<<
>>

3.1. Influence of a hypothyrosis on frequency of occurrence of diseases of a mammary gland

At both investigation phases in 2010-2013 to all patients the x-ray mammography - 1008 (100 %) observations is spent. Ultrasonic of mammary glands in the V-mode is spent to all patients participating in the second investigation phase in 2012-2013, - 509 observations (50,5 % from total surveyed).

Distribution of pathological changes at patients depending on hypothyrosis presence is presented in table 5.

Table 5.

Distribution of pathological changes at patients depending on hypothyrosis presence at both investigation phases

Results

^ "^^. ^ researches

Stages

Researches

Hypothyrosis presence
G ipotireoz is G ipotireoza is not present In total
abs. % abs. % abs. %
II0Z-0I0Z The pathological

Changes

229 45,9 199 39,9 428 85,8
The normal

Structure

19 3,8 52 10,4 71 14,2
In total 248 49,7 251 50,3 499 100
U

U

CH

ABOUT

(N

і

(N

ABOUT

(N

The pathological

Changes

241 47,4 220 43,2 461 90,6
The normal

Structure

12 2,3 36 7,1 48 9,4
In total 253 49,7 256 50,3 509 100
In total The pathological

Changes

470 46,6 419 41,6 889 88,2
The normal

Structure

31 3,1 88 8,7 119 11,8
In total 501 49,7 507 50,3 1008 100

From table 5 follows, that during the first investigation phase pathological changes met most often in group of patients a hypothyrosis - 229 observations (45,9 % from quantity of patients at the first investigation phase).

That significantly exceeded quantity

Observations of pathological changes in group of patients without a hypothyrosis - 199 (39,9 %) observations.

Thus the quantity of observations of a normal structure was essentially above at patients without a hypothyrosis - 52 (10,4 %) observations in comparison with patients with a hypothyrosis - 19 (3,8 %) observations.

The similar picture is observed and at the second investigation phase so the quantity of observations of a pathological structure was more in group of patients with a hypothyrosis - 241 observation (47,7 % from quantity of patients at the second investigation phase). Accordingly, quantity of observations of a normal structure above in group of patients without a hypothyrosis - 36 (7,1 %) observations.

Differences in number of pathological changes at the first and second stage of researches are bound basically to use complex rentgenosonograficheskogo inspections of mammary glands at the second investigation phase, unlike the first when spent only a x-ray mammography. Therefore the quantity of the pathological changes taped at patients, participating in the second period of research, without dependence from presence or absence of a hypothyrosis was above - 461 observation (45,7 % from total of the surveyed patients), than at the first investigation phase - 428 (42,5 %) observations.

Thus, statistically significant communication between presence of a hypothyrosis and pathological changes of a mammary gland is defined. OSH revealings of a pathology of a mammary gland has made 3,2 at 95 % of Dee from 2 to 5 (р=0,0001; p0,05), that testifies to absence of statistically significant communication between a hypothyrosis and occurrence RMZH.

The hypothyrosis possesses statistically significant stimulating influence on development of a diffusive mastopathy as a basic disease, OSH has made 1,7 at 95 % of Dee 1,3-2,2 (p=0,0001, p0,05). Results of definition OSH for fibroadenomas are presented more low.

Diagnosed at morphological research at the patients suffering RMZH (n=92, 100 %), pathomorphologic types of structure RMZH are presented in table 8.

Distribution of observations RMZH depending on a pathomorphologic structure and hypothyrosis presence

Table 8.

