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Breast diseases that occur in women. Types of neoplasms

Methods for diagnosing mammary glands begin with general analysis patient information. Next, the doctor conducts clinical examination, which includes preliminary examination and palpation. If necessary, ultrasound examination methods, x-ray diagnostics, and a number of other important studies are used.

As for the age groups of patients, up to the age of twenty, young girls come with problems with engorgement and pain in the breast area, which are often associated with premenstrual syndrome.

Until the age of forty, women come to us about discharge after lactation, and in their fifth decade, representatives of the fair sex are examined for the presence of oncological pathology of the mammary gland.

Clinical examination

First, the doctor interviews the patient, finds out if she has any complaints, and asks what is bothering her. If these are pains in the mammary gland, then it is necessary to clarify their nature, what they are associated with, and whether there is discharge from the nipple. The doctor conducts a survey about the function of the reproductive system.

After the conversation, the doctor proceeds with a direct examination and palpation - this is the simplest method for diagnosing breast diseases. Feeling, unfortunately, will not allow you to determine the immediate nature of the changes, but it is still considered the main thing. Moreover, it is also necessary to master self-examination; every woman should learn it, so that if any lump is detected, consult a doctor in time.

In addition to palpating the breast, the doctor also examines the thyroid gland, examines regional lymph nodes in the axillary, subclavian, and supraclavicular region.

Palpation method

During the first stage, the patient sits on a chair while the doctor conducts an examination. The main thing is to cover the entire breast area, paying attention to the outer upper quadrant of the mammary glands and nearby lymph nodes.

The second stage is carried out standing. The doctor determines the presence of nodular seals, if any. The third point is that the patient lies on her back, and the chest is examined in the direction from the collarbone to the costal arch. In this case, the doctor should pay attention to the presence pain, consistency of the mammary glands, and other important factors.

X-ray mammography

This diagnostic method allows you to timely identify the presence, as well as the extent of existing changes in the mammary glands. Usually this procedure is recommended to be carried out on the seventh day menstrual cycle, do x-rays in two projections, lateral and direct.

Starting from the age of forty, mammography is recommended for all women every year. This will allow changes to be identified at an early stage and the development of the disease to be prevented in time by prescribing appropriate therapy. With benign neoplasms, the contours of the tumor in the image are smooth, but with malignant neoplasms, they are often lumpy.

Ultrasound examination

This method is carried out to clarify changes in tissues; it is considered safe and quite informative. With its help, you can diagnose the presence of cysts, any nodular formations, and you can also assess the spread of the tumor process.

Ultrasound examination has some disadvantages; with its help it is impossible to recognize very small tumors, as well as microcalcifications, and analysis difficulties arise in the presence of a large volume of adipose tissue.

Biopsy

This procedure refers to invasive research methods. In this case, a special long needle is inserted into the area suspected of a pathological process, then, using a syringe, the doctor collects material, which is sent for histological examination to the laboratory.

Cytological examination reveals abnormal and cancerous cells that are present in the breast. A histologist examines the obtained material under a microscope and identifies the presence of atypical formations. A biopsy is performed only if a malignant process is suspected.

Biopsy can be of several types:

Puncture-aspiration biopsy. With this method, a fairly long needle and syringe are used to collect the material.
Trephine biopsy. In this case, a thick cutting needle with a special niche and a stylet is used, with the help of which a small area of breast tissue is cut off for examination, no more than two millimeters.
Smear-imprint. This technique is based on obtaining discharge from the nipple. In this case, the woman needs to squeeze the discharge directly onto a special glass, which is then sent to the laboratory for examination.
Excisional biopsy with urgent histological examination. This technique is performed directly under local anesthesia. Its essence is that the oncologist excises the suspected area completely, which is immediately examined. If there are cancerous changes, the patient undergoes extensive surgery.

Additional research methods:

Additional methods include magnetic resonance imaging, thermography, ductography - the introduction of a contrast agent immediately before mammography, pneumocystography, as well as microwave radiometry.

Conclusion

Take care of your health, undergo the necessary examination on time, and do not delay your visit to the doctor.

The initial examination begins with an analysis of anamnestic data. Of great importance for determining the causes of mastopathy are data on previous and especially concomitant diseases genital organs, liver and thyroid gland. Information about the nature and time of the onset of menstruation deserves special attention. The age at first pregnancy, the number of births, artificial and spontaneous abortions are taken into account. Social and everyday data should not be neglected, since it is known that one of the leading risk factors for the occurrence of mastopathy is long-term mental stress. As already mentioned, in some patients mastopathy manifests itself against the background of a genetic predisposition. In this regard, it is important to establish the nature of diseases in close relatives, especially focusing on diseases of the female genital organs and mammary glands. Then the complaints are clarified: the time of their appearance, their connection with the menstrual cycle, the presence of discharge from the nipples, their color, consistency, duration and consistency.

Clinical examination includes examination and manual examination, which examines the degree of development of the mammary glands, shape, size, condition of the skin, nipple, the presence of skin scars, retractions, bulges, pigmentation, etc.

