Search

The purpose of this study was to analyze the causes of false results in the ultrasound (US) and sonoelastography (SEG) examination of non-palpable and palpable lesions of the breast. The efficacy of diagnosis of non-palpable and palpable lesions by US and SEG was compared. 211 women with histologically confirmed focal breast lesions (146 non-palpable and 65 palpable) were included in the group. Women had a mean age of 52.0 +/- 13.6 years. The diameter of non-palpable lesions was less than 2 cm. Local mastopathy and medullar carcinoma were the reason of false results in most US. SEG allowed differentiating of these lesions. We found that SEG increased the specificity of diagnostics of non-palpable breast lesions by 19%.

This is an analysis of the use of sonoelastography as part of complex instrumental diagnostic procedure (mammography, gray-scale and Doppler ultrasonography) for small breast tumors. A total of 126 patients with breast lesions below 20 mm in diameter were divided into two groups depending on lesion size. The first group consisted of women with 5-10 mm lesions (21 patients with carcinoma and 20 patients with benign tumors), the second group was characterized by 11-20 mm lesions (69 carcinoma patients and 16 patients with benign lesions). According to analysis results the diagnostic complex of gray-scale ultrasonography and sonoelastography is most sensitive, the sensitivity is higher in the second group (89.1% and 97.7% respectively). The complex ultrasonography procedure yielded better overall results than mammography in both patients' groups.

The breast cancer occupies one of the first places among women's malignant neoplasms. Breast cancer case rate annually increases in the majority of the countries of the world. It is very important early diagnostics and active revealing of breast pre-tumor diseases. With the purpose of definition of value of color Doppler, there were inspected 127 patients with various breast pathologies. Breast ultrasonic research, color Doppler and power Doppler allowed obtaining the essential additional data for carrying out of differential diagnostics. According to the results, concentration of vessels in a zone of tumor unit with a primary locating on periphery is characteristic for malignant formations of breast. It is, accordingly, cause of rising vascularisation of tissues of breast, and also high parameters of linear speed of blood-flow - Vmax - 0,34+/-0,05 m/s, Pi (Pulls index )- 1,42+/-0,04, Ri (Resistance index) - 0,71+/-0,02. Parameters of linear rate of a blood-flow are lower for non malignant nodal formations - Vmax from 0,14+/-0,02-0,19+/-0,02 m/s, Pi - 1,42+/-0,12-1,42+/-0,06, Ri - 0,60+/-0,02-0,62+/-0,02. In cases of weak vascularised of nodal formations the method of power Doppler was used. The maximal rate in circumflex vessels of the pathological formations in most cases did not exceed 0,25 m/s, when size of formation was up to 1,5 sm and 0,7 m/s when size of formations was more than 3 sm. At use of ultrasonic intervention combining with color Doppler and power Doppler sensitivity of diagnostics has made 93,8% and specificity - 88,6%. Proceeding from, color Doppler especially in a combination to other methods of research is the effective method, allowing increase of diagnostic accuracy. Dopplerography, allowing to visualization of blood-flow in fine vessels and even perfusion in a tissue of breast, undoubtedly, soon will occupy the one of the conducting places in diagnostics of breast diseases.

The purpose of the study was to estimate the capacities of digital mammography in screening in women followed up by a mammologist in the Surgut Clinical Perinatal Center. The results of analog and digital mammography were compared using a Senographe DS in 1772 subjects who had been followed up by a mammologist in the Surgut Clinical Perinatal Center for 3-7 years. Females in whom mammography was first made as a basic study on a digital mammography were identified in an individual group of 887 subjects. Analysis of the capacities of analog and digital mammography indicated many advantages of the latter.

The basic features of the process of development of medical optical introscopes are considered. Design characteristics of preproduction and production models of devices for diagnosis of the brain and the mammary gland are described.

The possibility of estimating the effective atomic number distribution from the ratio of the scattering and total absorption coefficients is considered. To illustrate the use of this technique in mammology, the results of measurement of microcalcinate and cholesterol distribution are discussed. It is suggested that tomographic examination of mammary gland should include detection of scattered radiation.