G istologicheskie variants RMZH The first stage, 2010-2011 The second stage, 2012-2013 In total
G ipotireoz is G ipotireoza is not present G ipotireoz is G ipotireoza is not present
abs. % abs. % abs. % abs. % abs. %
protokovyj

The invasive

9 9,8 12 13 13 14,1 15 16,3 49 53,2
protokovyj invasive (scirrhus) 6 6,5 2 2,2 9 9,8 5 5,4 22 23,9
Dolkovyj

The invasive

2 2,2 3 3,3 5 5,4 3 3,3 13 14,1
The medullary 1 1,1 1 1,1 0 0 1 1,1 3 3,3
The mucous 0 0 1 1,1 1 1,1 1 1,1 3 3,3
Papilljarnyj 0 0 0 0 1 1,1 1 1,1 2 2,2
In total 18 19,5 19 20,7 29 31,5 26 28,3 92 100

From table 8 follows, that invasive protokovyj RMZH it is defined at the overwhelming majority of the surveyed patients with RMZH - 71 (77,1 %) observation. Invasive protokovyj RMZH it is diagnosed in 49 (53,2 %) observations in the typical form

Diffusions, and invasive protokovyj RMZH in skirroznoj to the form differing ekspansivnym by growth with diffusion of a tumour on a stroma of a mammary gland and expressed by desmoplastic reaction, in 22 (23,9 %) observations. Under the typical form of diffusion

Invasive protokovogo RMZH understood papillotubuljarnuju and solidnotubuljarnuju forms [314].

It is characteristic, that at patients with a hypothyrosis invasive protokovyj RMZH in skirroznoj to the diffusion form meets more often, than at patients without a hypothyrosis for all period of research - 15 (16,3 %) observations and 7 (7,6 %) observations, accordingly. Especially often skirroznaja the form of diffusion invasive protokovogo RMZH met at patients a hypothyrosis participating in the second investigation phase - 9 (9,8 %) observations (fig. 15). Most less often this form met at patients without a hypothyrosis in the first investigation phase - 2 (2,2 %) observations.

Fig. 15. Patient Z, 59 years. A x-ray mammography; a fragment

Mammograms (), ultrasonic (), power dopplerovskoe kartirovanie (), qualitative elastografija (). Invasive protokovyj RMZH with skirroznym diffusion type. Formation of the wrong form with expressed tjazhistostju is defined, non-uniform structure (finger), the blood flow on the admixed type, at qualitative elastografii is defined 5 type elastogrammy.

Invasive protokovyj RMZH most often meets at patients without a hypothyrosis, participating in the second investigation phase-15 (16,3 %) observations. Most less often this form RMZH meets at patients a hypothyrosis, participating in the first investigation phase - 9 (9,8 %) observations.

Along with the most frequent protokovym RMZH, in research more rare forms RMZH have been diagnosed. Invasive dolkovyj RMZH it is taped in 13 (14,1 %) observations. Most often dolkovyj RMZH meets at patients a hypothyrosis in the second investigation phase - 5 (5,4 %) observations. Medullary and mucous RMZH on 3 (3,3 %) observations and papilljarnyj RMZH in 2 (2,2 %) observations (fig. 16).

Fig. 16. Patient T, 61 the X-ray mammography of the right mammary gland in slanting mediolateralnoj projections (), the enlarged fragment of a mammogram (), ultrasonic (), power dopplerovskoe kartirovanie (), qualitative elastografija (). Papilljarnyj RMZH. Formation ovoidnoj forms with tjazhistostju on the forward pole, homogeneous structure on mammograms (marksman) is defined. At ultrasonic the cyst with hyperechoic formation of the roundish form in (marksman) with a blood flow on the admixed type is defined; at qualitative elastografii the combination cystic and 3 types elastogrammy is defined.

The importance of influence of a hypothyrosis on the most frequent pathomorphologic forms RMZH is defined. The hypothyrosis makes statistically insignificant negative impact on occurrence invasive protokovogo RMZH with typical type of diffusion, OSH has made 0,8 at 95 % of Dee 0,4-1,5 (р=0,6;> 0,05). On occurrence invasive protokovogo RMZH with skirroznym type of diffusion the hypothyrosis renders statistically insignificant, but close to significant, stimulating influence - OSH has made 2,2 at 95 % of Dee 0,8-6 (р=0,09; p> 0,05).

