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Kholdarova Zulkhumorkhon Ravshanbekovna, Assistant at Tashkent Medical Academy, Department of «Oncology and radiation diagnosis», Ministry of Health of Uzbekistan, Tashkent, Uzbekistan E-mail: xoldarova.zulxumor@mail.ru
The role of digital mammography in the differential diagnosis of small form breast cancer with underlying diseases of mammary glands (Literature review)
Abstract: The article contains an overview of publications devoted to differential diagnosis of small form breast cancer with underlying diseases of mammary glands. Currently, the most common methods of differential diagnosis are clinical, X-ray and ultrasonic methods. Studying of modern diagnostic of malignant neoplasms showed the need for the early detection of the disease, before the onset of symptoms or signs, concerning which patients would subsequently applied for medical aid. The valuation of early detection of breast cancer is that, it becomes possible to detect cancer at an early stage, when it has non — invasive character and can be completely cured.
Keywords: breast cancer, screening mammography, ultrasound, digital mammography, multislice computed tomography, differential diagnosis.
Breast cancer (BC) is a serious medical and social problem in many developed countries, and in recent years — in developing countries too [6]. In 2008, in the world diagnosed 1.38 million new cases, compared to 500 000 cases in 1975, accounting for 23 % of all cancer cases in women and 16 % of deaths [20, 28]. BC in the last 8 years, In Republic of Uzbekistan consistently ranked 1st in structure of cancer deceases [4]. In 2015, the absolute number of cases of BC was 2915. From these, 1590 patients were in I - II stage, 991 patients in III stage, and 334 patients in stage IV of BC (According of the National Cancer Research Center of Uzbekistan, cancer register). In recent years, the death rate from breast cancer in Uzbekistan is leading cause of death among cancer deceases and continues to increase in absolute and relative terms (3.4; 3.9; 4.2; and 4.2 per 100 000 women in 2011; 2012; 2013 and 2015 according of the National Cancer Research Center of Uzbekistan, cancer register). Control the growth of breast cancer is not possible due to lack of effective pathways of primary prevention [15]. Accordingly, the current is early diagnosis of the disease, which may have an impact on mortality [24]. It was offered many different types screening of breast cancer: self-examination, physical breast examination, ultrasound, radiometry, electrical impedance tomography, etc. [12, 2]. Despite the variety screening methods of breast cancer, a recognized effective method in the world is X-ray mammography [14; 16]. The introduction of mammography screening contributed to a significant increase in detection of breast carcinoma in situ (CIS), accounting for one author 15-20 % of clinical cases [5], and on the other — 20-30 % [31]. According to Luke C. and Priest K. [22; 10], in Australia as a result of mammographic screening CIS increased about 7 times in the last 20 years in comparison with the increase in the incidence of invasive cancers — about 40 %.
Abduraimov A. B. et al. studied 115 women with suspected breast nodal education [3]. Age of patients ranged within 19-82 years. Depending on the morphological types of tumors examined patients was
as follows: BC — 65 (56.6 %) patients, 26 fibroadenoma (22.6 %), cyst — 10 (8.7 %), nodular breast — 9 (7.8 %) lipoma — 5 (4.4 %). The aim of this study was to explore the possibilities ofmultislice computed tomography (MSCT - mammography) in diagnosis and determining the prevalence of breast cancer. The study was conducted with absolute intravenous contrasting. During the MSCT - mammography without intravenous contrasting in majority cases densitometric indicators of glandular tissue in fibro-cystic mastitis did not differed from malignant process in the breast, which caused serious difficulties in differential diagnosis.
The study Zakharova N. A. was to evaluate the results of the implementation of mammography screening in Khanty-Mansiysk Autonomous Okrug — Ugra for the period 2007-2012 years [7]. In the region 249 106 women has been carried out of preventive breast examination. For the period the target population coverage of screening mammography was 67.5 %. In total 624 women were identified with a malignancy tumors of mammary glands. This indicates that the analog mammography ineffective in detecting the background of breast diseases.
Korzhenkova G. P. and colleagues examined for digital mam-mography, women seeking to Moscow Cancer Research Center. N. N. Blokhin [8]. During the work, they drew attention to the high possibilities of digital systems to identify nodules in women with radiographically dense breast tissue. The author believes that, due to the small sample of patients to make serious conclusions are not currently possible.
Radiology (ACR) The American College to standardize the terminology used to describe a mammogram, and further optimization tactics recommended use a BI-RADS system (the Breast Imaging Reporting And Data System — a system of interpretation and recording of breast imaging). According to requirements of the BI-RA.DS system, the protocol should include a description of the structure of the breast (I), pathologic findings (II) and conclude with setting
The role of digital mammography in the differential diagnosis of small form breast cancer with underlying diseases.
category BI-RADS (III). In a study of American authors estimated positive predictive value of categories 0-5 for the diagnosis of breast cancer through mammography comparison data with the results of histological examination of the postoperative material. It was found that out of 40 tumors B-RADS 2 were all benign, from 141 tumor BI-RADS 3 malignancies were 2 % (3), from 936 tumor BI-RADS
4 malignancies were 30 % (279) and from 170 tumors BI-RA.DS
5 malignant were 97 % [25]. Particular difficulties in the differential diagnosis has microcalcifications with sclerosing adenosis and early cancers, which located in a limited area. Kharchenko V. P. et al. surveyed 39 women with local accumulation ofmicrocalcifications, clustered in a limited area without a visible tumor nodule, revealed cancer in 28 observations, 11 — sclerosing adenosis [17]. In all cases it was histological confirmation of the diagnosis. Ultrasound microcalcifications such a small size was not visualized, but in 24 of 28 cases (78 %) of cancer at the site of accumulation of microcalcifications detected typical sonographic signs of malignancy — areas of reduced echogenicity, heterogeneous structure, with indistinct contours. At the same time on mammograms nodules were not differentiated. In 11 cases have been identified sclerosing adenosis. Of these, ultrasound only in 2 cases (18.2 %) had area with reduction echogenicity with crisp boundaries. For the most typical cancer were worm-like calcifications or lumps, having an irregular shape. The authors also noted out that for cancer more common characterized small calcifications of up to 500 microns, and their combination with dust-like calcareous inclusions.
In a study of Finnish radiologists sonography did not allow to detect microcalcifications in most cases [26].
The mammography remains the main method to detect microcalcifications.
The key and most significant in practical terms, of course, it is the question of choosing the adequate scheme of patient examination with non-palpable tumor and determining the indications for surgical treatment. According to Sickles E. A., in the presence of "probably benign" non-palpable lesions on mammogram should be recommended to follow-up [27]. Dynamic observation
of the 3184 impalpable "probably benign" formations, breast cancer was diagnosed in 17 cases (0.5 %). The author believes that this tactic to avoid a large number of unnecessary surgical biopsies.
Vega A. and colleagues were analyzed 619 cases of non-palpable mammary tumors by comparing mammography data with the results of an open biopsy or stereotactic cor-biopsy [29]. The authors believe that the "probably benign" non-palpable lesions should be recommended to follow-up. The ratio of benign and malignant tumors in this study was 4:1.
Lee C. H. et al. summarized the results of follow — 298 dynamic observation tumors, diagnosed on the basis of strereotak-sicheskoy cor-biopsies as benign [23]. On control mammograms the negative dynamics were recorded in 21 cases, which required additional biopsy in 18 patients. Malignant tumors were diagnosed in 2 patients. The authors conclude that a control mammogram after 6 months after stereotactic biopsy of non-palpable benign tumor is a reasonable tactic. According to the American authors, stereotactic cor-biopsy is indicated for tumors of categories 4 and 5 by BI-RADS classification [18; 19; 32].
Velichko S. A. and colleagues analyzed 47,000 primarily studied women in the period from 1996 to 2003. They believe that the mammography imaging and interpretation of pathological processes considerably complicates in age of reproductive women with fibro — cystic disease [30; 21].
In the majority of works by Russian authors considered issues of diagnosis and treatment of benign tumors palpable or non-palpable breast cancer, whereas, in practice, the main task of the doctor — the differential diagnosis of pathological processes in a particular patient [11; 13; 1; 9].
For a complete diagnosis and evaluation response of conducted treatment at small forms of breast cancer with underlying diseases of breast, use an analog mammography is not enough. So, digital mammography should firmly take its place in the diagnostic algorithm. The lack ofwork on these issues awakens a more accurate and detailed study of the role of digital mammography in the differential diagnosis of breast cancer with underlying diseases.
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Khudaiberdiyeva Mashkhura Shavkatovna, Djuraev Mirjalol Dehkonovich, Khudoyorov Sanjar Sarvarovich, Juraev Farrux Mirjalolovich, National Cancer Research Center of Ministry of Health of the Republic of Uzbekistan E-mail: Dr.Mashhura@mail.ru
The impact of prognostic factors on the recurrence of stomach cancer
Abstract: The study included the results of retrospective studies conducted in 128 patients with recurrent gastric cancer. Retrospective analysis of prognostic factors on the recurrence of stomach cancer showed that non-adherence of one factor during the operation was observed in 6 (4.7 %), 2-factors in 72 (56.2 %) of 3 or more in 50 (39.1 %) patients. In terms of resection, in 114 (89.1 %) patients relapsed gastric cancer was determined after distal subtotal resection in 8 (6.3 %) after the proximal subtotal resection in 6 (4.7 %). The most important prognostic factor of treatment of SC is a radicalism of performed surgery. Based on the above mentioned data it can be concluded convincingly that, the reasons for recurrence was non-compliance with the principles of radicalism in the main group, in comparison with the control group, where was a low rate of recurrence (3.8 %), duration of recurrence-free period 22.4 + 0.4 months and in more than 47 % cases late relapse was diagnosed. This demonstrates the importance of minimization of negative prognostic factors affecting the abidance of the principles of radicalism. Keywords: prognostic factors, stomach cancer, recurrence, surgery.
Actuality
Stomach cancer (SC) has taken a crucial position in the structure of cancer incidence and mortality [4]. Furthermore, an aggressive forms predominant amongst the morphological forms of SC, that are characterized by infiltrative growth, early lymphatic dissemination and low resectability [5].
A high qualified level of surgical technique as well as the development of combined and expanded operations with maximum compliance of oncologic principles will abet to improve significantly the survival of patients with SC, but even after the overextended surgical interventions, tumor recurrence takes leading position in case of main cause of death [1; 2]. The prognosis of survival of patients