Superficial and deep palpation of the glands and regional lymph nodes is carried out, which makes it possible to determine the consistency of the mammary glands, symmetry, presence of seals, their nature, prevalence, presence of edema and relationship with surrounding tissues.

Particular attention is paid to the diagnosis of nodular formations: their size, density, uniformity, quantity, mobility, connection with the underlying tissues and skin are determined, the possibility of skin displacement is checked, and any skin changes in the formation area and regional sections are recorded. It is mandatory to examine the axillary zones to identify enlarged lymph nodes.

The main method of objective assessment of the condition of the mammary glands is x-ray mammography, which allows timely diagnosis of pathological changes in the mammary glands in 95-97% of cases. Therefore, unlike other diagnostic methods, mammography is the main method for screening for breast diseases. The role of this method is especially great in the detection of non-palpable tumors in the preclinical phase of their development, in the identification of malignant tumors against the background of diffuse and nodular forms of mastopathy. In this regard, mammography has become an integral and basic part of the examination aimed at identifying the early stages of breast cancer.

Mammography gained universal recognition in the 1960s and was officially included in the set of mandatory methods for examining the mammary glands. As a rule, mammography is performed in two projections (direct and lateral) on the 8-10th day of the menstrual cycle.

Speaking about the advantages of the method, it is necessary to say about the limits of its capabilities. It should be noted that false negative results are 12-24%. Such a high percentage is due to the fact that in young women, especially during pregnancy and lactation with well-developed, dense glandular parenchyma, the ability to detect tumor formations is noticeably reduced. In this regard, a number of researchers consider it inappropriate to conduct mammography for women under 35 years of age. In women of late reproductive age (over 35 years old) with fairly pronounced involutive changes, formations larger than 1 cm in size are clearly recognized on mammograms.

Currently, it is generally accepted throughout the world (WHO, 1984) to conduct a mammographic examination once every 2 years starting from the age of 35 (in the absence of indications for more frequent examinations), and after 50 years - once a year. The exceptions are nursing, pregnant women and adolescents, for whom mammography is prescribed only when indicated.

IN recent years Ultrasound examination of the mammary glands is gaining increasing popularity, since it significantly complements and clarifies data on the condition of the mammary glands.

Ultrasound makes it possible to accurately recognize nodular formations (including small cysts with a diameter of 2-3 mm) when examining dense mammary glands in young women, while without additional interventions it allows for differential diagnosis of cysts and fibroadenomas. In addition, echography is the leading method in the study of lymph nodes and mammary glands with diffuse changes.

However, echography has a number of disadvantages. First of all, these are difficulties in diagnosing microcalcifications, which are one of the first signs of malignancy, in diagnosing small tumors, and low information content when assessing diffuse processes against the background of fatty transformation. All this allows the use of ultrasound only as an additional method in combination with x-ray. Their combined use makes it possible to increase the accuracy of diagnosing breast diseases to 97%. Thus, it is advisable to consider ultrasound and x-ray mammography not as alternative, but as complementary techniques that should be widely used in the diagnostic algorithm for breast diseases.

The thermography method became quite widespread in the 1970s, the operating principle of which is based on the difference in temperature of the skin over damaged and undamaged areas, which is associated with the characteristics of the blood circulation of healthy and pathologically altered tissues.

The absolute harmlessness, the possibility of unlimited control studies, the simplicity and relative accessibility of this method have attracted the attention of many researchers. However, low resolution, the impossibility of detailing the structure of the mammary glands, and difficulties in identifying small, especially deeply located nodes, allow us to classify this method as only auxiliary.

To diagnose changes localized in the milk ducts, the method of ductography, or contrast mammography, is used. A contrast agent is injected into the dilated milk duct using a thin needle, then mammography is performed in 2 projections and the sector in which the pathological formation is located is identified. This method allows you to evaluate the diameter, direction and contours of the ducts, intraductal neoplasms, their size, number and shape. The severity of the ducts depends on the age and characteristics of the development of glandular tissue. The main signs of mammary gland diseases manifest themselves in the form of a filling defect, deformation of the ducts, their narrowing or expansion.

Given the fairly high risk of malignancy of intraductal papillomas, in most cases, when they are identified, there is a need for surgical intervention. A contraindication to ductography is acute inflammation of the mammary glands.

It should be noted that oncological alertness should be maximum if the patient is over 40 years old, as well as in cases where discharge is noted from one duct of one breast and transformation of serous discharge into hemorrhagic over time is observed. In this case, it is necessary to conduct an examination of the mammary glands, as well as the axillary and supraclavicular areas. It is recommended to conduct ductography, which allows not only to identify, but also to determine the nature of intraductal changes.

It is mandatory to conduct a cytological examination of smear impressions of nipple discharge, since it is one of the most informative in making the correct diagnosis, and therefore clinical diagnostics diseases of the mammary glands this method is given great value. This is due to both the high reliability of the results obtained and the possibility in simple ways taking material to quickly obtain data on the nature of the disease. Using the cytological method, differential morphological diagnosis is carried out, which is of particular importance in clinical practice. The material for research is discharge from the nipples, scrapings-imprints from eroded surfaces or from cracks in the nipple area. The most common object of study is a punctate obtained directly from the tumor or a targeted aspiration biopsy. Thus, cytological examination is considered one of the most important methods for assessing the pathological process, the diagnostic accuracy of which is 90-100%.