Because mikrokaltsinaty (the sizes 50-850 microns) are the important diagnostic phenomenon at a x-ray mammography, their prevalence among observations RMZH has been analysed in the present research. The grouped clumps polymorphic mikrokaltsinatov have the diagnostic importance. Absent-minded amorphous and monomorphism mikrokaltsinaty no especial importance for diagnostics have.

Among the patients suffering RMZH, mikrokaltsinaty were defined only in observations protokovogo RMZH (n=71, 100 %). mikrokaltsinaty were defined as at patients with skirroznym a variant of diffusion RMZH, and with a typical variant of diffusion. During research prevailing variants of a structure polymorphic mikrokaltsinatov - punctual and linear have been allocated. Distribution of morphological types polymorphic mikrokaltsinatov depending on type of diffusion invasive protokovogo RMZH for all period of research are presented in table 9.

Table 9

Distribution polymorphic mikrokaltsinatov depending on

Type protokovogo RMZH

Prevailing type of a structure

mikrokaltsinatov

protokovyj

The invasive

Cancer

protokovyj an invasive cancer (scirrhus) In total
abs. % abs. % abs. %
The punctual 26 36,6 13 18,3 39 54,9
The linear 11 15,5 3 4,2 14 19,7
Clumps are not present 12 16,9 6 8,5 18 25,4
In total 49 69 22 31 71 100

From table 9 follows, that is the widest in the present research clumps polymorphic mikrokaltsinatov in which the punctual type of a structure - 39 observations (54,9 % from total taped mikrokaltsinatov) prevailed have been extended.

This pattern was observed as at patients with invasive protokovym RMZH c typical and with skirroznym diffusion - 26 (36,6 %) observations and 13 (18,3 %) observations, accordingly. Clumps mikrokaltsinatov linenogo type met prevalence a little bit less often - in 14 (19,7 %) observations. A share of clumps linear

mikrokaltsinatov at skirroznom type of a structure it is less, than at a typical variant of diffusion - 3 observations (21,4 % from quantity of observations of the given type mikrokaltsinatov) and 11 (78,6 %) observations, accordingly. A share of clumps punctual mikrokaltsinatov at skirroznom type of diffusion invasive protokovogo RMZH also more low, but it is not so appreciable, in comparison with a typical variant of diffusion - 13 observations (33,3 % from quantity of observations of the given type mikrokaltsinatov) and 26 (66,6 %) observations that is bound not so much to features of growth of a tumour, how many with different number of corresponding groups (fig. 17).

Fig. 17. A x-ray mammography; the enlarged fragment of a mammogram. Invasive protokovyj RMZH. Are defined grouped polymorphic mikrokaltsinaty, mainly punctual form, the majority of them against inspissation of soft tissues of a mammary gland of the wrong form with tjazhistymi contours.

The X-ray pattern protokovogo RMZH without clumps mikrokaltsinatov was defined in 18 observations (25,4 % from total taped mikrokaltsinatov).

Interest is represented by localisation mikrokaltsinatov concerning tumours (table 10).

Table 10.

Distribution of observations mikrokaltsinatov at the patients suffering RMZH

Localisation

Clumps

mikrokaltsinatov

The first stage, 2010-2011 The second stage, 2012-2013 In total
Hypothyrosis

Is

Hypothyrosis

No

Hypothyrosis

Is

Hypothyrosis

No

abs. % abs. % abs. % abs. % abs. %
mikrokaltsinaty in a tumour and in interfacing areas 6 8,5 3 4,2 9 12,7 5 7 23 32,4
mikrokaltsinaty in interfacing to a tumour areas 1 1,4 2 2,8 3 4,2 3 4,2 9 12,7
mikrokaltsinaty in a tumour 3 4,2 5 7 6 8,5 7 9,9 21 29,6
mikrokaltsinaty are not defined 5 7 4 5,7 4 5,7 5 7 18 25,3
In total 15 21,1 14 19,7 22 31 20 28,2 71 100

From table 10 follows, that at patients with a clump hypothyrosis mikrokaltsinatov, assotsiirovannye with invasive protokovym RMZH, meet a little bit more often, than at patients without a hypothyrosis - 28 (39,5 %) observations and 25 (35,1 %) observations, accordingly.