A randomized double blind placebo-controlled trial of efficiency of a dietary supplement "Karinat" in patients with benign breast disease was carried out. Karinat contains beta-carotene 2.5 mg, alpha-tocopherol 5 mg, ascorbic acid 30 mg and garlic powder 150 mg per one tablet. Out of 66 patients, 33 patients were given karinat, 33 were given placebo. The patients reccived a tablet of karinal or placebo twice a day during 6 months. Examinations of the patients included clinical estimation of symptoms of mastopathy and dysalgomenorrhea, breast sonography and mammography. It was found that karinat reduced the severity of mastalgia, premenstrual syndrome, dysmenorrhea and algomenorrhea and caused regression of palpable symptoms of the breast fibromatosis. On the whole karinat had positive action in 75.8% that was significantly greater by 45.5% as compared with placebo. Karinat may be useful for the treatment of patients with benign breast disease.

The efficiency of therapy (a quantitative index that reflects the frequency of remissions due to treatment) of diffuse mastopathy with thyroid hormones in the maximum tolerable dose (the dose with which a female patient feels comfortable) averaged 54 to 100% depending on the group of the examined females. The high efficiency of therapy of diffuse mastopathy with thyroid hormones in the maximum tolerable dose and the absence of adverse reactions allow the author to recommend that this treatment should be widely used in medical practice (patient RU No. 2172635).

Specialized mammographic screenings of 61,276 industrial workers of the City of Perm and Perm Region were carried out in 1991-1999. Examinations included palpation, mammography and ultrasound (in some patients), aspiration biopsy and cytological analysis of nipple discharge, if necessary. Various pathological sites were identified in 9,126 (14.9%). Diffuse mastopathies were diagnosed in 7,286 (11.9%), mostly in women aged 31-50 (5,239; 72%). Nodal tumors (cancer, localized fibrocytic disease, fibroadenoma, cysts and lymphomas) were detected in 1,840 (3%). Their frequency ranged 2.6-3.3% in all age-brackets: causation by fibroadenoma--in the younger women, cancer--elderly women. Breast cancer was reported in 62 (0.1% of all screenees; 0.7% of patients, and 3.4% of patients with locally-advanced tumors). Cancer stage I was identified in 31 (50%), stage II--25 (40.3%), and stage III--6(9.7%). Hence, it may be assumed that early-onset cancers accounted for 90.3% while tumor process remained localized within the gland in 72.2%. Out of 509 patients followed-up after surgery for benign tumors, 207 (40.5%) revealed signs of proliferation and 12 (2.4%)--dysplasia. These findings point to the prophylactic and therapeutic value of mammography for breast cancer control.

The authors state their opinion on this problem by analyzing their 5-year use of their programme specially developed for detection of breast disease, mainly cancer, among females visiting specialized rooms of non-mammological profiles (gastroenterology, endocrinology, rheumatology, pulmonology, neurology, cardiology, hematology, nephrology, etc.) in the consulting polyclinics of regional (territorial) hospitals and large city hospital-polyclinic complexes. In this period, mammographic studies were made in 9169 women included into a breast cancer-risk group. Of them 1370 young female patients with well-developed glandular tissue that makes mammographic diagnosis of presumed masses difficult underwent breast ultrasonography. Abnormalities were found in 6092 (66.44%) patients. Breast cancer and nodal benign masses (including cysts and fibroadenomas) were detected in 278 (3.03%) and 669 (7.30%) women, respectively. The detection rates of unpalpable breast malignant and benign masses carcinomas were 0.4 and 3.03%, respectively. The findings allow the authors to recommend their proposed screening programme for wide use in large regional (territoreal), city, and town polyclinic complexes.

100% of cases of cystic breast disease were effectively diagnosed using high-tech complex examination procedures. The most efficient invasive methods of diagnosis and therapy are discussed. Surgery was reduced to 88% due to application of sclerosing-solution techniques for conservative treatment of breast cysts.

The data on such highly-effective invasive diagnostico-therapeutic procedures as ductography, sclerosing-solution cystography, X-ray-controled puncture biopsy, stereotactical computer technique, sonography and preoperative maging of nonpalpable lesions were analyzed following a complex mammographic examination of 20,000 patients with different breast pathologies. Advantages offered by complex breast examination are discussed. Among them were the use of optimal effects of each invasive procedure, an accuracy of preoperative diagnosis reaching 95-98% (nonpalpable breast lesions included) and a significantly reduced extent of breast surgery.