The most common benign breast formations are cysts. According to a number of authors, they are detected in 60% of cases and more often in women in the age group from 40 to 59 years (Harris J. et al., 1996). At the same time, despite the apparent safety of the disease, in 1-3% of cases, parietal growths of a malignant or benign nature can develop in the cyst cavity, which once again emphasizes the need for early diagnosis, which significantly influences the choice and scope of treatment measures. In order to determine pathological processes in the mammary gland, pneumocystography is performed, which has a high resolution ability to detect intracystic formations with a diameter of up to 1-2 mm. As the experience of using this technique has shown, the possibilities of pneumocystography are much wider, since it allows not only to assess the internal state of the cyst cavity, but also has a high therapeutic effect.

Research in recent years has revealed the significant role of the immune system in the development of the tumor process in the mammary glands, which has led to the introduction of a number of immunological tests for diagnosis, monitoring the clinical course and effectiveness of therapy for diseases of the mammary glands. Experimental studies have proven the presence of specific tumor antigens, shown their role during the tumor process, as well as the possibility of using early immunodiagnosis and immunocorrection of pre-tumor conditions of the mammary glands (determination of β-fetoprotein, cancer embryonic antigen, trophoblastic globulin, as well as monoclonal antibodies to various tumors, including including breast cancer).

The study of cellular immunity revealed that with an increase in proliferative processes in the mammary gland, the total number of T-lymphocytes decreases, with the most pronounced decrease specific gravity T-active lymphocytes. It should be noted that fluctuations in immunological parameters are individual for each woman. The most clear picture of unfavorable changes can be seen in the example of the T-helper/T-suppressor ratio. As the process progressed from non-proliferative fibroadenomatosis to grade III proliferative dysplasia, the ratio index significantly changed towards a decrease in the content of T-helpers and an increase in the level of T-suppressors, reaching maximum values in breast cancer.

Considering that the pathology of the mammary glands is a hormonal-dependent process, determining the hormonal status is an obligatory component in a comprehensive examination of women with diseases of the mammary glands for the correct choice of treatment tactics.

The search for screening tests that allow us to judge with a certain degree of reliability the likelihood of developing pathological processes in the mammary glands has been enriched in the last two decades by the discovery of tumor markers. Literature data indicate an increased level of tumor markers in groups of women with severe diffuse forms of mastopathy. It is more rational to determine the level of markers in predicting the occurrence of mammary gland pathology in patients who have genetic or anamnestic factors of predisposition to a malignant process, or with proliferative forms of mastopathy.

According to a number of authors, tumor markers such as carcinoembryonic antigen (CEA), high-molecular antigens CA 125 and CA 19_9, mucin-like cancer-associated antigen (MRA) allow monitoring the effectiveness of treatment.

Considering the role of hyperprolactinemia in the formation of mastopathy, a mandatory component of a hormonal study is to determine the level of prolactin. In addition, to exclude the secondary nature of hyperprolactinemia, the levels of TSH, T3, T4, antibodies to thyroglobulin and microsomal fraction are simultaneously determined.

Thus, significant progress has now been made in studying the causes of mammary gland pathology and developing diagnostic methods. There are many techniques in the arsenal of diagnostic tools, indicating intensive attempts to optimize the diagnostic process, to find comprehensive approaches to the earliest and most accurate recognition of pathological changes in the mammary glands. However, at present, X-ray mammography remains the main method for diagnosing breast diseases. All other diagnostic methods have an important auxiliary value and can be used in combination with the x-ray method as valuable additional techniques.

Questioning

In the anamnesis, attention is paid to past diseases of the mammary gland, to symptoms such as pain, hardening of individual parts of the mammary gland, discharge from the nipples, skin changes, etc., arising in connection with the menstrual cycle, pregnancy, lactation. They find out the nature of the menstrual cycle, at what age menstruation began and at what age it ended, when the first birth occurred; the course of pregnancy, childbirth, the nature of lactation. The presence of gynecological diseases, genital surgeries, and the number of abortions are clarified.

Physical research methods

The examination of the mammary glands is carried out in a bright room (the woman should be undressed to the waist) in the patient's position - standing with arms down, standing with arms raised, and lying on her back and side. This technique allows you to identify subtle symptoms. Pay attention to the development of the mammary glands, their size, shape, level of standing of the mammary glands and areolas (symmetry), as well as the condition of the skin, nipples, and areolas. It is known that vascular pattern, skin coloring, skin retractions, deformation of contours, ulceration of the nipple and areola can be very important signs of cancer and other diseases of the mammary gland.

