Complex radiology diagnostics of non-palpated breast lesions in premenopausal period.

Novikova E. V., Serova N. S., Nudnov N.V.

Non-palpable breast lesions occur in 60-75% of women in premenopausal period. The risk of cancer in this age group is high, while 2/3 of lesions are benign. The difficulties of diagnostics are presented with diversity and similarity of radiological manifestations. US-negativity complicates the categorization of preclinical breast lesions in one third of cases, thereby increasing the number of unjustified biopsies. Purpose. To determine the cause of US-negativity in preclinical breast lesions, the predictive value of important radiological criteria for the correct assessment of changes and indirect signs of lesions of the breast classification system BI-RADS; to develop a strategy in respect of the US-negative for the first time and newly identified non-palpable formations. Materials and methods. The study included 423 patients in premenopausal age with non-palpable formations of the mammary glands, 132 of which were not visualized with ultrasound. Breast cancer identified in 129 cases, of which 65 (50.3 percent) were US-negative. Diagnosed on the basis of results of complex clinical-instrumental examination, including X-ray mammography (MG) in different projections, ultrasound, MRI, CT of the breast and biopsies. Significant radiological signs of malignancy of the lesions were found, determines their diagnostic value. Results. The use of additional diagnostic techniques of mammography contributes to a confident visualization of direct and indirect radiological criteria of malignancy, has a high predictive value (=87%). A comprehensive analysis of the breast cancer signs, localization of changes and detection from screening round allows a 20% increase informatively in diagno-sis of non-palpable breast cancer, helps to reduce the number of unjustified biopsies of 11%. MSCT-MG demonstrates 100% accuracy in the differential diagnosis of ULTRASOUND-negative lesions on the type of clusters of microcalcifications. Conclusion. US-negativity of preclinical lesions of the breast certainly complicates the categorization of the latter and require using of additional diagnostic techniques, and in some cases, clarifying and high-tech methods: MSCT–MG and MR MG. The combination of standard and optional projections of X-ray MG increases the diagnostic value of the method: the sensitivity from 72% to 93.2% and the specificity from 67,4 to 78.4. CT–MG and MR MG show even higher efficiency: MSCT–MG CE (100% sensitivity and 99% specificity) and Mr–MG CE (100% sensitivity, 98% specificity). However, even in the absence of recent, compre-hensive analysis of significant and indirect radiological signs, including the location and de-pending on the round of screening, demonstrated the high information content of 77.3% (102 out of 132 cases).

1 - Institute for advanced studies of FMBA of Russia, department of radiology and mammology. 2 - I. M. Sechenov First Moscow State Medical University. 3 – Russian scientific center of radiology and nuclear medicine. Moscow, Russia.

 

 

 

 

 

Keywords: intervertebral disc, hydrophilicity, dystrophic changes of the spinal column, MRI.

 

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

 

For citation: Novikova E. V., Serova N. S., Nudnov N.V. Complex radiology diagnostics of non-palpated breast lesions in premenopausal period. REJR 2017; 7 (3):90-107. DOI:10.21569/2222-7415-2017-7-3-90-107.

Received: 19.04.2017 Accepted:04.05.2017