The report deals with such present-day invasive procedures of breast examination as X-ray-controlled puncture, puncture using X-ray contrast, Cytoguide video-accessory unit controlled puncture biopsy, "pistol-needle" application, ultrasound aiming puncture, pneumocystography, ductography and preoperative interstitial marking of nonpalpable masses. If latest invasive procedures are used during complex examination of the breast, diagnostic accuracy can be raised to 95-97%.

Based on examinations of 133 females having the normal breast, benign and malignant tumors, the potentialities of color Doppler mapping of breast vessels are shown. Cancers showed an increased vascularity in the peritumor areas and high flow velocity (Vmax' Vmean) in the surrounding tumor vessels. These criteria are not related to the size of a malignant tumor.

The concept of nodal mastopathy is accumulative. Both fibrotic segments and fibroadenomas, cysts, lipomas and other formations with atypical manifestations may serve as a substrate for forming a node. In addition to the clinical method, a diagnostic set should involve mammography that detects the true nature of a formation in 75-91% of cases, traditional sonography providing additional information in cysts in 88% of cases, Doppler sonography suspecting enhanced proliferative processes by the higher blood flow velocity and defining indications for surgical treatment, as well as new puncture bioptic procedures yielding better information materials by 25-30%. The comprehensive assessment of non-specific manifestations of nodal mastopathies from the data obtained by diagnostic techniques enables a more exact preoperative diagnosis to be made.

The authors show the comparative data on ultrasonic examination and mammography in 204 patients with nodular new growths in the breast: 66 had breast carcinoma and 138 had benign diseases. They suggest 6 ultrasonic criteria characteristic of breast carcinoma and describe the ultrasonic picture of the most commonly encountered benign breast tumors: fibroadenoma, nodular mastopathy, cysts. USE sensitivity was 68.8 +/- 7% in breast carcinoma, 82.6 +/- 8.1% in fibroadenoma, 72.8 +/- 7.2% in nodular mastopathy, and 100% in cysts (the respective values in mammography were 76.7 +/- 6.4%, 69.6 +/- 9.8%, 74.4 +/- 7%, and 60 +/- 11.2%). USE sensitivity and sensitivity of mammography were found to differ for different age categories in early forms of breast carcinoma. It is shown that the histological structure of a malignant tumor may be assumed from the ultrasonic criteria. The authors conclude that USE has a high diagnostic value in nodular new growths of the breast and that differential diagnosis of malignant and benign lesions is possible.

The authors propose their screening program for detection of breast cancer. It includes the entire complex of present-day screening diagnostic methods, starting from an original system for the formation of groups at risk of breast cancer and completed by the direct diagnostic model of detection of the condition, oriented at a differentiated approach to the use of mammographic techniques. The proposed organizational and methodologic screening measures are both economic and diagnostically effective, thus meeting the principal requirements to screening programs. Screening of 8541 risk-group patients helped detect 867 nodular formations, 244 of which were cancer and 623 benign formations.

New accurate methods of puncture of the mammary gland, making use of preliminary layout using roentgenograms, coordination nets, Cytoguide comprter device, and ultrasound-monitored spot biopsy replaced the traditional poorly informative methods. Sonography-monitored puncture is the most informative in cases with both palpated and unpalpated formations shaped as nodules: it permits imaging in 85% of cases. However, in 25-30% of cases unpalpated cancer presents as microcalcinates and cord-like restructuring which cannot be imaged on sonograms. Moreover, unpalpated cancer presenting as a nodule against the background of fatty involution also may be undiscernible on sonograms. In such cases puncture controlled by roentgenography with a computer device and a relevant kit of disposable instruments is advisable, giving accurate information in 61.1% of cases.

The authors analyze the results of iodamide use for galactography. 434 females with discharge from the nipples were examined making use of galactography, and 136 women were selected for surgical treatment; the local processes in the mamma were previously unpalpated, nor were they confirmed by the laboratory findings. Clinical and morphologic analysis of the preparations resected in surgery has lead the authors to a conclusion that galactograms made with use of iodamide are sufficiently contrast and informative. The authors recommend this agent for the diagnosis of unpalpated mammary tumors.