Palpation performed in a standing position, lying on the back and side. During superficial palpation, the area of the areola is examined with the fingertips, then the peripheral parts of the gland - sequentially, starting from the upper-outer quadrant to the upper-inner, and then from the lower-inner to the lower-outer quadrant. Deep palpation is performed in the same sequence. First, the healthy mammary gland is palpated. When a tumor-like formation is identified, its size, consistency, nature of the surface, and mobility in relation to the skin are determined. Then the axillary, subclavian and supraclavicular lymph nodes are palpated. The patient should relax her hands, placing them on her waist or on the examiner’s shoulders. When palpating the supraclavicular lymph nodes, it is better to stand behind the patient; She should tilt her head slightly towards the examination to relax the sternocleidomastoid muscle. The size, consistency, quantity, mobility, and tenderness of the lymph nodes are determined.

Breast self-examination technique

For early detection of precancerous changes and tumors of the mammary glands, all women over 25 years of age are recommended to independently monitor the condition of the mammary glands, i.e., learn self-examination techniques, which should be carried out on any day of the 1st week after each menstrual cycle.

The examination begins with the underwear, especially in those places where it comes into contact with the nipples. The presence of spots (bloody, brown or colorless) indicates discharge from the nipple. They appear in diseases of the mammary gland. The exception is milk-like discharge from the nipples of those who have recently fed, when the changes associated with pregnancy and lactation have not yet completed.

Then the mammary glands are examined in front of a mirror, first in a position with hands lowered and then with hands raised to the back of the head. In this case, you need to slowly turn to the right, then to the left. These techniques make it possible to determine whether the shapes and sizes of the mammary glands are the same, whether the mammary glands and nipples are located at the same level, whether changes have appeared in the nipple and areola area, whether there is skin retraction or bulging

Palpation of the mammary glands and armpits relieved by lying on your back. When examining the outer half of the right mammary gland, a pad or small roll from a towel should be placed under the right shoulder blade, the right arm should be extended along the body, with the fingertips of the left hand, lightly pressing on the mammary gland with soft circular movements, all its parts should be felt. First, the center of the mammary gland (nipple area) is examined, and then the entire gland is palpated, following from the nipple towards its outer edge along the radius upward, then outward, downward. When palpating the inner half of the right mammary gland, place the right hand under the head, and the examination is performed with the left hand in the same sequence - from the center to the inner edge of the mammary gland, radially upward, then inward, downward. All these techniques are repeated when examining the left breast.

Special research methods

Mammography - X-ray examination of the mammary glands without the use of a contrast agent. A special apparatus is used to take x-rays of the mammary glands in two projections. If necessary, targeted radiographs with magnification are taken. The method allows you to identify changes in the structure of the breast tissue, identify a tumor with a diameter of less than 10 mm, i.e. a tumor of a size that a doctor, as a rule, cannot determine by palpation (non-palpable tumors), especially if it is located in the deep parts of the mammary gland large size. Mammography remains the most sensitive method for detecting breast cancer, although the specificity of the method is not high enough. Some changes in mammograms and palpation data are not always accurate: a mammogram gives the same image of a malignant and benign node and even variations in the normal architecture of the gland. Therefore, it is advisable to combine the study with ultrasound, which makes it possible to distinguish a cystic node from a solid one, and other methods.

Breast ductography - X-ray examination of the mammary gland ducts after the introduction of a contrast agent into them. The indication is discharge from the nipples. The area of the areola and nipple is treated with alcohol. Drop by drop of secretion, the external opening of the secerating milk duct is found. Into it to a depth of 5-8 mm. a thin needle with a blunt end is inserted. Through a needle under slight pressure, 0.3-1 ml of a 60% solution of verografin or urografin is injected into the duct until a feeling of slight distension or mild pain appears. Analysis of the images allows us to judge the shape, outline, and defects in the filling of the ducts.

Ultrasound examination is currently one of the main methods instrumental research mammary glands. Ultrasound makes it possible to determine changes in the structure of the mammary gland, identify tumor nodules, make a differential diagnosis between cancer and benign breast tumors, and identify small formations (cysts are detected from 0.5 cm in diameter). A puncture fine-needle biopsy, performed under ultrasound guidance, allows one to obtain material for cytological examination and diagnosis verification faster and more accurately than with mammography. Immediately before surgery, ultrasound allows you to accurately indicate the location of the tumor and more acceptable access to it. In recent years, special devices for ultrasound stereotactic biopsy of mammary glands have appeared. The stereotactic method allows not only a fine-needle biopsy for cytological examination, but also a biopsy to obtain a tissue column and subsequent histological examination of the specimen. Equipment for such examination of the mammary glands is currently available only to large oncology institutions. Due to the absence of radiation exposure, ultrasound can be used repeatedly in any age group.

Magnetic resonance imaging (MP tomography) allows not only to visualize the pathological focus in the mammary gland, but also to characterize it (cyst, tumor containing little fluid), as well as changes in the surrounding tissue. This expensive method should be used for special indications.

Morphological study is the main method of differential diagnosis. For this purpose, a fine-needle biopsy of the tumor under ultrasound guidance is used. The resulting material, as well as nipple discharge, is subject to cytological examination. A negative answer does not exclude the presence of a malignant tumor. Only the detection of tumor cells gives confidence in the diagnosis and makes it possible to outline a treatment plan for the patient before surgery. The final answer in doubtful cases can be obtained only after histological examination of the remote sector containing the tumor. A biopsy should be performed only in those medical institutions where it is then possible to perform urgent radical surgery.

