Диагностика и лечение рака молочной железы: что изменилось за 20 лет

Objective of the Review: To describe the progressive development of new imaging techniques for diagnosing breast disorders and methods of conservative surgery for these conditions. Key Points: As the latest trends show, digital imaging techniques allowing for breast visualization have become most popular and improved detection of breast cancer at early stages. New diagnostic options opened up further possibilities for conservative surgery. Combined-modality treatment, including surgery, precise radiation therapy, and targeted pharmacotherapy, has accounted for better survival rates and a 12.5% reduction in mortality over the last 10 years. The implementation of new complex technologies requires substantial changes in the system of specialist training, harmonization of regulatory documents and identification of new approaches to universal screening. Modern techniques used at specialist cancer facilities to diagnose and treat breast cancer have been shown to improve the 5-year survival rate in patients with stage 1-2 breast cancer up to 96%. Conclusion: The current system for diagnosis and treatment of breast disorders is rather well developed. However, some extra efforts are required to achieve goals identified for health care givers, including further improvement of screening models and prevention strategies for breast diseases as well as actions to increase the awareness of malignancies among primary-care physicians and to inform women about risk factors for breast disorders and current screening and prevention programs. Timely treatment for benign breast disease is the earliest and most effective preventive care for malignancies.Цель обзора: показать поступательное развитие новых технологий лучевой диагностики и методов органосберегающего лечения заболеваний молочной железы. Основные положения. Согласно тенденциям последних лет, наибольшее развитие получили цифровые технологии визуализации молочной железы, что повысило выявляемость ранних форм рака молочной железы. Новые возможности диагностики открыли перспективы органосохраняющего лечения. Комплексное использование хирургических вмешательств, прецизионной лучевой и таргетной лекарственной терапии увеличило продолжительность жизни и снизило смертность за последние 10 лет на 12,5%. Внедрение новых сложных технологий требует перестройки системы подготовки кадров, оптимизации нормативных документов и разработки новых подходов к организации массовых проверочных обследований населения. Современные технологии диагностики и лечения рака молочной железы, реализуемые в условиях специализированных онкологических учреждений, показывают позитивные тенденции в повышении 5-летней выживаемости больных с 1-2-й стадией заболевания до 96%. Заключение. Сейчас достаточно хорошо разработана система диагностики и лечения патологий молочной железы. Однако для достижения поставленных перед здравоохранением задач нужны дополнительные усилия по совершенствованию моделей скрининга и методов их профилактики, повышения онкологической настороженности врачей первичного звена здравоохранения, информированности женского населения о факторах риска развития заболеваний молочной железы, действующих программах скрининга и профилактики. Своевременно начатое лечение доброкачественных дисплазий молочной железы является наиболее ранней и эффективной профилактикой онкологических заболеваний

