0:00

Case number 13 is a 34 year

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old pregnant female with a palpable Mass. What

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is your recommendation based on

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this ultrasound?

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Okay, perfect. So everybody it's

0:15

like 100% got the correct

0:18

answer here. You could see it is

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a mass with indisting margin and

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echogenic foci.

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I obviously because the patient is

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pregnant. We don't recommend contrast

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enhance MRI because all the

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gadolinium based contrast agents or

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classified as category C and

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again surgical consult is not appropriate when

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you have a ultrasound finding that can be biopsied with

0:47

high probability of success.

0:59

And the pathology was a dcis with

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a micro invasion in this case and this particular

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case. We ended up doing the

1:08

mammal before the biopsy. The patient

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was 36 weeks pregnant, and she

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Insisted us to do the mammal before

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she delivered. So here you

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could see finallyomorphic calcifications in

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grouped distribution correlating to the palpable area,

1:28

which we saw on ultrasound as

1:31

well.

1:34

So just a few words about pregnancy Associated breast

1:37

cancer. It is the cancer that occurs

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during pregnancy or within the first year

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of childbirth ultrasound is

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the initial modality of choice.

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You can have you can do mammography if there's

1:52

a high index of Suspicion.

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in before the biopsy

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or if you definitely want to do mammography after you

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got the diagnosis of breast cancer to determine

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the extent of disease in the ipsilateral breast

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and contralateral breast.

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and a few words

2:12

about the mammography is that the estimated

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dose to the uterus is less

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than 0.03 micrograms,

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which is

2:26

Which is exponentially less than 15 milligram threshold.

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So it is

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you know, and when you the lead apron

2:35

actually Shields shielding decreases

2:38

the dose do you uterus up

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to 50%

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as far as the core biopsy is concerned that local

2:47

and seizure with lidocaine has

2:50

no known harmful fetal effects.

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And when the patient has a position is lactating

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there is a rare complication called milk

3:00

fistula. Where is it?

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It's attract between the skin and the duct and

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the milk will flow through the path of

3:09

least resistance and out through this skin instead

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of the nipple. So we minimize it

3:15

by nursing or pumping before we do the

3:18

collateral biopsy and

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and encourage them to continue pumping out

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even after the biopsy majority of

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the time it's spontaneously regressed. But if it

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continues to lead through that skin tract then

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the patient have to stop nursing from that breast.