The relevance of the problem of mammary gland diseases is primarily due to the steady growth of this pathology throughout the world. Thus, in the population, non-cancerous diseases of the mammary glands occur in 30-70% of women, and with simultaneous gynecological diseases, their frequency increases to 76-97.8%. In Russia, more than 34,000 new cases of breast cancer are detected annually, and a significant decrease in the age of those affected is noted. 25% of women under 30 years of age and 60% after 40 years of age are diagnosed with dishormonal diseases of the mammary glands (mastopathy). Despite the fact that mastopathy is not an obligate precancer, breast cancer occurs 3-5 times more often against the background of diffuse dishormonal benign diseases of the mammary glands and 30-40 times more often in nodular forms of mastopathy with proliferation of the mammary epithelium. In this regard, interest in benign diseases has increased significantly, and reducing the incidence of mastopathy is a real way to reduce the incidence of breast cancer. In general, breast cancer is not the subject of study and treatment by obstetricians-gynecologists, but women often turn to them with problems that are not directly related to the content of the specialty, including problems related to the mammary glands. Therefore, obstetricians-gynecologists can significantly improve the work of preserving the health of women with extragenital pathology and with some forms of cancer, in particular with breast cancer. Undoubtedly, the priorities for gynecologists are the diagnosis and treatment of benign diseases of the mammary glands. Since the mammary glands are an integral part of a woman’s reproductive system, solving the problem of her health is impossible without observation and examination of the mammary glands, which undoubtedly should be included in the duties of obstetricians and gynecologists. Identification of diffuse and focal pathology of the mammary glands and correct interpretation of the examination results make it possible to promptly refer women to a comprehensive examination and navigate the correct choice of treatment method.

Traditionally, in Russia and a number of other countries, diseases of the mammary glands are mainly dealt with by surgeons, oncologists and mammologists. In this regard, obstetricians-gynecologists could not pay due attention to the examination and treatment of the mammary glands in the screening mode (as is, for example, carried out for diseases of the cervix). And without their participation, doctors of the above-mentioned specialties often underestimate the entire range of functional and organic disorders of the reproductive system as a whole. In addition, it should be noted that the low detection of breast diseases in the early stages is often due to a lack of knowledge in the field of clinical mammology among obstetricians and gynecologists, since this category of doctors is the most frequently visited among women. During a preventive examination by an obstetrician-gynecologist, the condition of the mammary glands is often not included in the examination and history taking of the patient. The above indicates that early diagnosis of breast pathology is difficult. An important task is to organize interactions between gynecologists and oncologists-mammologists. The participation of primary care physicians in referring the female population for mammological screening is an important tool in reducing mortality from breast cancer.

The purpose of our article is to provide a brief overview of modern methods for diagnosing breast diseases and possible diagnostic criteria for breast cancer.

Inspection and palpation - the basic and accessible methods are performed by a doctor in a woman’s vertical position (with her arms lowered and then raised up) and in a horizontal position. When examining the mammary gland, anomalies (accessory mammary glands), changes in shape and volume, changes in skin color (the presence and severity of a venous pattern, skin symptoms) are taken into account. By palpation, the entire gland is examined sequentially in quadrants and the area of the submammary fold. When palpating the mammary glands, areas of painful compactions without clear boundaries in the form of strands, as well as rough glandular lobules in the form of a “cobblestone street” are identified. Local soreness is quite common. These changes are most pronounced in the upper outer quadrants, which are functionally the most active.

The accessibility of the mammary glands for examination and the apparent simplicity of diagnosis often lead to incorrect interpretation of the results clinical trial, which is often carried out by specialists poorly trained in this matter. All this leads to both under- and over-diagnosis.

Therefore, manual examination should be supplemented by comprehensive X-ray, ultrasound (ultrasound), radiothermometry (RTM diagnostics), electrical impedance mammography (EIM), and other types of instrumental studies.

The main method for objective assessment of the condition of the mammary glands today is x-ray mammography. This X-ray examination technique allows for timely recognition of pathological changes in the mammary glands in 95-97% of cases. It is this quality, unlike other diagnostic methods, that allows us to consider mammography as the leading screening method. Currently, it is generally accepted throughout the world (WHO, 1984) to conduct a mammographic examination once every 2 years starting from the age of 40 (in the absence of indications for more frequent examinations), after 50 years - once a year. The exceptions are women under 35 years of age, breastfeeding women, pregnant women and adolescents for whom mammography is contraindicated.

Mammography is an x-ray of the breast without the use of contrast agents. The method is simple, safe for subjects, and has high diagnostic efficiency.

Mammography is performed in two projections (direct - craniocaudal and lateral) on days 5-10 of the menstrual cycle, when the mammary gland parenchyma is less swollen and painful, and in the absence of menstruation - on any day. An additional lateral projection with a mediolateral beam path (oblique projection) can also be used. On lateral photographs, with correct placement, the pectoral muscle, retromammary tissue, and transitional fold should be partially visualized. In the direct projection - the nipple, displayed on the contour of the gland, all the structural elements of the mammary gland, in 20-30% - the pectoral muscle.