Significant influence of a hypothyrosis on occurrence mikrokaltsinatov becomes perceptible statistically not - OSH makes 1,2 at 95 % of Dee 0,4-3,5 (p=0,8; p> 0,05).

Most often in all period of research clumps mikrokaltsinatov, located in a tumour and interfacing to it areas - 23 (32,4 %) observations are defined. A little bit more low quantity

Observations of clumps mikrokaltsinatov, laying in the tumour, but not leaving for its limits - 21 (29,6 %) observation. Most seldom

Clumps mikrokaltsinatov were defined in interfacing to a tumour areas, but not in the tumour - 9 (12,7 %) observations (fig. 18).

Fig. 18. A x-ray mammography; the enlarged fragments of mammograms. Invasive protokovyj RMZH. Are defined grouped polymorphic mikrokaltsinaty inside and out of formation - continuous and dotted marksmen, accordingly (), only in formation - a finger (), only outside of formation - it is allocated ().

At patients with a hypothyrosis, suffering invasive protokovym RMZH, clumps mikrokaltsinatov, located in a tumour and interfacing to it mammary gland tissues - 15 (21,1 %) observations over all period of researches are more often defined. Statistically little significant positive communication between a hypothyrosis and occurrence mikrokaltsinatov, located in a tumour and interfacing to it mammary gland tissues becomes perceptible, OSH has made 2,2 at 95 % of Dee 0,7-7,1 (p=0,1; p> 0,05).

Clumps mikrokaltsinatov, localised only in the tumour - 12 (16,9 %) observations were a little bit less often defined. Most less often patients with a hypothyrosis and at patients without a hypothyrosis had clumps mikrokaltsinatov, located only in interfacing a tumour mammary gland tissues - 4 (5,7 %) observations and 5 (7 %) observations, accordingly. Total OSH formations of clumps mikrokaltsinatov, localised in the tumour or in interfacing to a tumour areas has made 0,5 at 95 % of Dee 0,2-1,6 (p=0,2; p> 0,05), that is there is statistically insignificant negative communication

Hypothyrosis with occurrence of the specified types of clumps mikrokaltsinatov.

The quantity of observations of X-ray pattern RMZH without visible clumps was identical at patients with a hypothyrosis and without a hypothyrosis - on 9 (12,7 %) observations.

The important question is definition of influence of a hypothyrosis on a stage on which has been diagnosed RMZH. Distribution of stages RMZH depending on hypothyrosis presence is presented in table 11.

Table 11.

Distribution of patients with various stages of development RMZH depending on hypothyrosis presence

Presence

Hypothyrosis

Stage

Diseases ^ - ^

The first stage, 2010-2011 The second stage, 2012-2013 In total
G ipotireoz is G ipotireoza is not present G ipotireoz is G ipotireoza is not present
abs. % abs. % abs. % abs. % abs. %
I T1N0M0 0 0 3 3,3 0 0 4 4,3 7 7,6
IIa T1N1M0 0 0 4 4,3 0 0 6 6,5 10 10,9
T2N0M0 0 0 6 6,5 1 1,1 5 5,4 12 13
IIb T2N1M0 1 1,1 3 3,3 2 2,2 4 4,3 10 10,9
T3N0M0 2 2,2 1 1,1 4 4,3 2 2,2 9 9,8
IIIa T2N2M0 4 4,3 2 2,2 7 7,6 3 3,3 16 17,4
T3N1M0 5 5,4 0 0 6 6,5 2 2,2 13 14,1
IIIb T4N1M0 3 3,3 0 0 5 5,4 0 0 8 8,7
T4N2M0 2 2,2 0 0 3 3,3 0 0 5 5,4
IV TNM1 1 1,1 0 0 1 1,1 0 0 2 2,2
In total 18 19,6 19 20,7 29 31,5 26 28,3 92 100

