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The present review shows a modern view on ultrasound differential diagnosis of hyperechoic benign breast lesions. The main ultrasound semiotic signs of the most common focal benign structures are noted, in comparison with the data of histopathological analysis.

This article presents a clinical case of pregnancy-associated breast cancer. We have analyzed the features of the diagnostic algorithm, considered the radiological manifestations and presented the main literature sources about this pathology. Pregnancy-associated breast cancer is breast cancer that occurs during pregnancy or within the first year after a baby birth. It is most often diagnosed only after first clinical symptoms, the most characteristic of which is a feeling of compaction in the breast, less often bloody discharge from the nipple, pain, breast deformation and baby's refusal to breastfeed. Radiological signs of pregnancy-associated breast cancer are not pathognomonic and may mimic benign changes associated with pregnancy and lactation at early stage: lactation adenoma, mastitis, abscess, galactocele, fibroadenoma. Uncertainty of physicians about the harm of radiological methods of examination for pregnant women and the fetus and, consequently, incorrect diagnostic algorithms can delay the early detection of pathology, establish an accurate diagnosis and worsen the prognosis for the patient. Compliance with a sequential diagnostic algorithm using sonographic diagnostics, X-ray mammography with digital breast tomosynthesis, magnetic resonance imaging in accordance with the diagnostic categories of the BI-RADS scale allows you to verify breast tumors. Diagnosis should be consistent with American College Radiology guidelines. In case of detection of suspicious breast pathology in a pregnant woman or woman in labor, a doctor of any specialty should refer the patient to specialized specialists in the diagnosis and treatment of breast diseases. Adherence to the correct algorithms for the appointment, conduct and interpretation of radiological studies, taking into account changes in the breast structure, will allow timely diagnosis, proper treatment and save the lives and health of childbearing aged women.

Rationale: A standard algorithm for the assessment of patients with breast trauma does not exist, as such trauma usually does not incur any significant health problems. However, according to existing clinical and work-up data and various radiological signs, posttraumatic abnormalities of the breast can mimic cancer lesions and complicate the differential diagnosis for a radiologist.Aim: To evaluate the potential of digital mammography and breast ultrasound examination in the identification of breast posttraumatic abnormalities and to describe their semiotics.Materials and methods: The study included 150 female patients aged 40 to 86 years (mean±SD, 60±11.9 years) with a history of breast trauma. Digital mammography with tomosynthesis (combined mode) and multiparametric ultrasound were able to identify breast abnormalities in 62 patients. The results of all assessments (n=62) were interpreted according to BI-RADS. Should any confirmation of the abnormalities be necessary, fine needle aspiration biopsy or core-biopsy with stereotaxic or ultrasound control were performed.Results: At mammography, the typical posttraumatic abnormality in the breast was fat necrosis (n=54). It was represented as nodular masses with round (20/34; 58.8%) or oval shape (13/34; 38.2%) and circumscribed margins. In most cases, the masses contained eggshell calcification (27/34; 79.4%). In 35.1% (19/54) of the cases fat necrosis was represented by various calcifications. At ultrasound, fat necrosis could be identified as avascular (40/40; 100%), mostly round (26/40; 65.0%), less frequently oval (12/40; 30.0%), and hypoechoic (19/40; 47.5%) masses with circumscribed margins. Atypical signs of fat necrosis (BIRADS 4) were found in 16.1% (10/62) of the cases, in which 7 (11.2%) core-biopsies with ultrasound control and 3 (4.8%) stereotaxic biopsies were performed. In all the cases, breast fat necrosis was confirmed, with various ratios of fibrous and necrotic fat tissue and lymphoid infiltration.Conclusion: In most cases, standard radiological methods used in the diagnostic algorithm for posttraumatic breast lesions are sufficient for the diagnosis. In uncertain diagnostic cases, morphological verification seems necessary.

Clinicoroentgenological diagnosis of early breast cancer - BC (non-invasive or invasive small-sized cancers) is difficult due to the absence of any characteristic clinical symptoms and pathognomonic roentgenological signs of the malignant process. Screening of BC has shown to be one of the most successful projects for early diagnosis of malignancies, but the probability to receive false negative results using screening mammography reaches 12%, and, on the one hand, this is due to interval cancers, and on the other hand - to defects in the primary screening. Among the factors associated with the likelihood of ineffective screening of BC, the most authors highlight such as high breast density, preceding the breast biopsy for a benign process, young age, as well as the use of hormone replacement therapy. The main methods of instrumental BC diagnostics are mammography, ultrasound (US), magnetic resonance imaging (MRI) and positron emission tomography (PET). Mammography is the "gold standard" for both screening and best diagnostics, but is characterized by a high proportion of both false positive and false negative results, and this can be partially solved by the use of digital mammography with tomosynthesis (performing a series of mammography images obtained at different angles and producing the focused 3-D images). Contrast enhanced mammography allows to identify angiogenesis in the area of the predicted malignancy, but is characterized by a high radiation exposure. Breast ultrasound is characterized by low specificity of the method and the high dependence of the result of data interpretation depending on physician qualifications. MRI of the breast for screening is characterized by high sensitivity, but also high cost and high proportion of false positive results. The role of PET/computer tomography in the diagnosis of early BC remains unclear, and the informative value of research in patients with nonpalpable tumors is extremely low. The roentgenological picture of early BC is widely variable; characteristic features include the presence of clustered calcifications, lumps with jagged edges, rough multinodular lumps. However, in a significant proportion of women the only manifestation of early BC is the presence of microcalcinates. Careful analysis of the localization and the shape of microcalcinates and basic characteristics allows correctly interpret the roentgenological diagnosis and helps to choose the optimal diagnostic and treatment algorithm.

