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Kahharov Alisher, Atakhanova Nigora, Shayusupov Nariman, Iskhakov Doniyor, Abdukarimov Temur, Ishankhodjaeva Dilobar, Tashkent Medical Academy Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology E-mail: alisher1510@mail.ru
RADIOLOGICAL PROGNOSTIC FACTORS OF BREAST CANCER
Abstract. This article analyzed the main mammographic and ultrasound signs affecting the outcome of the disease, as well as their proportion. From mammographic signs, worm-like, treelike microcalcifications, star-shaped tumors were mainly found in patients with an unfavorable outcome of the disease. Heterogeneity of the tumor with ultrasound diagnosis, posterior darkening, hyperechoic ring and hypoechoic ring around the tumor are also considered unfavorable signs and are more common in patients with early progression of the disease. Keywords: Breast cancer, mammography, ultrasound, prognosis.
Introduction mortality rates are higher in patients with mammograms of
In developed and developing countries, there is a ten- which there were cast-type microcalcifications compared with dency to an increase in the incidence of breast cancer, due patients without them [3].
to a change in the reproductive behavior of the population, a The use of ultrasound in addition to mammographic
examination increases their sensitivity and specificity, and is also a convenient method for visualizing and controlling minimally invasive procedures (fine-needle aspiration biopsy, core-biopsy, etc.). The joint use of mammographic examination with ultrasound increased the diagnostic accuracy up to 100%. However, as an independent method of diagnosing breast cancer, it cannot be used, since it is not able to determine microcalcifications, and is less effective in visualizing solid formations. According to Bassett et al, only in 63% of cases, ultrasound allowed visualization of solid formations.
One of the most pressing and complex problems of modern oncology is the problem of individual forecasting.
A personalized approach to treating patients is most often based on the physician's personal experience, which takes into account only a few factors that characterize the tumor and the organism-tumor carrier. At the same time, only an individual prognosis makes it possible in each individual case to most accurately determine the tactics of patient management.
Objective: to determine the effect of mammography and ultrasound signs on the prognosis of breast cancer. Materials and methods
To study the causes and conditions of generalization in patients with breast cancer and the characteristics of the course, a censored study of 350 case histories of patients who
change in lifestyle and an increase in the life expectancy of the population. According to forecasts of GLOBACAN2012 (International Cancer Research Institute), by 2020 in low- and middle-income countries, the number of newly detected cases of breast cancer will be about 1 million cases per year [2].
According to the IARC, mortality from breast cancer varies depending on the income level of the country, in high-income countries the mortality rate is 24%, while in low- and middle-income countries, 48%, 38%, respectively. With about 1.5 million deaths from breast cancer, it might be preventable [2].
Breast cancer is a heterogeneous disease with a different clinical course, response to therapy and prognosis.
The complex of diagnostic measures for breast cancer includes clinical examination and palpation, ultrasound, mam-mography, MRI of the mammary glands.
By mammography, one can judge the pathological changes in the anatomical structure and density of the mammary glands, the biological aggressiveness of the tumor, the presence of concomitant pathologies of the mammary glands. The advantage of mammographic research is the ability to detect intraductal formations, as well as various kinds of microcalcifications. Mammographic features of the structure of the tumor provide prognostic data on the nature of the course of the disease. According to Tot T., Tabar L. et al 2000, breast cancer
Section 2. Medical science
had previously undergone combined and complex treatment was carried out. Selected case histories of 95 patients for retrospective analysis. Of these, the main group of 32 patients in whom within 5 years after the combined and complex treatment, progression of the process was noted. For comparison (control group), 63 case histories of patients who lived for more than five years after combined and complex treatment without signs of disease progression were identified.
Mammography was performed in two standard (cranio-caudal and medio-lateral) projections with breast compression.
Ultrasound examination was carried out according to the standard method on a Toshiba-xario-200 device with a frequency of 7.5 MHz linear sensor.
The basis of evidence-based statistics was: to highlight common factors - factor analysis with the determination of the proportion of each symptom affecting the outcome of the disease; to determine the relationship between indicators non-parametric (rank) correlation analysis by the method of Kendall (Rk); to determine the differences - the criterion of the angular Fisher transform (F *), the criterion of compliance (consent) of Pearson (%2), the criterion of relative risk (RR and 1/RR).
To determine the differences, four main levels of statistical significance were adopted: high - p < 0.001, average p < 0.010, low (marginal) p < 0.05, insignificant (unreliable) - p > 0.05. The main verifiers of the reliability of the differences were the results of multifunctional (universal) methods - Fisher.
Results
A mammographic examination revealed a star-shaped tumor in the majority of patients with an unfavorable outcome of the disease.
Adverse symptoms in mammographic studies were wormlike, treelike microcalcifications (casting type calcification) (p < 0.01), star-shaped (p < 0.01) tumors that had a high factorial effect. Such mammographic signs, such as the absence of calcifications (p < 0.01), in patients were associated with a favorable outcome of the disease and had a significant distribution. Powder calcification microcalcifications, crushed stone-like calcification microcalcifications, the round shape of the tumor and unifocal growth were not reliably associated with the outcome of the disease (p < 0.05).