From table 11 follows, that at the first investigation phase, in 20102011, for patients with hypothyrosis RMZH has been more often diagnosed at stage SHa (T3N1M0) - 5 (5,4 %) observations. Most seldom RMZH at patients with a hypothyrosis at the first investigation phase it was defined at stages IIb (T2N1M0) and IV (TNM1) - on 1 (1,1 %) to observation. It is characteristic, that early stages of development RMZH (I-IIa) were not defined in the given group of patients.

Among patients without a hypothyrosis, surveyed at the first investigation phase, RMZH it was most often defined at the Pas stage (T2N0M0) - 6 (6,5 %) observations. Most less often - at stage IIb (T3N0M0) - 1 (1,1 %)

Observation. Unlike group of patients with a hypothyrosis late stages RMZH (IIIa-IV) have not been diagnosed.

The similar parity is observed and at the second investigation phase, 2012-2013 So with hypothyrosis RMZH most often diagnosed for patients at stage IIIa (T2N2M0) - 7 (7,6 %) observations. Most less often RMZH it was defined on IIa (T2N0M0) and IV stages - on 1 (1,1 %) to observation. Early stages of development RMZH (I-IIa) at patients with a hypothyrosis were not defined.

At the second investigation phase, at patients without hypothyrosis RMZH has been more often taped at stage IIa (T1N1M0) - 6 (6,5 %) observations. Most less often - at stages IIb (T3N0M0) and IIIa (T3N1M0) - on 2 (2,2 %) observations. Also as well as at the first investigation phase late stages of development RMZH (IIIb-IV) it is taped not were.

The resulted results testify that there is statistically significant communication between a hypothyrosis and recognition RMZH at later stages of development of disease about what value OSH peer 20,1 testifies at 95 % of Dee 6,2-68,7 (р=0,0001; p0,05).

At an adenosis mikrokaltsinaty were defined in 22 (7,1 %)

Observations. At patients with a hypothyrosis mikrokaltsinaty against an adenosis were defined more often, than at patients without a hypothyrosis - 7 (2,2 %) and 3 (0,9 %) observations, accordingly at the first investigation phase, 8 (2,6 %) and 4 (1,3 %) observations, accordingly at the second investigation phase. The hypothyrosis does not render influence on occurrence mikrokaltsinatov at an adenosis - OSH makes 1,1 at 95 % of Dee from 0,4 to 3,3 (p=1; p> 0,05).

mikrokaltsinaty at a sclerosing adenosis met more often at patients a hypothyrosis, than at patients without a hypothyrosis - 17 (5,5 %) and 5 (1,6 %) observations, accordingly at the first investigation phase, 14 (4,5 %) and 3 (0,9 %) observations, accordingly at the second investigation phase.

mikrokaltsinaty at a sclerosing adenosis were defined in 43 (13,8 %) observations that makes 91,5 % from total of observations of a sclerosing adenosis. For all period of research quantity of observations mikrokaltsinatov at a sclerosing adenosis concerning total of observations of a sclerosing adenosis at patients with a hypothyrosis (n=34 observations, 100 %) make 31 (91,2 %) observation. The quantity of observations mikrokaltsinatov at a sclerosing adenosis concerning total of observations of a sclerosing adenosis for all period of research at patients without a hypothyrosis (n=13 observations, 100 %) has made 8 (61,5 %) observations. Thus, at patients with a hypothyrosis and a sclerosing adenosis mikrokaltsinaty are defined more often, than at patients with a sclerosing adenosis without a hypothyrosis. The hypothyrosis makes stimulating impact on revealing mikrokaltsinatov at a sclerosing adenosis boundary on the statistical importance - OSH makes 5,2 at 95 % of Dee 0,7-38,5 (p=0,06; p> 0,05).