If it is necessary to clarify the condition of a certain area of the mammary gland, it is necessary to carry out targeted radiography using special tubes of various sizes. This better delimits the pathological area, and the use of dosed compression increases image clarity. With the help of targeted radiographs, it is possible to bring the tumor to the edge of the gland. At the same time, it is revealed more clearly, the lymphatic path and the condition of the skin in the adjacent areas are better determined. Spot shots allow you to avoid errors caused by the projection effects of shadow summation. In some cases, it is advisable to use targeted radiography with direct magnification of the X-ray image.

The X-ray picture of the mammary gland is individual for each woman. It is important for primary care physicians to understand the signs of malignancy when describing mammograms. Mammography distinguishes between primary and secondary signs of malignancy.

The primary and main radiological signs of breast cancer are the presence of a tumor shadow and microcalcifications. The tumor shadow is differentiated most clearly in women of the older age group against the background of involutively altered breast tissue. The shadow of the tumor is usually irregular - stellate or amoeboid in shape, with uneven, unclear contours, and characteristic radial heaviness. Very often, the tumor node is accompanied by a “path” to the nipple and retraction of the latter, thickening of the skin of the gland, sometimes with its retraction. One of the most reliable and early signs of cancer is the presence of microcalcifications, which are a reflection of salt deposition in the walls of the ducts. Sometimes microcalcifications are the only radiographic manifestation early cancer mammary gland. Typically, microcalcifications are small-celled in nature (1 mm or less in size), resembling grains of sand. The more there are and the smaller they are, the greater the likelihood of cancer. Calcifications can occur in mastopathy and even normally, but their character is significantly different from that described above: there are few of them, they are much larger (more than 3-5 mm), more shapeless and clumpy.

Secondary (indirect) radiological signs of breast cancer include symptoms from the skin, nipple, surrounding breast tissue, increased vascularization, etc.

Despite the effectiveness of the x-ray method, in a number of patients the resolution of mammography sharply decreases: with pronounced diffuse forms mastopathy, in young patients with dense mammary glands, in the presence of implants, severe inflammatory changes, swelling of the gland and background diseases such as fibroadenomatosis. In this case, ultrasound of the mammary glands comes to the rescue.

The main advantages of mammography used in the diagnosis of breast diseases: the ability to obtain a positional image of the mammary gland, high information content during examination, the ability to visualize non-palpable formations, the ability comparative analysis dynamic pictures. Disadvantages of the method that limit its use: dose load, although it is negligible; In 1.8-6% of cases, according to the literature, X-ray negative cancer occurs. According to most authors, the percentage of reliability of mammography in diagnosing cancer ranges from 75% to 95%. The benefits of the new technology are not limited to clinical aspects. The advent of digital image receivers has allowed mammography to develop in the context of fundamental changes occurring in all areas of medical imaging and in the medical service organization itself.

According to generally accepted opinion, ultrasound is the main method for diagnosing diseases of the mammary glands in women under 35-40 years of age, during pregnancy, lactation, and at a later age, preference should be given to x-ray mammography. Ultrasound diagnostics is constantly increasing its potential thanks to the improvement of existing ones and the development of new diagnostic methods. Scanning is performed on ultrasound machines with a linear sensor with a frequency of 7.5-10 MHz at an image magnification factor of 1.5, using immersion - the presence of a layer of gel on the contacting surfaces of the skin and the sensor - to reduce the air content between them.

Benefits ultrasound examinations mammary glands are: safety in terms of dose load, which allows examination of pregnant and lactating women; high resolution, which is important with a dense background of the mammary gland in young women (the ability to visualize X-ray negative tumors, formations located near the chest wall); differential diagnosis of solid and cavitary formations (almost 100% diagnosis of cysts of any size); assessment of the condition of silicone breast implants, especially when they rupture and leakage of contents; examination of the mammary glands during the acute period of injury or inflammation; visualization of regional lymph nodes; conducting targeted puncture biopsies under objective visual control of palpable and non-palpable formations in the mammary gland; multiple dynamic studies during treatment.

