Dados do Trabalho

Título

Breast pathology in Transgender Female patients

Descrição sucinta do(s) objetivo(s)

The objective is to inform breast pathology radiologists about specific considerations in transgender patients, particularly those undergoing cross-hormone therapy and sex reassignment surgery to affirm gender identity through a rapid literature review.

Descrição da(s) doença(s), método(s) e/ou técnica(s)

Transgender individuals, with gender identity differing from their reproductive biology, are estimated to be 8 to 25 million worldwide, and this population is growing. Transgender women commonly use estrogen and anti-androgens to induce breast development, with histological changes mirroring cisgender women. Benign and malignant breast pathologies, including fibroadenomas and invasive carcinomas, have been reported in imaging studies. Postoperative complications from top surgery and breast implants, such as symmastia and implant rupture, are also observed.
Consequently, transgender women can develop a wide range of breast pathologies, and nowadays imaging exams and screening is performed similarly to non-transgender women using mammography, tomosynthesis, ultrasound, magnetic resonance imaging, or CT, depending on the case or findings.

Discussão

The American College of Radiology (ACR) recommends screening protocols based on age, duration of hormonal therapy, and risk factors. For patients under 30 with less than 5 years of hormonal therapy, screening aligns with assigned sex at birth. Patients aged 25-30 with 5 or more years of therapy and higher risk should undergo tomosynthesis or annual mammography. For those aged 40 or older with 5 or more years of hormonal therapy and average risk, tomosynthesis or annual mammography is appropriate.

Around 70% of transgender women consider breast augmentation. Implant evaluation, similar to cisgender women, involves mammography, ultrasound, and MRI. The FDA suggests rupture assessment starting at 5-6 years post-surgery, differing from ACR recommendations.

Conclusões

The transgender female population is on the rise, necessitating specialized breast pathology screening guidelines. Limited research underscores the need for continued studies. The ACR's age-specific and breast cancer risk-based screening recommendations consider hormonal therapy duration. Less common is to find targeted recommendations on breast implants. Understanding breast imaging characteristics in transgender women is crucial for radiologists and mammologists, enabling effective responses to breast pathology in this growing patient group.

Palavras Chave

Breast imaging; Transgender

Arquivos