Among nodal formations of a mammary gland mikrokaltsinaty were defined at fibroadenomas. For fibroadenomas are characteristic kaltsinaty, not representing essential interest in the present research, however at certain stages of a calcification of a fibroadenoma in it clumps mikrokaltsinatov, demanding carrying out of the differential diagnosis with RMZH can be defined. mikrokaltsinaty in fibroadenomas were defined in 52 (16,7 %)

Observations (fig. 25). At patients they met a hypothyrosis less often, than at patients without a hypothyrosis - 9 (2,9 %) and 16 (5,1 %) observations, accordingly at the first investigation phase, 12 (3,8 %) and 17 (5,5 %) observations, accordingly at the second investigation phase. The hypothyrosis makes statistically significant negative impact on occurrence mikrokaltsinatov at a fibroadenoma - OSH has made 0,4 at 95 % of Dee from 0,3 to 0,9 (p=0,03; p0,05).

Fig. 25. Patient M, 53 l. A x-ray mammography; a fragment

Mammograms. A fibroadenoma of the admixed structure. Formation of the oval form with the contours (marksman) veiled at the expense of a fibrosis is defined; in it are defined mikrokaltsinaty.

<< | >>
A source: Lesko Konstantin Aleksandrovich. Radiological diagnosis of breast disease in women with hypothyroidism. Thesis for the degree of candidate of medical sciences. Moscow 2014. 2014

More on topic 3.1. Influence of a hypothyrosis on frequency of occurrence of diseases of a mammary gland:

  1. Lesko Konstantin Aleksandrovich Luchevaja. diagnostics of diseases of a mammary gland at women with a hypothyrosis. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow -,
  2. diffusive dysplastic diseases of a mammary gland
  3. additional methods of radial diagnostics of diseases of a mammary gland
  4. 4.2. Influence of a hypothyrosis on occurrence and character of implications RMZH
  5. methods of radial diagnostics of diseases of a mammary gland
  6. Influence of a hypothyrosis on occurrence of a diffusive mastopathy
  7. ultrasonic research of a mammary gland
  8. the relation to a resection kontralateralnoj a mammary gland.
  9. ultrasonic research of a mammary gland
  10. the Remote results after organosohrannogo treatments concerning a mammary gland cancer.
  11. PET AT THE CANCER OF THE MAMMARY GLAND WITH METASTASISES IN GOLOVYONOM THE BRAIN.
  12. the characteristic rentgenosonograficheskoj diagnostics fine dopplerograficheski avaskuljarnyh mammary gland formations
  13. surgical principles organosohranjajushchih operative measures at a cancer of a mammary gland and their evolution.
  14. Chapter 4 Cosmetic results organosohrannogo treatment of a cancer of a mammary gland.
  15. Rentgenosonografichesky diagnostics fine avaskuljarnyh mammary gland formations
  16. Shalashnaja Elena Vladimirovna. USE of INDICATORS SVOBODNORADIKALNOGO of OXIDATION FOR the ESTIMATION of PREVALENCE of MALIGNANT PROCESS And EFFICIENCY of ANTITUMORAL INFLUENCE AT the CANCER of the MAMMARY GLAND the DISSERTATION on competition of a scientific degree of a Cand.Biol.Sci. Rostov-on-Don, 2005 2005
  17. Organosohranjajushchie radical operations at a mammary gland cancer, as a stage of complex treatment.
  18. 4.2. Results of an estimation of cosmetic effect after organosberegajushchego surgical treatment of a cancer of a mammary gland.
  19. Molekuljarno-biological aspects of an aetiology and the forecast of a cancer of a mammary gland