Despite all the advantages of breast ultrasound, practitioners in most cases, when prescribing treatment for patients of any age group, are guided mainly by X-ray mammography data. Distrust of ultrasound of the mammary glands is due to the fact that the mammary gland is one of the most difficult objects for ultrasound diagnostics, since the ratio of its constituent tissues constantly changes depending on age, phase of the menstrual cycle, physiological periods of life, body weight, and the presence of pathological processes. Therefore, the specialist performing ultrasound must not only be able to correctly identify the various tissue components that make up the mammary gland, but also have sufficient experience to get an idea of what the normal structure of the mammary gland should be in each examined patient, taking into account the factors noted above. At present, there is still no unified approach to identifying the various tissues that form the mammary gland, therefore the same echographic picture is often assessed differently by different specialists. In addition, if the doctor does not have a clear understanding of the entire range of structural features of the mammary gland that are normally detected by ultrasound, then he may regard some deviations within the spectrum of normal development as pathological. Apparently, this can explain the surprising high frequency such a diagnosis as fibrocystic disease (FCD). Most publications are devoted to ultrasound diagnosis of various breast tumors, both benign and malignant. And here there are no fundamental discrepancies in echograms, since a clear echosemiotics of nodular formations of the mammary gland has been developed. Another thing ultrasound diagnostics a disease such as FCD, the essence of which is benign breast dysplasia with varying degrees of severity of proliferative and regressive changes in its tissue elements. Considering the obvious overdiagnosis of FCD according to ultrasound data, the question again arises about the need to develop correct echographic identification of tissue components of the normal breast. A separate point is mastalgia, the diagnosis of which using existing methods of visualizing the mammary glands seems absurd. And timely differential diagnosis of mastalgia of various etiologies presupposes the correct choice of further tactics for managing women. Discrepancies in the interpretation of the same echographic structure of the mammary gland by different authors dictate the need to improve old methods and develop new methods for studying the mammary glands.

The echographic criteria for breast cancer include: irregular shape, unclear contours, hypo-echoic heterogeneous structure, hyperechoic inclusions of different sizes, acoustic shadows, predominance of the anteroposterior size of the formation.

A new technology for measuring the temperature of breast tissue and its digital image is the method of microwave radiothermometry (RTM study) using a computerized diagnostic complex (RTM-01-RES), designed to measure the intensity of the patient’s own electromagnetic radiation of the internal tissues in the ultrahigh frequency range, which is proportional to tissue temperature (Fig. 1).

A change in temperature (temperature abnormality) can, in particular, be caused by increased metabolism of cancer cells, which is what early cancer diagnosis is based on. According to existing concepts, changes in tissue temperature usually precede structural changes that are detected by conventional methods of examining the mammary gland - ultrasound, mammography, palpation. Therefore, thermometry is of interest for the early diagnosis of diseases. In addition, the thermometry method, according to its operating principle, is absolutely safe and harmless for patients and staff, since the study measures the intensity of human tissue’s own electromagnetic radiation. Therefore, the use of radiothermometry is extremely effective for objective monitoring of the progress of treatment and for conducting screening studies. The specific heat generation in a tumor is directly proportional to its growth rate, i.e., rapidly growing tumors are “hotter” and therefore are better visible on thermograms. Thus, radiothermometry has the unique ability to detect rapidly growing tumors first. The introduction of radiothermometric examinations into complex diagnostics will lead to natural diagnostic selection of breast cancer patients with rapid tumor growth. The RTM examination technique consists of measuring the internal temperature and skin temperature of the mammary glands at 10 points on each gland, including the axillary region, the areola area, the mid-quadrants and the borders of the quadrants. The measurement results are displayed on the computer screen in the form of thermograms and temperature fields. In addition, the program includes an expert system for diagnosing breast cancer.

Currently, in addition to existing diagnostic methods, it has become possible to visualize breast tissue using electrical impedance tomography (Fig. 2), a method for obtaining images of the impedance distribution in tissues. To visualize breast tissue, a multi-frequency 256-electrode electrical impedance mammograph (MEM), developed by the Institute of Radio Engineering and Electronics of the Russian Academy of Sciences, is used at frequencies of 10 kHz and 50 kHz.

In order to implement the electrical impedance mammography method, a measuring system and an image reconstruction algorithm have been developed that allow, using a set of electrodes located in the form of a two-dimensional matrix on a flat surface, to visualize the static distributions of electrical conductivity of the medium adjacent to the surface with the electrodes. The result of visualization is a set of images of cross sections of the medium with planes parallel to the plane of the electrodes and located at different depths from the surface of the medium.

During the examination, the matrix is pressed against the mammary gland in the direction of the ribs, so that the maximum number of electrodes is in contact with the patient’s body, and the thickness of the examined tissue is minimal. Two output electrodes, one of which is used as the common electrode of the current source, and the second as the reference electrode of the potential difference meter, are docked together and located on the patient’s wrist (Fig. 3).

The operating sequence of the measuring system is as follows. The potential difference meter is connected by a multiplexer to the first electrode of the matrix, the procedure for compensating the contact potential difference is performed, and then the current source is sequentially connected to each of the remaining electrodes of the matrix and measurements are made. After this, the cycle is repeated for another recording electrode. The complete data set used to reconstruct 3D conductivity distributions consists of 65,280 measurements. Data processing and initiation of the measurement process is carried out using personal computer, connected to the device via a universal serial bus (USB).

The result of the reconstruction is electrical impedance images of seven cross sections of the medium under study, parallel to the plane with the electrodes, taken with a step of 0.7 cm in depth (Fig. 4).

The duration of the reconstruction procedure is about 15-20 seconds for a personal computer with a clock frequency of about 1 GHz.

