Mammographic signs of breast diseases

There are two groups of radiation studies of the breast: check and diagnostic. The first is the periodic mammogram of healthy women in order to identify hidden diseases, primarily cancer. Figuratively speaking, this is a "mammogram of healthy women who want to stay healthy". In all women who have no signs of breast disease, it is recommended that a mammogram ("basic mammograms") be performed at the age of 40 years. Repeated clinical and mammographic examinations should be performed at intervals of 2 years, if a woman is not included in the group at high risk of developing breast cancer. Mass screening surveys of the female population using mammography (mammography screening) provide a reduction in mortality from breast cancer by 30-50% and a significant reduction in the frequency of mastectomy.

Diagnostic mammography is performed in patients who are suspected of having a mammary gland on the basis of clinical data. Indications for this study are diverse: palpable seals, discharge from the nipple, mastodynia, complications after breast prosthesis, etc. The main task of radiation diagnosis is the detection of breast cancer, especially at the stage when it is not determined either by the patient during self-examination, nor by the doctor at examination and palpation of the mammary gland, i.e. Non-palpable cancer.

Breast cancer is a chronic and slowly developing disease. The tumor originates from the epithelium of the milk ducts or glandular lobules. Accordingly, there are two main types of cancer: protocoll and lobular. Transformation of the epithelium is stereotyped: norm - hyperplasia - atypia - cancer. Before the formation of a tumor with a diameter of 1 mm, an average of 6 years, and up to 1 cm - 6-10 years.

Depending on the stage of tumor morphogenesis, non-invasive (non-infiltrating) cancer can be isolated (often referred to as "intraductive cancer in situ", or DCIS) and invasive (infiltrating) cancer. Similarly, lobular carcinoma is divided into non-invasive (non-infiltrating cancer in situ, or LCIS) and invasive (infiltrating).

The main sign of the tumor on mammograms and tomograms is the image of the tumor node. From surrounding tissues the tumor differs in increased density. The shape of the node is different. Sometimes it is a form of a circle or an oval, and an additional protuberance in the form of a prominence departs from some side of it. Still more typical is a star-shaped figure formed by a dense central core of an irregular configuration, from which gradually tapering strands stretch into the surrounding tissue.

The second most important sign of cancer is microcalcination. This term denotes the smallest accumulations of calcareous salts in the zone of growth. They resemble grains scattered in a limited area or forming aggregations. The form of microcalcinates in cancer is diverse, unlike the more correct form of calcified cysts or lime deposits in dyshormonal proliferates or artery walls. For a cancer node, jagged or fine-wavy outlines, changes in the structure of the surrounding tissue are characteristic. The later symptoms include skin retraction and thickening, deformity of the nipple.

In order for the surgeon to find a non-palpable formation on the operating table, the radiation diagnostician brings the needle to him. Through the needle introduce a special metal thread with a harpoon-shaped device at the end. Then the needle is removed, and the thread is left in order for the surgeon to orient on it.

On sonograms, the tumor is defined as a focal formation with uneven outlines and a heterogeneous structure. If glandular elements predominate, the tumor echogenicity is low, and, conversely, when the stroma predominates, it is increased. CT and MRI can not be used for mass screening tests, so they are not yet used to detect nonpalpable cancers. However, in principle, tumor formations provide a demonstrative image on the tomograms.

Mammography is indicated for all women with dyshormonal hyperplasia of the gland tissue (mastopathy). Mammograms allow us to specify the form of the lesion, the prevalence and severity of the process, the presence of malignant degeneration. Repeated pictures reflect the dynamics of the disease, associated with cyclical changes in the body of a woman and medical activities. In adenosis on mammograms, multiple rounded and indistinct outlines of compaction are determined. Fibrous form of mastopathy is expressed in the fact that the shadow of the glandular part becomes intense and almost homogeneous. Against this background, some coarser strands can be allocated, sometimes lime deposits can be seen along the dairy ducts. If the ducts are predominantly affected, galactography can be used to determine deformations and enlargements of small ducts, carpal cavities along their course or cystic dilations of the end sections of these ducts.

Small-cystic perestroika, as a rule, occurs in both mammary glands. Larger cysts give round and oval shadows of different sizes - from 0.5 to 3-4 cm with clear, even arched contours. The multi-chamber cyst has polycyclic outlines. The shadow of the cyst is always uniform, there is no lime deposit in it. The radiologist produces a puncture of the cyst, aspiration of its contents and introduces air or sclerosing composition into it. The most demonstrative cyst on sonograms.

It is very important to follow the complete evacuation of the cyst during puncture and to establish the absence of intra-cystic enlargement (papilloma or cancer) in it. When the pressure of the sensor on the cyst, its shape changes.

Mixed forms of mastopathy cause a variegated x-ray picture: instead of the sharply marked shadow of the glandular triangle with the trabeculae radially diverging from the base of the gland to the areola, a restructuring of the gland structure with multiple areas of darkening and enlightening of different shapes and sizes is revealed. This picture is figuratively called "lunar relief".

Of benign breast formations, fibroadenoma is most often observed. It gives on mammograms a round, oval or, more rarely, lobular shadow with even, sometimes slightly scalloped contours. Shadow of fibroadenoma is intense and homogeneous, if it does not contain lime deposits. Calcifications can be located both in the center and along the periphery of the node and look like large clumps. On sonograms, the heterogeneity of the fibroadenoma structure is revealed with its overall low echogenicity. Sonograms allow you to immediately distinguish fibroadenoma from the cyst, which is not so easy to do on mammograms.

Diagnosis of mastitis is carried out on the basis of clinical data, but sonography is a valuable auxiliary method. In the initial period of mastitis, the glossiness of the usual pattern of the gland is determined. In the glandular part, there are echo-negative inclusions 0.3-0.5 cm in size, often located in groups. If a rarefaction site appears on this background, this indicates a destruction and development of purulent mastitis. Formed abscess gives a picture of echo-negative education.

Timely recognition and treatment of diseases of the mammary glands is based on well-thought-out examination tactics. In view of the high incidence of these diseases, we consider it necessary to cite typical schemes of the diagnostic process.

[1], [2], [3], [4], [5], [6]