urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.4.127ZCZNBHurmj-1582Research ArticleОригинальные статьи | Original articlesOriginal articlesОценка ультразвукового и интраоперационного гистологического методов в диагностике метастазов сторожевых лимфоузлов при различных биологических подтипах рака молочной железыEvaluation of Ultrasound and Intraoperative Histological Methods in the Diagnosis of Sentinel Lymph Node Metastases in Various Biological Subtypes of Breast Cancerhttps://orcid.org/0000-0002-4056-2775МагдаляноваМ. И.MagdalyanovaM. I.

Маргарита Ивановна Магдалянова — заведующий онкологическим отделением № 1

Екатеринбург

Margarita I. Magdalyanova — Head of Oncology Department No. 1

Ekaterinburg

breastcancer2008@yandex.ruhttps://orcid.org/0009-0005-4753-2463ПоповаА. Ю.PopovaA. Y.

Алиса Юрьевна Попова — заведующий отделением рентгенодиагностики

Екатеринбург

Alisa Y. Popova — Head of the Department of Radiation Diagnostics

Ekaterinburg

mrs.alisapopova@gmail.comhttps://orcid.org/0009-0002-4908-4826ЗорниковаО. С.ZornikovaO. S.

Ольга Сергеевна Зорникова — рентгенолог

Екатеринбург

Olga S. Zornikova — Radiologist

Ekaterinburg

dr.olga.zornikova@yandex.ruhttps://orcid.org/0000-0001-6212-0495КазанцеваН. В.KazantsevaN. V.

Наталья Владимировна Казанцева — заведующий патологоанатомическим отделением

Екатеринбург

Natalya V. Kazantseva — Head of the Pathology Department

Ekaterinburg

nvkazantseva@mail.ruДорофеевА. В.DorofeevA. V.

Александр Владимирович Дорофеев — доктор медицинских наук, заместитель главного врача по хирургии

Екатеринбург

Alexander V. Dorofeev — Doctor of Sciences (Medicine), Deputy Chief Physician for Surgery

Ekaterinburg

avdonco@gmail.comhttps://orcid.org/0009-0000-6301-6753БелоглазоваЕ. П.BeloglazovaE. P.

Елизавета Павловна Белоглазова — онколог

Екатеринбург

Elizaveta P. Beloglazova — Oncologist

Ekaterinburg

lenl68288@gmail.comhttps://orcid.org/0000-0001-8732-9500ШевченкоС. А.ShevchenkoS. A.

Светлана Анатольевна Шевченко — кандидат медицинских наук, рентгенолог

Екатеринбург

Svetlana A. Shevchenko — Candidate of Sciences (Medicine), Radiologist

Ekaterinburg

sv_maxson@mail.ruhttps://orcid.org/0000-0001-9132-215XЗорниковД. Л.ZornikovD. L.

Данила Леонидович Зорников — кандидат медицинских наук, доцент, заведующий лабораторией генетических и эпигенетических основ прогнозирования нарушений онтогенеза и старения человека, доцент кафедры медицинской микробиологии и клинической лабораторной диагностики

Екатеринбург

Danila L. Zornikov — Candidate of Sciences (Medicine), Associate Professor, Head of the Laboratory of Genetic and Epigenetic Bases of the Human Ontogenetic Abnormalities and Human Aging, Associate Professor of the Department of Medical Microbiology and Clinical Laboratory Diagnostics

Ekaterinburg

zornikov.rus@gmail.comhttps://orcid.org/0009-0000-2151-2708ПерфильевВ. Д.PerfilyevV. D.

Вадим Дмитриевич Перфильев — рентгенолог

Екатеринбург

Vadim D. Perfilyev — Radiologist

Ekaterinburg

Vadim-radiology@yandex.ruСвердловский областной онкологический диспансер; Уральский государственный медицинский университетРоссияSverdlovsk Regional Oncology Center; Ural State Medical UniversityRussian FederationСвердловский областной онкологический диспансерРоссияSverdlovsk Regional Oncology CenterRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation202403092024234Специальный выпуск «Онкология»127–137Copyright © Магдалянова М.И., Попова А.Ю., Зорникова О.С., Казанцева Н.В., Дорофеев А.В., Белоглазова Е.П., Шевченко С.А., Зорников Д.Л., Перфильев В.Д., 20242024Магдалянова М.И., Попова А.Ю., Зорникова О.С., Казанцева Н.В., Дорофеев А.В., Белоглазова Е.П., Шевченко С.А., Зорников Д.Л., Перфильев В.Д.Magdalyanova M.I., Popova A.Y., Zornikova O.S., Kazantseva N.V., Dorofeev A.V., Beloglazova E.P., Shevchenko S.A., Zornikov D.L., Perfilyev V.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1582Введение

