ULTRASONIC EXAMINATION AT THE STAGES OF DIAGNOSIS AND MINIMALLY INVASIVE TREATMENT OF INTRADUCTAL BREAST LESIONS

 

Marushchak E.A.^1,2, Zubareva E.A.², Fisenko E.P.¹, Melchenko D.S.¹, Presnyakov Е.V.¹

 

1 – B.V. Petrovsky Russian Scientific Center of Surgery Scientific and Clinical Center No. 2.

2 – N.I. Pirogov Russian National Research Medical University. Moscow, Russia.

Purpose. To study the possibilities and analysis of the ultrasound examination results at the stages of diagnosis and minimally invasive treatment of intraductal breast lesions.

Materials and Methods. From 2017 to 2025 at B.V. Petrovsky Russian Research Surgery Center, SCC No. 2, (formerly the Central Clinical Hospital of the Russian Academy of Sciences) there were performed 695 ultrasound examinations (US) in patients with breast pathology, which later required surgical treatment. At the same time, 60 surgical interventions were performed in patients, who, according to US, were diagnosed with intraductal lesion (IDL). The US results were compared with the final histological material of the resected tumor. 15 cases of intraductal papillomas (IDP), verified by morphological examination, were also analyzed in comparison with the results of US, that did not detect this pathology. Subsequently, the long-term results of surgical treatment using vacuum aspiration biopsy (VAB) with complete excision, marking, and navigation under real-time US control were analyzed by performing US in dynamics of histologically confirmed IDP in 30 women.

Results. Of the 60 patients with suspected IDL on US, only 31 women (51.6%) had IDP diagnosis confirmed by morphological verification. In remaining 29 patients, histological examination verified: hamartoma – 1, variants of fibroadenomas – 9, nonproliferative fibrocystic mastopathy – 14, sclerosing adenosis – 1, phylloid tumor – 1, intraductal carcinoma in situ – 2, invasive lobular cancer – 1. In an analysis of 15 cases of IDP detected by histological examination and not suspected by US, ultrasound specialists suggested that 6 patients had malignant neoplasms (and 2 of them had intraductal carcinoma in situ at the same time), while 6 other patients were suspected of having fibroadenoma, and 3 had a focus of mastopathy. When analyzing the long-term results of minimally invasive surgical treatment by VAB-resection in patients with morphologically confirmed IDP in more than 6 months, relapse or residual tumor tissue was detected only in 3 out of 30 (10%) women who attended a follow-up US.

Discussion. When comparing the US data with the results of morphological study, it was found that the method has low sensitivity, but high specificity in relation to the IDТ, which is caused by the diversity of the ultrasound picture of the IDL, which has signs similar to a number of other diseases of the breast, as well as diagnostic difficulties due to the small size of the masses and its difficult visualization. In this regard, knowledge of the variants of the ultrasound picture of the IDL and the availability of diagnostic equipment with good resolution and additional modes play an important role. In addition to its diagnostic function, US provides visualization and navigation for minimally invasive removal of IDL by VAB, which, given the specific location of the neoplasm in the ducts, is the optimal treatment method for this pathology with good long-term results.

Conclusion. The main role of US in the primary diagnosis of IDL is to detect a suspicious neoplasm. Later, when an oncologist determines the indications for surgical treatment, US is the optimal tool for preoperative marking and intraoperative navigation during VAB resection, which allows good long-term results.

 

Keywords: ultrasound diagnostics, breast, intraductal lesion, intraductal papilloma, vacuum aspiration biopsy, VAB, BI-RADS.

 

Corresponding author: Marushchak E.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Marushchak E.A., Zubareva E.A., Fisenko E.P., Melchenko D.S., Presnyakov Е.V. Ultrasonic examination at the stages of diagnosis and minimally invasive treatment of intraductal breast lesions. REJR 2026; 16(1):52-64. DOI: 10.21569/2222-7415-2026-16-1-52-64.

Received: 31.03.26 Accepted: 06.05.26