Mammographic signs of breast disease

There are two groups of radiation examinations of the mammary gland: screening and diagnostic. The first group includes periodic mammography of healthy women to detect hidden diseases, primarily cancer. Figuratively speaking, this is "mammography of healthy women who want to stay healthy." All women who have no signs of breast disease are recommended to undergo a clinical mammographic examination ("baseline mammograms") at the age of 40. Repeated clinical mammographic examinations should be performed at intervals of 2 years, unless the woman is in a high-risk group for developing breast cancer. Mass screening examinations of the female population using mammography (mammographic screening) provide a 30-50% reduction in mortality from breast cancer and a significant reduction in the frequency of mastectomies.

Diagnostic mammography is performed on patients who are suspected of having a breast lesion based on clinical data. Indications for this examination are varied: palpable lumps, nipple discharge, mastodynia, complications after breast prosthetics, etc. The main objective of radiation diagnostics is to detect breast cancer, especially at a stage when it is not detected by the patient during self-examination or by the doctor during examination and palpation of the breast, 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: ductal and lobular. The transformation of the epithelium is stereotypical: normal - hyperplasia - atypia - cancer. On average, 6 years pass before a tumor with a diameter of 1 mm is formed, and another 6-10 years pass before it reaches a size of 1 cm.

Depending on the stage of tumor morphogenesis, noninvasive (non-infiltrating) ductal carcinoma (often referred to as intraductal carcinoma in situ, or DCIS) and invasive (infiltrating) ductal carcinoma are distinguished. Similarly, lobular carcinoma is divided into noninvasive (non-infiltrating carcinoma in situ, or LCIS) and invasive (infiltrating).

The main sign of a tumor on mammograms and tomograms is the image of the tumor node. The tumor differs from the surrounding tissues by its increased density. The shape of the node varies. Sometimes it is a circle or oval, with an additional protrusion extending from one side of it. Even more typical is a star-shaped figure formed by a dense central core of irregular configuration, from which gradually narrowing strands extend into the surrounding tissue.

The second most important sign of cancer is microcalcification. This term refers to the smallest accumulations of calcareous salts in the area of the neoplasm. They resemble grains of sand, scattered over a limited area or forming accumulations. The shape of microcalcifications in cancer is varied, unlike the more regular shape of calcified cysts or lime deposits in dyshormonal proliferates or arterial walls. A cancerous node is characterized by jagged or finely wavy outlines, changes in the structure of the surrounding tissue. Later symptoms include retraction and thickening of the skin, deformation of the nipple.

In order for the surgeon to find a non-palpable formation on the operating table, the radiologist brings a needle to it. A special metal thread with a harpoon-like device on the end is inserted through the needle. The needle is then removed, and the thread is left so that the surgeon can orient himself by 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, if stroma predominates, it is increased. CT and MRI cannot be used for mass screening studies, so they are not yet used to detect non-palpable cancerous formations. However, in principle, tumor formations provide a demonstrative image on tomograms.

Mammography is recommended for all women with dyshormonal hyperplasia of glandular tissue (mastopathy). Mammograms help to clarify the form of the lesion, the prevalence and severity of the process, and the presence of malignant degeneration. Repeated images reflect the dynamics of the disease associated with cyclic changes in the woman's body and treatment measures. In adenosis, mammograms show multiple round and unclearly defined areas of compaction. The fibrous form of mastopathy is expressed in the fact that the shadow of the glandular part becomes intense and almost uniform. Against this background, individual coarser strands may stand out, and sometimes lime deposits are visible along the milk ducts. If the ducts are predominantly affected, then galactography may reveal deformations and expansions of small ducts, cystic cavities along their course, or cystic expansions of the terminal sections of these ducts.

Microcystic reorganization usually occurs in both mammary glands. Larger cysts produce round and oval shadows of varying sizes - from 0.5 to 3-4 cm with clear, even, arcuate contours. A multi-chamber cyst has polycyclic outlines. The cyst shadow is always uniform, there are no calcifications in it. The radiologist punctures the cyst, aspirates its contents and injects air or a sclerosing compound into it. The cyst is most demonstrative on sonograms.

It is very important to ensure that the cyst is completely emptied during the puncture and to establish the absence of intracystic growths (papillomas or cancer). When the sensor is pressed on the cyst, its shape changes.

Mixed forms of mastopathy cause a motley radiographic picture: instead of a sharply defined shadow of the glandular triangle with trabeculae radiating from the base of the gland to the areola, a reorganization of the gland structure is revealed with multiple areas of darkening and lightening of different shapes and sizes. This picture is figuratively called "lunar relief".

Of the benign breast tumors, fibroadenoma is the most common. It produces a round, oval, or, less commonly, lobular shadow on mammograms with smooth, sometimes slightly scalloped contours. The shadow of fibroadenoma is intense and uniform if there are no calcifications in it. Calcifications can be located both in the center and on the periphery of the node and look like large lumps. Sonograms reveal heterogeneity of the fibroadenoma structure with its overall reduced echogenicity. Sonograms allow one to immediately distinguish fibroadenoma from a cyst, which is not so easy to do on mammograms.

Mastitis is diagnosed based on clinical data, but sonography is a valuable auxiliary method. In the initial period of mastitis, the usual pattern of the gland is obscured. Echo-negative inclusions of 0.3-0.5 cm in size appear in the glandular part, often in groups. If a rarefaction area appears against this background, this indicates destruction and the development of purulent mastitis. The formed abscess gives a picture of an echo-negative formation.

Timely recognition and treatment of mammary gland diseases is based on a well-thought-out examination tactic. Due to the high frequency of these diseases, we consider it necessary to provide typical diagnostic process schemes.

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