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Urmanbaeva Dilbar Abdulkasimovna, Assistant of chair of oncology and medical radiology ASMI Mamarasulova Dilfuzahon Zakirjanovna, Head of chair of oncology and medical radiology ASMI
Djalalova Feruza Mahammatjanovna, Assistant of chair of oncology and medical radiology ASMI
Validova Albina Faalievna, Leader of Andijan branch of National center Oncology and radiology
Halilova Mavjuda,
Physician at Andijan branch center oncology and radiology
E-mail: [email protected]
^E RESULTS OF THE ULTRASOUND AT THE STAGES OF SCREENING WHEN CONDUCTING PROPHYLACTIC DAYS FOR THE DETECTION OF BREAST CANCER
Abstract. The International Agency for Research on Cancer (IARC, Lyon) Breast Cancer (Breast Cancer) is the "ideal" tumor for population screening. This is the most common tumor in women, especially over 50 years. Of the 10 million new cases of malignant tumors of various organs detected in the world, 10% are in the mammary gland.
Over the past decades, there has been an increase in the incidence rates of breast cancer (BC) in the Republic of Uzbekistan. One of the main reasons for the lack of effectiveness of therapeutic measures is the unsatisfactory state of early diagnosis, the late differential diagnosis of nodules of the gland and early forms of cancer. Along with palpation and mammography, the ultrasound method is widely used to diagnose breast cancer. Due to the absence of radiation exposure, it can be used many times, in any age group, during pregnancy and lactation. Echographic screening helps to identify not only the pathology of various organs and systems but also to conduct a differential diagnosis of malignant tumors at subclinical stages, which allows you to choose an adequate amount of surgical intervention. Keywords: prevention, decease of breast, breast cancer, ultrasound diagnosis.
The most common is the clinical (physical) examination of the ultrasound study, which was conducted in the Andijan of the mammary glands (CBE - Clinical Breast Examination) branch of the Republican Scientific and Practical Medical Cen-by medical personnel. According to Canadian researchers, the ter of Oncology and Radiology. Ultrasound examinations were CBE method can have high specificity (95-99%) and sensitiv- performed by highly qualified ultrasound diagnostics speciality in the range of47-80%. Based on 2740 studies, Ciatto and ists, as well as by breast examiners of this center. The exami-co-workers found that the sensitivity of CBE varies depending nation was conducted among healthy women in 14 districts on the stage of the disease: 48% - cancer in situ, 70% - stage including cities from 17-49 years of age. The contingent con-I, 90% - stage II, 89% - stage III, 93% - stage IV is 77% in the vened for inspections by advertising through the media. After age group of 20-29 years old, 58% - 30-39 years old, 75% - registration, each patient was given a questionnaire for comple-40-49 years old, 84% - 50-59 years old, 90% - 60-69 years tion, in which more than 20 questions were included for the col-old, 94% - are over 69 years old (Ciatto et al., 1991) The sen- lection of anamnestic data. After collecting the questionnaires sitivity of clinical examination of the mammary glands in early and clinical examination by a mammologist, the patient was stages and at a young age decreases [2]. sent for an ultrasound examination (ultrasound) of the mam-
According to the Ministry of Health of Uzbekistan, the mary glands and zones of regional lymph outflow. most common type of cancer in the country is breast can- Results
cer. This type of cancer is detected in 9.1 cases per 100 thou- 1116 women from various regions of the Fergana Valley
sand population. According to experts, the hereditary factor were examined. Survey data showed the following results. is important in the development of breast cancer in women, The findings of the ultrasound examination of the ex-
namely on the maternal line. It is transmitted in 45-75% of amined women gave the following, half of the examined cases if there are mutations in the BCA 1-2 genes [6; 7; 8; 9]. 535 (49.7%) were healthy, with fibrocystic mastopathy 163 Materials and methods ofexamination. The basis of this (14.6%), fibrous mastopathy 140 (125%), nodal mastopathy study is the personal data of the applicants and the conclusion 64 (5.7%), diffuse mastopathy 30 (2.68%), cystic lesions of
THE RESULTS OF THE ULTRASOUND AT THE STAGES OF SCREENING WHEN CONDUCTING PROPHYLACTIC DAYS FOR THE DETECTION OF BREAST CANCER
the mammary gland 95 (8.51%), fibro adenoma 13 (1.16%), Mintz disease 13 (1.16%) and suspected malignant neoplasm 11 (0.98%). Other pathologies such as galactocele, atheroma, lipoma were found in 2 (0.26%) and 1 (0.089%).