Aim. To assess the predictive value of digital mammography, breast ultrasound and a combination of these methods in the diagnosis of early breast cancer - BC (carcinomas in situ and invasive tumors up to 1.0 cm in size). Outcomes and methods. We retrospectively reviewed clinical records of 110 patients of the FSBI “N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of Russia Federation who were examined and treated for early BC (ductal carcinoma in situ, lobular carcinoma in situ, and invasive breast cancer no larger than 1.0 cm in size without regional or systemic tumor spreading). All patients were examined using digital mammography across two projections, with targeted magnification if it was necessary, as well as breast ultrasound with B-mode, Doppler ultrasound and elastography. We analyzed a frequency of establishing various BI-RADS categories according to data of mammography and breast ultrasound. We also assessed breast tissue density, a presence of nodules and calcifications and their radiological characteristics, as well as a frequency of false-negative results of mammography and breast ultrasound, their radiological characteristics, and causes of obtaining the false-negative results. According to the data of mammography and breast ultrasound, the study group was divided into 2 subgroups: patients who were diagnosed with BC (BI-RADS 5) and patients with changes in the breast which were not clearly interpreted as malignant (BI-RADS 0-4). Statistical analysis was carried out using the SPSS 20.0 program; differences were considered statistically significant with p

The article is devoted to problems of diagnosis of cystic disease of breast at different ages including children and teens. Analyzed various options for classification of cystic changes. The main method of detecting liquid formation is breast ultrasound, then, as a final verification is possible after thorough laboratory studies education (cytological, biochemical and histological method). Therapeutic and diagnostic puncture cysts do not affect the continued operation of the glandular tissue and can be used at any age. Active sanitation of cysts in children due to the high probability of occurrence of inflammation on the available background cystic cavity. In the adult diagnostic and treatment interventions have a diagnostic character and for reducing local pain symptoms associated with overexertion cysts. Analysis of the results carried out on the basis of examination and treatment of 22 381 patients aged 8 to 72 years, who applied to receive a specialized mammography department of the Federal State Autonomous Institution “National Health Research and Practical Center for Children” of the Ministry of Health of the Russian Federation for the period from 2008 to 2015. According to the results of instrumental studies, cystic changes were detected in 12.1% of 6 126 examined children and adolescents aged from 8 to 17 years, as well as in 49% of 16 255 examined patients over the age of 18. The authors summarize that the current International Classification of Diseases of the 10th revision does not reflect the structural features of the revealed cystic breast pathology for determining forms with increased oncological alertness. At present, for the formation of groups of oncological alertness, the most approximate to the work of the clinician is the classification of cysts according to Berg, which more closely examines the internal structure of the revealed cystic formations and determines indications not only for cytological, but for histological examination in groups whose types of cysts have high risk of malignancy.

Breast cancer (BC) is the most common female cancer type and the leading cause of female cancer mortality in Russia and in majority countries of the world. Along with the most common type of BC – ductal carcinoma, there are a lot of histological types, distinguished by structure features, which lead to a variable clinical and instrumental semiotics.These histological types of BC in the group marked out special types of BC, including medullary carcinoma. The concept of medullary cancer includes typical medullary BC, atypical medullary BC and invasive ductal BC with evidence of medullary morphology.Based on the current literature data, the authors discuss the main epidemiological, clinical and morphological diagnostic features of medullary BC. The authors pay special influence pathological picture, forming the characteristic diagnostic features of medullary cancer detected using X-ray mammography and ultrasound of the breast – the basic techniques of BC and other breast diseases detection.In 2003–2013 diagnosed 19 medullary BC cases in women aged 18–56 years, with 18 of them were recorded in patients aged 34–56 years. The authors describe in detail the features of clinical, mammographic and ultrasound semiotics of medullary BC. Article is focused on the main X-ray and ultrasound characteristics, such as mass shape and margin features, as well as its internal structure, and also the results of power Doppler. One of the main features of this article is description of ultrasound elastography pattern of medullary BC, which could be find in only a small number of scientific articles.Typical medullary BC, atypical medullary cancer and ductal carcinoma with medullary signs have different prognosis. This problem leads to necessity find reliable distinguishing features in mammograpic and ultrasound semiotics. It is seems important to reveal sites with indistinct margin. We have found the indistinct margin detection is not statistically significant for the differential diagnosis of typical forms of medullary BC from atypical forms and invasive ductal BC with evidence of medullary structure.The authors conclude that the mammographic and ultrasound semiotics of medullary BC makes accurate differential diagnosis with benign breast pathology by X-ray mammography as well as breast ultrasound impossible. There are no statistically significant differences in the results of the mammography and breast ultrasound in different histological types of medullary BC. So these diagnostic features are not reliable for the differential diagnosis. However, the application of a comprehensive usage of mammography and breast ultrasound using modern technology of ultrasound diagnosis allows to suspect BC.

The article describes the main epidemiological, clinical and morphological diagnostic features of one of the rare breast cancer form – mucinous carcinoma of the breast. Current scientific data are followed by the results of own research the 9-year period of research.Authors draw attention to the very complex radiology peculiarities of the mucinous carcinoma of the breast.