Диагностика и лечение рака молочной железы: что изменилось за 20 лет

Objective of the Review: To describe the progressive development of new imaging techniques for diagnosing breast disorders and methods of conservative surgery for these conditions. Key Points: As the latest trends show, digital imaging techniques allowing for breast visualization have become most popular and improved detection of breast cancer at early stages. New diagnostic options opened up further possibilities for conservative surgery. Combined-modality treatment, including surgery, precise radiation therapy, and targeted pharmacotherapy, has accounted for better survival rates and a 12.5% reduction in mortality over the last 10 years. The implementation of new complex technologies requires substantial changes in the system of specialist training, harmonization of regulatory documents and identification of new approaches to universal screening. Modern techniques used at specialist cancer facilities to diagnose and treat breast cancer have been shown to improve the 5-year survival rate in patients with stage 1-2 breast cancer up to 96%. Conclusion: The current system for diagnosis and treatment of breast disorders is rather well developed. However, some extra efforts are required to achieve goals identified for health care givers, including further improvement of screening models and prevention strategies for breast diseases as well as actions to increase the awareness of malignancies among primary-care physicians and to inform women about risk factors for breast disorders and current screening and prevention programs. Timely treatment for benign breast disease is the earliest and most effective preventive care for malignancies.Цель обзора: показать поступательное развитие новых технологий лучевой диагностики и методов органосберегающего лечения заболеваний молочной железы. Основные положения. Согласно тенденциям последних лет, наибольшее развитие получили цифровые технологии визуализации молочной железы, что повысило выявляемость ранних форм рака молочной железы. Новые возможности диагностики открыли перспективы органосохраняющего лечения. Комплексное использование хирургических вмешательств, прецизионной лучевой и таргетной лекарственной терапии увеличило продолжительность жизни и снизило смертность за последние 10 лет на 12,5%. Внедрение новых сложных технологий требует перестройки системы подготовки кадров, оптимизации нормативных документов и разработки новых подходов к организации массовых проверочных обследований населения. Современные технологии диагностики и лечения рака молочной железы, реализуемые в условиях специализированных онкологических учреждений, показывают позитивные тенденции в повышении 5-летней выживаемости больных с 1-2-й стадией заболевания до 96%. Заключение. Сейчас достаточно хорошо разработана система диагностики и лечения патологий молочной железы. Однако для достижения поставленных перед здравоохранением задач нужны дополнительные усилия по совершенствованию моделей скрининга и методов их профилактики, повышения онкологической настороженности врачей первичного звена здравоохранения, информированности женского населения о факторах риска развития заболеваний молочной железы, действующих программах скрининга и профилактики. Своевременно начатое лечение доброкачественных дисплазий молочной железы является наиболее ранней и эффективной профилактикой онкологических заболеваний

Aggregation of minced hake during frozen storage

Aggregation in minced hake muscle (Merluccius merluccius) during storage at -20 °C was studied in conditions where there is progressive deterioration of functionality and texture as measured by apparent viscosity and shear resistance. Natural actomyosin was extracted with 0.6 M NaCl over a period of 49 weeks. Insoluble residue was extracted successively with 2% sodium dodecyl sulphate (SDS) and 2% SDS plus 5% β-mercaptoethanol (ME) solutions. SDS-polyacrylamide gel electrophoresis was performed on the extracted fractions. The results showed a 75% decrease in 0.6 M NaCl extractability by the end of the storage period. Initially the remaining precipitate was all extracted in 2% SDS and although the amount extracted in this solution increased as storage time progressed, its proportion decreased, accounting for as little as 40-50% of the protein aggregate by the end of storage. The proteins most involved in formation of the aggregate not extracted in 0.6 M NaCl were myosin and actin. Neither of these proteins was fully recovered in the fractions extracted with 0.6 M NaCl, 2% SDS, or 2% SDS plus 5% ME, and therefore it was inferred that they were forming part of the aggregates, bound by covalent bonds. © Springer-Verlag 1999.Peer Reviewe

Доброкачественные заболевания молочной железы

В руководстве изложены современные представления об этиологии и патогенезе доброкачественных дисплазий молочной железы. Приведена морфологическая классификация диффузных и узловых доброкачественных заболеваний молочной железы. Описанные диагностические технологии основываются на последних достижениях медицины, накопившей новые сведения об особенностях клинических, рентгенологических, сонографических и патоморфологических проявлений этой группы заболеваний. Успехи молекулярной биологии позволили обосновать патогенетические механизмы воздействия факторов риска на формирование дисгормональных перестроек молочной железы, а также варианты их своевременного консервативного, стационарозамещающего и хирургического лечения, предупреждающего злокачественную трансформацию. Даны рекомендации по профилактике заболеваний, представлена программа школы женского здоровья. Иллюстративный материал показывает возможности современной медицины при многообразии патологии молочной железы. Представленный междисциплинарный подход к освещению проблемы дисплазий молочной железы позволит пополнить багаж знаний врачей не только в своей узкой специальности, но и в смежных дисциплинах для правильного выбора диагностической тактики, адекватного метода лечения и профилактики рака. Предназначено для врачей общей практики, хирургов, рентгенологов, специалистов ультразвуковой диагностики, акушеров-гинекологов, онкологов и других специалистов, занимающихся патологией молочных желез