At the disposal of doctors involved in the diagnosis of diseases of the mammary glands, a new, affordable, safe and highly informative method of electrical impedance mammography has appeared, which significantly complements the existing arsenal of modern examination methods, which can be used as a screening method for women of all ages, and as a reliable monitoring of breast health. glands when taking combined oral contraceptives and hormone replacement therapy without limiting the number of examination procedures.

The EIM method significantly expands the capabilities of obstetricians-gynecologists and doctors of other clinical specialties in relation to the instrumental diagnosis of diseases of the mammary glands and gives them unique opportunities to objectively assess their condition as an integral part of an integral part of a single reproductive system.

The proposed program of multi-frequency electrical impedance examination allows us to identify clear diagnostic criteria for various diffuse and focal pathologies of the mammary glands, to differentiate mastalgia of various etiologies, which is important for the correct choice of tactics for managing women with diseases of the mammary glands.

The advantages of electrical impedance imaging are: the ability to conduct dynamic observation in women of any age and conduct a comparative assessment of images depending on the side and position during the study, the phase of the menstrual cycle, and previous diagnostics; the possibility of examining the mammary glands during pregnancy and lactation; color scanning and image “filtering” mode, allowing to differentiate benign and malignant formations by different colors; the possibility of visual assessment at different scanning depths and visualization of the organ as a whole. The multi-frequency EIM method makes it possible to digitally determine the electrical conductivity of the mammary glands, which to some extent eliminates subjective assessment in making a diagnosis.

Breast cancer is characterized by:

On electrical impedance tomograms, at the site of the probable location of the tumor, hypoimpedance areas with unclear blurred contours appear, spreading over several scanning planes with high electrical conductivity (most often more than 0.95 conventional units).
When additional contrast is used, areas with high electrical conductivity are colored red.
When visualized in color scale mode, cancer areas are highlighted in white with a bright red outline.
The difference in images depending on the side of the scan is due to a violation of the architectonics of the internal structures of the affected mammary gland with an unchanged healthy mammary gland.
Differences in electrical conductivity in the affected mammary gland depending on the position during the study.
The presence of deformations of the image contours of the affected breast and clear, undeformed contours of the healthy breast.
Displacement of internal structures.
A sharp shift in the graph of the frequency distribution of electrical conductivity to the right compared to the unaffected mammary gland and with the graph of the distribution of electrical conductivity of the affected mammary gland

Despite the huge arsenal of methods for diagnosing breast cancer in the practice of an obstetrician-gynecologist, it must be remembered that only a comprehensive examination of patients and cytological or histological verification of the diagnosis, carried out in specialized medical institutions, makes it possible to provide qualified necessary list medical events. If there is even the slightest suspicion of the possibility of malignancy, the patient must be sent to an oncology facility. In such a situation, overdiagnosis and false alarms can, at worst, become a tactical mistake, but it can avoid a strategic mistake, which is much more important.

Literature

Korzhenevsky. A.V. Quasi-static electromagnetic tomography for biomedicine: Dis. ... dr. physics and mathematics Sci. M., 2009. 326 p.
Korzhenevsky A.V., Karpov A.Yu., Kornienko V.N. and others. Electrical impedance tomographic system for three-dimensional visualization of breast tissue // Biomedical technologies and radio electronics. 2003. No. 8. P. 5-10.
Letyagin V. P. Mastopathy // Gynecology. 2000. No. 11. P. 468-472.
Ozerova O. E. Normal echographic features of the structure of the mammary glands in various age periods, during pregnancy and lactation // Sonoace international. 2001. Issue. 9. pp. 50-57.
Radzinsky V. E., Zubkin V. I., Zolichev G. E. and others. Collection of scientific papers “Oncological screening, carcinogenesis and early stages of cancer in the practice of a gynecologist.” Izhevsk, 2000. S. 201-203.
Radzinsky V. E., Ordiyants I. M. An integrated approach to the diagnosis and treatment of gynecological and mammological diseases and disorders // Gynecology. 2003. T. 5. No. 4. P. 1-6.
Radzinsky V. E., Ordiyants I. M., Zubkin V. I. and others. Non-cancerous diseases of the mammary glands and gynecological diseases // Journal of the Russian Society of Obstetricians and Gynecologists. 2006. No. 2. P. 34-42.
Serov V. N., Tagieva T. T., Prilepskaya V. N. Diagnosis of diseases of the mammary glands // Gynecology. 1999. No. 1. P. 6-10.
Cherepenin V., Korjenevsky A., Kornienko V. et al. The electrical impedance tomograph: new capabilities // Proceedings of the IX international conference on electrical bio-impedance. Heidelberg. 1995. P. 430-433.
et al. Three-dimensional EIT imaging of breast tissues: system design and clinical testing // IEEE Trans. Medical Imaging. 2002. V. 21 (6). P. 662-667.
Cherepenin V., Karpov A., Korjenevsky A. et al. Preliminary static EIT images of the thorax in health and disease // Physiological Measurement. 2002. V. 23 (1). P. 33-41.
Cherepenin V., Karpov A., Korjenevsky A. et al. A 3D electrical impedance tomography (EIT) system for breast cancer detection // Physiological Measurement. 2001. V. 22 (1). P. 9-18.