Ultrasonic semiotics of breast changes after minimally invasive surgical treatment of benign neoplasms: a observational analytical: a prospective cohort study

INTRODUCTION: The increase in the incidence of benign breast tumors, as well as the improvement and active introduction of new high-tech surgical techniques into medical practice, has led to an increase in the number of resections performed using vacuum aspiration biopsy (VAB) technology. The capabilities of VAB are constantly expanding: large and multiple tumors can now be successfully and safely resected, thanks in part to the improvement of ultrasound (US) methodology at various stages of the procedure, which is an integral part of the procedure.

OBJECTIVE: is to examine the ultrasound semiotics of breast changes at different time intervals after vacuum aspiration resection of benign neoplasms.

MATERIALS AND METHODS: For the period 2017–2024 inclusive in the day hospital of NCC No. 2 of the Russian National Research Center named after Academician B. V. Petrovsky (formerly the Central Design Bureau of the Russian Academy of Sciences) performed ultrasound-controlled VAB in 986 patients. A total of 1,433 neoplasms were removed. The number of simultaneously removed neoplasms in one patient ranged from 1 to 7. The size of the removed formations reached a maximum of 54 mm. In addition to intraoperative ultrasound, the patients underwent dynamic studies after surgery: on the 1st day (all patients), as well as in the long-term period (1 follow-up ultrasound — 273 patients; 2 or more follow-up ultrasounds — 47 patients).

Statistics: data analysis was performed using Excel 2019 (Microsoft, USA) and JMP Pro 17 (SAS, USA) software.

RESULTS: Ultrasound was performed in the early postoperative period in all 986 patients, who had a total of 1433 breast neoplasms removed. The number of hemorrhagic complications, represented by hematomas ranging from 1.5 to 3 cm in size, was 2.63% (26 patients). After the 1st dynamic ultrasound, residual tissue of the removed neoplasm was initially suspected in 83 of the 319 women who attended the examination (83 residual fragments out of 490 removed neoplasms, which accounted for 16.93%). Subsequently, during dynamic ultrasounds, this percentage decreased to 14.28% (70 cases) — in 13 patients, residual tissue was excluded during later examinations. Performing ultrasound scans in patients with suspected residual tissue up to 6 months after surgery allowed for the exclusion of solid tumors in 29% of cases in the second group of patients.

DISCUSSION: The main objective of ultrasound in the early postoperative period was to control hemorrhagic complications, while the differentiation of the possible residual tumor tissue against the background of edema is difficult and should be performed at a later time. A characteristic pattern of changes in the breast tissue during the first months after the intervention is the presence of hypoechoic «immature» scar tissue in the bed, often having a star-shaped appearance and making it difficult to differentiate the possible residual tumor tissue. Over the following months, the tissues in the bed area become more compact in size and contour, their echogenicity increases, and their structure becomes more consistent with connective tissue. By the 6th month, various outcomes of the reparative processes in the surgical area can be observed, with significant variability: from almost intact tissue corresponding to the unchanged gland (which is observed in most cases after VAB), to the formation of scars with different shapes and structures. At this time, it is possible to convincingly differentiate the likely residual tissue of the neoplasm against the background of good visualization. The most difficult in terms of differential diagnosis in ultrasound are structural changes in the tumor bed, which are a hypoechoic formation of an irregular stellate shape, mimicking a malignant neoplasm. 

CONCLUSION: The ultrasound semiotics of structural changes in the mammary glands at various stages of breast-conserving surgery have specific features related both to the intervention technology and to the course of healing of the bed of the removed neoplasm. Knowledge of the variability of the ultrasound picture at different times after performing breast-conserving surgery and performing ultrasound in dynamics helps to avoid diagnostic errors in terms of differentiation of residual tissue or recurrence of the neoplasm.

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