Breast cancer (BC) steadily occupies the first place in the structure of oncological pathology in Ukrainian women. Among the 10 main nosological forms of malignant neoplasms, its share is 23.2%, which exceeds the proportion of uterine and ovarian cancers combined.
Deployment of mass screening, an increase in the number of radiological examinations of the breast (BC) contributes to the detection of RHD in the early stages, when organ-preserving interventions are possible, and significantly improves the quality of life of patients.
Only in our article on estet-portal.com it is possible to get acquainted with the actual analysis of the methods of preoperative screening of intraductal neoplasms (IVNO) of the breast.
Type of breast cancer
Clinically, there are forms of breast cancer (BC) that do not have palpation or radiation signs and are manifested only by pathological discharge from the nipple (PVS). However, PVA is also seen in other intraductal neoplasms (IDN) of the breast, such as papilloma, ductal hyperplasia, carcinoma in situ, and the like.
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This etiological heterogeneity of HPNO significantly complicates the planning and implementation of surgical interventions due to the impossibility of confident preoperative histopathological verification (PHV) using targeted trephine biopsies (TB) with negative results of X-ray mammography (RMG) and / or echography (EG), which are noted with a frequency of 38.1-85.0 and 34.5-71.0%, respectively.
The high (18.0-19.3%) chance of breast cancer, especially in pre- and menopausal women, to some extent justifies routine ductectomy (RDE), which is essentially an open biopsy.
Disadvantages of RDE as a screening method
Routine ductectomy (RDE) of mammary glands, as it is today, is characterized by a number of disadvantages, such as the need for an urgent histopathological examination of a fresh frozen biopsy and re-cutting when breast cancer is detected in 18.0-20.0% of cases, the difficulty of intraoperative search for small according to the size of the HPNO, frequent (up to 25.4%) leaving them outside the resection, an unreasonably large volume of removed tissues, often (up to 16.0%) ischemic-necrotic complications from the areolar-nipple complex (ASC), etc.
The indicated shortcomings of the IDR are mostly due to the "blind" marking of secernating milk ducts (SMP), in which the probability of uncontrolled penetration of markers to those branches that do not contain HPNU is at least 50.0%. Therefore, these indicators indicate the low effectiveness of this method as a screening and, in essence, is a surgical intervention.
Mammography: disappointment in breast examination
Endoscopic preoperative screening techniques
Targeted endoscopically controlled marking facilitates the intraoperative search for small breast cancerous tumors and contributes to their adequate excision with a minimum amount of adjacent tissues, but in 16.3-22.7% of cases, endoscopic mammodoscopy (EMDS) is ineffective due to anatomical features and pathological changes in the nipple and / or secerating mammary glands, as well as in the peripheral placement of pathological foci in the ducts of small caliber.
In addition, when marking with a single wire, the possibility of incorrect installation, displacement, loss of the marker or damage to it during the operation is not excluded.
The method of endoscopically controlled selective ductography involves performing endoscopic mammodoscopy, identifying an endoscopically unreachable SMP branch, catheterizing it with a flexible capillary, injecting a contrast agent, and performing x-rays of the breast.
Stereotactic Screening Techniques
A method for stereotaxic trephine biopsy of X-ray-negative intraductal neoplasms (HNO) including traditional or selective galactoductography of the mammary glands and, with positive results, directing the puncture needle either directly into the filling defect, or 0.1 cm proximal to the "amputation" line.
The structure of the breast: a beautiful and vulnerable female organ
Method for preoperative echo- and endoscopically controlled marking of HPNO with determination of the features of arterial blood supply of the areolar-nipple complex of the mammary gland, provides for endoscopic mammodoscopy, double marking of HPNO, calculation of the distance between markers, scanning of the area of the proposed surgical incision in the color Doppler mapping mode, detection branches of arterial vessels and planning the type and topography of the surgical incision, depending on the data obtained.
X-ray GDG and endoscopic mammodoscopy as traditional methods of preoperative diagnosis of HPN GC are characterized by insufficient specificity (33.3 and 32.0%, respectively), which limits their significance in planning and performing surgical interventions.
"Tight breasts": an anatomical feature or a dangerous syndrome
Routine ductectomy after blind pre- or intraoperative marking of the SMP is characterized by a significant (45.4 ± 12.8 cm3) volume of removed tissues, frequent (61.7%) leaving of the HPNO outside the resection, the development of postoperative complications in 11.1% of cases.
So, for the current period of planning and conducting surgical interventions in patients with intraductal breast neoplasms, it is not perfect and needs to be optimized by expanding the possibilities of preoperative diagnosis, objectifying the choice of the type and topography of the surgical incision, ensuring targeted and low-traumatic removal of pathological foci, minimizing postoperative complications.
Comprehensive approach to breast cancer
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