Breast filariasis. Complex diagnostic and treatment [ФИЛЯРИОЗ МОЛОЧНОЙ ЖЕЛЕЗЫ. КОМПЛЕКСНАЯ ЛУЧЕВАЯ ДИАГНОСТИКА И ЛЕЧЕНИЕ]

Filariasis is a tropical disease caused by the parasite Dirofilaria repens. The lesion of the breast occurs in 10%. Purpose. To present a clinical case of a woman with breast pathology. Materials and methods. The condition did not manifest clinically. Detection of atypical cyst in the breast using ultrasound technology and its subsequent biopsy allowed to confirm the pathology. Results. The possibilities of an integrated approach in the diagnosis of breast lesions and minimally invasive treatment of a patient with a parasitic lesion of the breast are demonstrated. © 2019 Russian Electronic Journal of Radiology. All rights reserved

ФИЛЯРИОЗ МОЛОЧНОЙ ЖЕЛЕЗЫ. КОМПЛЕКСНАЯ ЛУЧЕВАЯ ДИАГНОСТИКА И ЛЕЧЕНИЕ

F ilariasis is a tropical disease caused by the parasite Dirofilaria repens. The lesion of the breast occurs in 10%. Purpose. To present a clinical case of a woman with breast pathology. Materials and methods. The condition did not manifest clinically. Detection of atypical cyst in the breast using ultrasound technology and its subsequent biopsy allowed to confirm the pathology. Results. The possibilities of an integrated approach in the diagnosis of breast lesions and minimally invasive treatment of a patient with a parasitic lesion of the breast are demonstrated.Ф иляриоз - это тропическое заболевание, вызванное паразитом Dirofilaria repens. Поражение молочной железы встречается в 10%. Цель. Представить клиническое наблюдение женщины с патологией молочной железы. Материалы и методы. Состояние клинически не проявлялось. Выявление атипичной кисты в молочной железе с применением ультразвуковых технологий и последующая ее биопсия позволили подтвердить патологию. Результаты. Продемонстрированы возможности комплексного подхода в диагностике поражений молочной железы и малоинвазивного лечения пациентки с паразитарным поражением молочной железы

Use of mastodynon for the treatment of mastalgia in patients after augmentation mammoplasty

Objective. To investigate the effectiveness of Mastodynon in women with benign breast diseases, which are accompanied by mastalgia after endoprosthetics of mammary glands for cosmetic purposes. Subjects and methods. The effectiveness of therapy with the herbal preparation Mastodynon was evaluated in 42 women with symptoms of mastalgia after augmentation mammoplasty. The patients used the drug as cycles of 1 tablet twice daily over a 3-month period at a 2.5–3 month interval. To analyze the results, the patients were divided into 3 groups. The study was conducted for 1 year through comprehensive survey with a questionnaire every 6 months. Results. After 6 months of Mastodynon intake, the questionnaire survey of patients showed varying degrees of positive results in 64.2% of cases. Following 1 year, the survey revealed a stable positive effect in 80.9% of cases. Conclusion. Mastodynon showed a high effectiveness and a good tolerance in treating mastalgia in women after endoprosthetics of mammary glands for cosmetic purposes. The administration of Mastodynon improved quality of life in patients. © Bionika Media Ltd

Breast cancer after augmentation mammoplasty. Surgical tactics

In recent years, an increasing number of cases of breast cancer in women after an earlier augmentation of the breast with the use of silicone implants. Diagnosis of tumors on the background of the implants and surgical approach are its essential features. Presents the experience on diagnosis and choice of adequate volume of removed tissues, and breast reconstruction in 10 patients is described. © Ruslania 2018. All rights reserved