Discussions Anatomical changes in various forms of mastopathy are diverse, but fibrous strands, intertwined and passing without clear boundaries into the surrounding tissue, are mandatory. Common to the three forms is the proliferation of connective tissue, atrophic lobules, small cysts with a uniform epithelium. Lots of nodular mastopathies did not look like nodules. They were distinguished by a more or less smooth contour, homogeneous echo structure, and deformation of the tissues around the nodal zone was not observed. When DDC vessels had a linear orientation, there were no signs of strengthening the vascular pattern. With qualitative elastogra-phy, the tumor stiffness cartogram had a green and red-green palette similar to the surrounding tissues.
The cysts had a picture of the anechoic homogeneous fluid formation of a round or ovoid shape, with a clear even contour, no reflection from the internal contents, lateral acoustic shadows and dorsal amplification of the signal. Blood flow was not recorded. With qualitative elastography, the cyst had a triple mapping, a layered blue, green, and red palette.
To interpret the data obtained during breast ultrasound, we follow the gradation according to the BI-RADS system. Planned tactics in each particular case can vary from dynamic observation with a survey interval of 1 year (in the absence of a pathological process) - category 1, to morphological verification of the pathological process to determine the histological and immunohistological features of the tumor - category 5 is established with obvious signs of cancer.
Category 1 is established in patients with no pathological process. Control tests are carried out 1 time per year.
Category 2 is established when identifying benign tumors (simple cysts, lipomas, atheroma, typical fibro adenomas, breast implants without signs of damage and traction), a control examination is carried out every 6-12 months.
Category 3 is established with benign changes with a probability of having a cancer of no more than 2% (first identified fibro adenomas without increased intra- and peritumoral blood flow, nodular hyperplasia of the parenchyma without calcifications, edematous-infiltrative forms of mastitis, breast abscesses, cysts with signs of inflammation). Control tests are carried out after a course of conservative treatment after 3 months. If after 3 months after a course of therapy, there is a negative trend, then the case is regarded as category 4, if there is a positive trend, the case is regarded as category 2.
Category 4 is established when detecting changes in the mammary glands suspicious of a malignant process with a probability of 3 to 94% (fibro adenomas larger than 3 cm (leaf-
shaped fibro adenomas), fibro adenomas of any size with an increase in size of more than 5 mm in the course of dynamic observation for 6 months, fibro adenomas with increased blood flow, with uneven contour, fuzzy visualization of the posterior contour or the presence of calcinoses; atypical cysts with the presence of intracystic solid formations, intraductal papilloma, node s formation without accurate ultrasound picture, edematous infiltrative and other forms of mastitis without positive dynamics after treatment, nodular hyperplasia zone with the presence of calcification. In identifying this pathology requires morphological verification process using the percutaneous needle biopsy or trepan biopsy.
Category 5 is established with obvious signs ofbreast cancer.
Taking into account the above-described grades according to the BI-RADS system, the USP physicians must have indicated the category of pathology identified, taking into account all ultrasound criteria using the B-mode, DDC, EDC, elastography. Clinicians, focusing on the received ultrasound conclusion, planned their treatment tactics.
In particular, 60 women out of202 (29.7%) were assigned 2 categories and re-attendance at the examination after 6 months was recommended. Category 3 was established in 65 patients from 202 (32.2%) was prescribed a course of conservative therapy with a subsequent attendance at the examination after 3 months, 6 women from 202 (3%) were assigned category 4. And 8 patients from 202 (4%) 5 category on the system BI-RADS.
All observations of focal pathology, 4.5 categories on the BIRADS system, had a morphological verification in the form of a cytological conclusion of the results of fine-needle puncture. The diagnosis of breast cancer was confirmed morphologically, after surgical treatment on the basis of histological findings.
At the same time, in one woman out of 8 (12.5%), ultrasound diagnosis of breast cancer was not established cytological, however, after a morphological study of the postoperative material, the diagnosis of breast cancer was confirmed. And in one case out of 8 (12.5%) with the ultrasound diagnosis of fibro adenoma, also after the surgical manual, the diagnosis offibro adenoma with malignancy was made cytological and histologically.
Findings. Thus, the complex as the data show that almost 50% of the surveyed have breast pathology. What can lay the foundation for the development of malignant neoplasms? If the world meets 2 cases per 1000, then in our case cancer is suspected in 11 (0.98%), which was confirmed by an aspiration biopsy and cytology. The number of precancerous pathologies like Mints' disease (intra-oral formations), nodular forms of mastopathy among the population of the Fergana Valley is high, which predicts an increase in the malignant pathology of breast cancer. This can be attributed to the population density in comparison with other regions of the Republic ofUzbekistan.
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