Table 1.- x2 - distribution of patients depending on the mammographic picture of the tumor and the probability of generalization of breast cancer
Mammographic picture Main group n = 32 Control group n = 63 Total n = 95 x2/p
Lack of calcifications 10*(18.6)** 44(35.4) 6.08; p < 0.01
Round shape of the tumor 10(17.6) 41(33.4) 1.74; p < 0.05
Unifocal growth 28(30.4) 60(56.6) 0.393; p > 0.05
Star shape 19(10) 10(18.9) - 12.3; p < 0.01
Worm-like, treelike microcalcifications 20(10.4) 10(19.6) - 13.7; p < 0.01
Note: * Actual result, ** In quote, Expected result
As is known, the growth of cancer in the mammary gland occurs in three directions:
1) on milk courses;
2) in the lymphatic crevices and vessels;
3) through the blood vessels.
The progression of the tumor can be carried out by continuous growth through the vessels and intercellular gaps and
transfer of the rejected tumor cells by the flow of lymph and blood. For the progression of a tumor, many conditions are needed that create a favorable background for the rejection of the tumor complex from the main node, its penetration into the blood or lymph flow, filtration of the tumor in organs and tissues, followed by the growth of the secondary node.
Table 2.- The distribution of patients depending on the relationship of the ultrasound picture of the tumor and the probability of generalization
Ultrasound picture Main group n=32 Control group n=63 Total n=95 x2/p
Heterogeneity 22*(25.1)** 26(22.9) - 0.801; p < 0.05
Posterior shadowing 18(15.2) 11(13.8) - 1.08; p < 0.05
Hyperechoic ring 15(14.7) 13(13.3) - 0.01; p > 0.05
Note: * Actual result, ** In quote, Expected result
The complex of compulsory studies of patients with suspected breast cancer includes ultrasound examina-
tion. Ultrasound examination was carried out according to standard methods. With ultrasound, heterogeneity
(RR=-10.688, p < 0.050), posterior shadowing (RR = -6.354, p < 0.050), hyperechoic ring (RR = -7.389, p < 0.050) had a major equity in patients with an unfavorable outcome of the disease. In the statistical processing of these characteristics, the correlation coefficient for the third degree of freedom was 0.9678, which is a highly reliable result (r = 0.01). The most significant ultrasound sign associated with an unfavorable outcome was the rear blackout.
Breast cancer is a heterogeneous disease, including malignant neoplasms of the breast with a different clinical course, response to treatment and prognosis.
It is interesting to note that the prognosis of a tumor with the same traditional histological characteristics, as well as in patients with the same stage of the disease, varies widely.
One of the most pressing and complex problems of modern oncology is the problem of individual forecasting.
In a generalized form, the purpose of forecasting in medicine, in particular in oncology, is to predict the nature of the course of pathological processes both at the stages of treatment and later in the course of its progression. The final results of predicting the nature of the course, outcomes and complications of any of the considered nosological forms directly depend on the competent choice of reliable diagnostic features that most fully reflect the clinical, functional, morphological, social and many other features of the pathological process.
According to Cil T. et al., high breast density on mammograms is associated with a high risk of relapse after radical surgery [1]. In addition, an association was found between breast density and tumor pathomorphism after neoadjuvant chemotherapy. The lower the density of the breast, the higher the probability of a pathologically complete response and the survival of patients. According to numerous studies, dense mammary gland refers to a biologically inferior phenotype, in which breast cancer is aggressive.
According to Tot T., Tabar L. et al., mortality from breast cancer is higher in patients with mammograms of which there were cast-type microcalcifications compared with patients without them [3].
Conclusion
1. From mammographic signs, worm-like, treelike microcalcifications, star-shaped tumors were mainly found in patients with an unfavorable outcome of the disease.
2. Tumor heterogeneity with ultrasound diagnosis, posterior darkening, hyperechoic ring and hypoechoic ring around the tumor are also considered to be unfavorable signs and are more common in patients with early tumor progression.
3. Thus, in our work, it has been shown that the nature of the correlation relationship between mammographic and ultrasound characteristics of a tumor reflects its biological potency and indicates its ability for early progression.
References:
1. Cil T., et al. Mammographic density and the risk of breast cancer recurrence after breast-conserving surgery. Cancer. 2009; 115:5780-7.
2. IARC GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. WHO 2015. 2. Torre L. A., Bray F., Siegel R. L., Ferlay J., Lortet-Tieulent J., Jemal A. Global cancer statistics, 2012. CA Cancer J Clin, 2015.- Mar, 65(2).
3. Tot T., Tabar L. The role of radiological-pathological correlation in diagnosing early breast cancer: the pathologist's perspective. Virchows Arch 2011; 458: 125-31.