Assessment of diagnostic efficiency of digital breast tomosynthesis in diagnostics of breast diseases [ОЦЕНКА ДИАГНОСТИЧЕСКОЙ ЭФФЕКТИВНОСТИ РЕНТГЕНОЛОГИЧЕСКОГО ТОМОСИНТЕЗА ПРИ ЗАБОЛЕВАНИЯХ МОЛОЧНОЙ ЖЕЛЕЗЫ]

purpose. To define the diagnostic efficiency and the main advantages of digital breast tomosynthesis. Material and methods. For achievement of the goal during the period from July, 2013 to September, 2017 examinations in 150 patients aged from 29 to 79 years (middle age – 58.4 ±11.3 years) were made in Gazprom clinic and MNIOI of P.A. Herzen using digital X-ray equipment: "GIOTTO Image TOMO", GIOTTO Image SDL (IMS, Italy) and "Senograph Essential" (GE Healthcare, the USA). The diagnostic complex included: clinical examination, mammography in two projections, digital breast tomosynthesis in a necessary projection depending on characteristics and localization of the pathology, breast ultrasonography. The fine-needle aspiration biopsy and core- biopsy under control of a method of the best visualization was applied for morphological verification. Results. The sensitivity of digital breast tomosynthesis in detecting of breast abnormalities was 92.6%, 95% of CI (82.4%-97.1%), specificity – 88.5%, 95% of CI (80.6%-93.5%), accuracy – 90.0%, 95%CI (83.8%-94.0%), PPV – 82.0%, 95% of CI (70.5%-89.6%), NPV – 95.5%, 95% of CI (89.0%-98.2%). The sensitivity of mammography in detecting of breast abnormalities was 79.6%, 95% of CI (67.1%-88.23%), specificity - 77.1%, 95% of DI (67.7%-84.3%), accuracy - 78.0%, 95% of CI (69.7%-84.5%), PPV – 66.1%, 95% of CI (54.0%-76.5%), NPV-of 87.1%, 95% of CI (78.3%-92.6%). Conclusion. The results of the analysis have shown that digital breast tomosynthesis has advantages in diagnostic efficiency in comparison with traditional mammography: higher accuracy and specificity because of an exception of superposition effect in identification of additional signs of diseases of the benign and malignant nature, including high mammography density. © 2019 Russian Electronic Journal of Radiology. All rights reserved

HOW to USE the KAISER SCORE AS A CLINICAL DECISION RULE for DIAGNOSIS in MULTIPARAMETRIC BREAST MRI [КАК ИСПОЛЬЗОВАТЬ ШКАЛУ КАЙЗЕРА ДЛЯ ПРИНЯТИЯ ДИАГНОСТИЧЕСКИХ РЕШЕНИЙ ПРИ МУЛЬТИПАРАМЕТРИЧЕСКОЙ МРТ МОЛОЧНОЙ ЖЕЛЕЗЫ]

Purpose. Development of a universal system for evaluating MRI images of the breast. Material and methods. Due to its superior sensitivity, breast MRI (bMRI) has been established as an important additional diagnostic tool in the breast clinic and is used for screening in patients with an elevated risk for breast cancer. Results. Breast MRI, however, is a complex tool, providing multiple images containing several contrasts. Thus, reading bMRI requires a structured approach. A lack of structure will increase the rate of false-positive findings and sacrifice most of the advantages of bMRI as additional work-up will be required. While the BI-RADS (Breast Imaging Reporting And Data System) lexicon is a major step toward standardised and structured reporting, it does not provide a clinical decision rule with which to guide diagnostic decisions. Such a clinical decision rule, however, is provided by the Kaiser score, which combines five independent diagnostic BI-RADS lexicon criteria (margins, SI-time curve type, internal enhancement and presence of oedema) in an intuitive flowchart. Conclusion. The resulting score provides probabilities of malignancy that can be used for evidence-based decision-making in the breast clinic. Notably, considerable benefits have been demonstrated for radiologists with initial and intermediate experience in bMRI. This pictorial essay is a practical guide to the application of the Kaiser score in the interpretation of breast MRI examinations. Teaching Points. 1)bMRI requires standardisation of patient-management, protocols, and reading set-up. 2) Reading bMRI includes the assessment of breast parenchyma, associated findings, and lesions. 3) Diagnostic decisions should be made according to evidence-based clinical decision rules. 4) The evidence-based Kaiser score is applicable independent of bMRI protocol and scanner. 5) The Kaiser score provides high diagnostic accuracy with low inter-observer variability. © 2020 Russian Electronic Journal of Radiology. All rights reserved