cases, BI-RADS 4 in two cases, and BI-RADS 5 in 11 cases. Trucut biopsy established the pathological diagnosis in 22 cases. Conclusion: Most of the pregnancy-associated breast masses are benign. Nevertheless, a strict assessment of any lesion is required, to exclude malignancy and to rule out lactational breast changes/lobular hyperplasia that may present as lump. US is the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation.