Assessing the effectiveness of instrumental diagnostics and pathogenetic therapy in patients with benign breast dysplasia

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Abstract

Objective: To assess the effectiveness of instrumental methods of breast examination in the diagnosis of benign breast diseases (BBD) according to the 2024 clinical guidelines. To evaluate the effectiveness of the Indinol Forto medication in patients with mastalgia according to the visual analogue scale (VAS) for pain.

Materials and methods: This paper presents the results of data analysis of 895 female patients aged 20 to 50 years diagnosed with BBD with mastalgia of varying severity. All the patients were examined at the Russian Scientific Center of Roentgen Radiology, Moscow, from January to December 2024. The evaluation of the patients’ condition was based on a comprehensive approach, including clinical examination, VAS pain assessment and instrumental studies (mammography, ultrasound with colour Doppler mapping (CDM) and elastography, MRI with contrast agents, core (trephine) biopsy of breast masses with subsequent histological examination depending on age and indications). The results of instrumental studies were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) classification on a scale from 1 to 5, including tissue density assessment by the ACR classification (for mammography). Following the results of the study, treatment with Indinol Forto (indolcarbinol) was recommended to patients with BBD with mastalgia of varying severity according to the VAS scale.

Results: Women with BBD aged 20 to 50 years most commonly have high radiological tissue density (ACR types C and D); the cystic component was predominant on breast ultrasound examination. Therapy with indolcarbinol has a positive effect on reducing the intensity of pain syndrome (mastodynia) within 6 months after treatment. There was a decrease in tissue density on mammograms and a decrease in the cystic component on ultrasound examination after completing the course of therapy.

Conclusion: High radiological tissue density and hormonal instability are risk factors for breast cancer. Indolcarbinol is effective as a first-line therapy for patients with cyclic mastalgia in BBD and it is included in the clinical guidelines of the Ministry of Health of the Russian Federation.

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About the authors

Elena V. Meskikh

Russian Scientific Center of Roentgen Radiology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Author for correspondence.
Email: meskihelena@rambler.ru

Dr. Med. Sci., Professor of the Department of X-ray Radiology, Pirogov Russian National Research Medical University, Ministry of Health of Russia; doctor of the highest category, Chief Researcher at X-ray Radiological Laboratory, Russian Scientific Center of Roentgenoradiology, Ministry of Health of Russia

Russian Federation, 117997, Moscow, Profsoyuznaya str., 86; Moscow

Lev A. Ashrafyan

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: levaa2004@yahoo.com
ORCID iD: 0000-0001-6396-4948

Academician of the Russian Academy of Sciences, Professor, Dr. Med. Sci., Head of the Institute of Oncogynecology and Mammology

Russian Federation, 117997, Moscow, Ac. Oparina str., 4

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Supplementary files

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2. Fig. 1. Distribution of patients by age

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3. Fig. 2. Assessment of pain syndrome using VAS

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4. Fig. 3. BI-RAOS classification (adapted from [3])

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5. Fig. 4. Types of radiographic density according to ACR (adapted from [3])

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6. Fig. 5. Evaluation of the effectiveness of instrumental research methods

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7. Fig. 6. Assessment of radiographic tissue density according to ACR

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8. Fig. 7. Evaluation of instrumental research methods according to BIRADS categories

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9. Fig. 8. Contrast mammography of patient A.

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10. Fig. 9. a) Mammography (high X-ray tissue density); b) Ultrasound of the mammary glands (suspicion of the presence of a nodular formation (BI-RADS 4a); c) MRI of the mammary glands with contrast (fibrocystic mastopathy (BI-RADS 2))

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11. Fig. 10. Changes in VAS scores before and after drug therapy with indolecarbinol

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12. Fig. 11. Evaluation of the condition of the mammary glands according to BI-RADS categories before and after drug therapy with indolecarbinol

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13. Fig. 12. Assessment of breast tissue density according to ACR before and after drug therapy with indolecarbinol

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14. Fig. 13. Mammography of patient M.: A. before treatment; B. after treatment, follow-up examination after 9 months

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