Mammography as a priority method of diagnosis of breast nodules in young women is of low efficacy as a result of a dense background of the breast as distinct from echography permitting the detection of abnormal lesion against this background. Altogether 126 patients with clinical manifestations of breast nodules were investigated. Apparatus methods used for investigation of 38 of them, revealed but manifestations of fibrocystic mastopathy. Assessment of the efficacy of x-ray and ultrasound diagnostic methods was performed in 88 patients with breast nodules (the patients varied in age from 14 to 40). Radiodiagnostic accuracy in benign tumors was 54.1%, that in malignant tumors--78.1%. Ultrasound investigation proved to be the most informative method for diagnosis of breast nodules in young women, and the use of a proposed algorithm would permit optimization of the diagnostic process.

This study included 62 women with hypergonadotropic amenorrhea. Clinical, hormonal, genetic, laparoscopic and histologic studies revealed three types of the disease: resistant ovary syndrome, dystrophic ovary syndrome, and "pure" gonadal dysgenesis. Mammary function and architectonics were correlated with gynecologic conditions. Fibrocystic breast disease was identified in 64.9% of patients with resistant ovary syndrome, and fatty glandular degeneration was seen in dystrophic ovary syndrome; pure gonadal dysgenesis was associated with breast hypoplasia, poor structural differentiation and prevalence of adipose tissue in the mammary glands.

Densitometry of roentgenograms was performed in 48 patients with benign tumors of mammary glands (16-cysts, 16-fibroadenomas, 16-phylloid fibroadenomas). The analysis of densitograms indicated that densitometry provides a more objective characteristic of the structure intensity of the shadow and distinctness of the pathological focus contour. Densitometric analysis of the roentgenological picture of cysts, fibroadenomas and phylloid fibroadenomas along with features common to these neoplasms enabled the recognition of a number of symptoms determining differences in their densitometric picture.

Mammographic and morphologic examination was carried out in 136 females bearing microcalcinates in breast tissue. Morphologic examination identified benign tumors (mostly fibrous cysts) in 72.1% and cancer (mostly ductal and lobular carcinoma in situ or initial signs of invasion) in 27.9% of cases. Calcinates occurred mainly in the epithelium and incipient cancer complexes. The analysis of the data showed shape, structure and distinctness of contours of calcinates to be instrumental in differentiating between malignant and benign lesions.

The authors analyze the X-ray picture of the changes occurring in the mammary glands in women with various endocrine diseases and in men with gynecomastia. Contrastless mammagraphy was carried out in 189 persons. In studying the mammagrams in patients with endocrine diseases assessment was made of the state of the subcutaneous-adipose cellular tissue, total dimensions of the organ. The majority of the endocrine diseases were accompanied at the initial stages of their development by changes in the endocrine gland, this serving as a direct indication for the use of contrastless roentgenography for the purpose of earlier and proper choice of the therapeutic method.

Analysis of a two-variant organization in the system of mammary gland diagnosis demonstrated the advantages of two-staged system, including prophylactic and specialized X-ray rooms. The need of radiomammographic units for realization of the proposed system in a region with population of 1 million persons is calculated.

Morphological and mammographic study of small (less than 1 cm) focal mammary gland lesions of 170 women revealed foci of typical epithelium proliferation of the ducts and lobules, fibrosing adenosis, small duct papillomas and fibroadenoma, intraductal and ductal carcinoma in situ, sometimes with small invasion foci, infiltrating carcinoma, infiltrating lobular carcinoma. Peculiarities of small focal lesion morphology determine the mammographic picture. Analysis of nodular shadows on the mammogram gives as a rule a possibility to differentiate between benign conditions (focal proliferation of the epithelium, fibroadenoma), early carcinoma (intraductal and lobular in situ, sometimes with small foci of invasion) and infiltrating carcinoma. Calcareous deposits in both benign lesions and carcinomas do not differ mammographically. Morphogenetic link was revealed between foci of epithelium proliferation (benign displasia), intraductal and lobular carcinoma in situ and infiltrating carcinoma. Among 65 cases of non-palpable carcinoma, 31 (47.7%) were classified as early carcinoma and 34 (52.3%) as infiltrating carcinoma with a relatively low histological degree of malignancy. In both groups a good postoperative survival was observed.