Введение. Определение биологических подтипов рака молочной железы (РМЖ) после проведенного клинического и инструментального методов обследований является рутинной практикой для определения индивидуальной тактики лечения, уточнения прогноза заболевания, а также предотвращения чрезмерного лечения. Полиморфизм проявлений РМЖ связан с гетерогенностью биологических подтипов опухолей молочной железы. Выявление метастатических аксиллярных лимфатических узлов имеет клиническое и прогностическое значение на предоперационном этапе, т. к. определяет тактику лекарственного лечения и объем хирургического вмешательства.

Цель работы — оценка значимости ультразвукового и интраоперационного гистологического методов исследований аксиллярных лимфатических узлов у пациенток с различными биологическими подтипами РМЖ в условиях реальной клинической практики.

Материалы и методы

Материалы и методы. В исследование включено 895 пациенток в возрасте от 28,8 до 91,8 лет с верифицированным диагнозом РМЖ, наблюдавшихся в Свердловском областном онкологическом диспансере в 2022 г. Всем пациенткам проводилась клиническая, ультразвуковая оценка аксиллярных лимфатических узлов, гистологическая верификация опухоли на предоперационном этапе, а также плановое и интраоперационное гистологическое исследование сторожевых аксиллярных лимфоузлов. Статистическую обработку и визуализацию данных проводили с помощью R версии 4.3.2 (сборка 2023-10-31).

Результаты

Результаты. В группе пациентов с наличием метастатических ЛУ, не определяемых при ультразвуковом исследовании, достоверно реже (p = 0,011) встречались пациентки с трижды негативным раком (ТНР). У пациенток с различным молекулярным типом РМЖ не отмечено достоверных различий по чувствительности, специфичности и эффективности ультразвукового метода исследования. Выявлены различия по положительному прогностическому значению выявления метастатических лимфоузлов (p = 0,048) при интраоперационном гистологическом методе исследования.

Заключение

Заключение. В исследовании ТНР был менее ассоциирован с метастазированием в аксиллярные ЛУ по сравнению с люминальными подтипами рака. Не выявлено связи между различными молекулярными подтипами и показателями предоперационного ультразвукового и интраоперационного гистологического методов исследования.

Introduction

Introduction. Determination of biological subtypes of breast cancer after clinical and instrumental examination methods is a routine practice to determine individualized treatment tactics, to clarify the prognosis of the disease, and to prevent overtreatment. Polymorphism of breast cancer manifestations is associated with heterogeneity of biological subtypes of breast tumors. Identification of metastatic axillary lymph nodes has clinical and prognostic significance.

Objective — to assess the significance of ultrasound examination of axillary lymph nodes in patients with various biological subtypes of breast cancer in real clinical practice.

Materials and methods

Materials and methods. The study included 895 patients aged from 28.8 to 91.8 years with a verified diagnosis of breast cancer, observed at the Sverdlovsk Regional Oncology Center in 2022. All patients underwent clinical, ultrasound evaluation of axillary lymph nodes, histological verification of the tumor at the preoperative stage, as well as routine and intraoperative histological examination of the sentinel axillary lymph nodes. Statistical processing and data visualization were performed using R version 4.3.2 (build 2023-10-31).

Results

Results. In our sample of patients, TNR was less associated with metastasis to axillary LU compared with luminal cancers. There was no effect of different molecular subtypes on the preoperative ultrasound and intraoperative histologic examination parameters.

Conclusions

Conclusions. Among our patients TNC was less associated with metastasis to axillary lymph nodes compared to luminal cancers. There was no effect of different molecular subtypes on the performance of ultrasound and intraoperative histological methods of examination.

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The authors declare that there are no conflicts of interest present.