Изучение различий в характеристиках заболеваний молочной железы: в фокусе внимания Бахрейн и Россия

Введение. Заболевания молочной железы (МЖ) включают в себя несколько типов, большинство из них не являются злокачественными. Некоторые из этих патологий достаточно безобидны и не требуют хирургического вмешательства. Другие, например, атипичная гиперплазия, эпителиоз, пограничная филлоидная карцинома и дольковая карцинома in situ (LCIS), имеют риск злокачественного перерождения и требуют тщательного наблюдения. Злокачественные поражения, включая инвазивную протоковую или дольковую карциному, протоковую карциному in situ (DCIS) и другие спорадические виды рака, в том числе злокачественную филлоидную карциному, составляют 20% от общего числа заболеваний МЖ. Цель исследования: сравнить заболевания молочной железы в Бахрейне и России в 2022 г.

Материал и методы. Проведено ретроспективное сравнительное исследование 200 пациенток из двух стран: 100 женщин из Бахрейна (группа А) и 100 – из России (группа В). В возраст участниц исследования варьировал от 14 до 76 лет. Данные собирали с помощью предварительно структурированной анкеты. Они содержали следующие показатели: возраст пациенток, предъявляемые ими жалобы, результаты физикального обследования, латеральность, локализацию и объем поражения по данным ультразвукового исследования, классификацию по Бираду, проведенные исследования, предоперационный и послеоперационный диагноз, а также выполненные хирургические процедуры.

Результаты. Результаты были проанализированы с использованием пакета программ SPSS (версия 27). Наиболее распространенной жалобой участниц исследования было безболезненное уплотнение в МЖ: 73% случаев в группе А и 56% – в группе В. Пальпируемое уплотнение в МЖ выявлено у 74 женщин (74%) в группе А и у 87 (87%) – в группе В. Наиболее распространенной локализацией поражения являлся верхний окклюзионный отдел: 57% случаев в группе А и 56% – в группе В. Возрастной диапазон при доброкачественных состояниях в группе А составил 14–71 год, в группе В – 18–75 лет. Злокачественные состояния были диагностированы в группе А у женщин в возрасте от 36 до 76 лет, а в группе В – от 27 до 60 лет. У большинства участниц исследования были диагностированы опухоли размером менее 30 мм, при этом в группе В таких пациенток оказалось больше, чем в группе А: 92 и 74%, соответственно. В группе А регистрировалось значительно большее количество случаев с BI-RADS 2 (44%) и BI-RADS 5 (3%), в то время как в группе В наблюдалась более высокая доля случаев с BI-RADS 3 (41%) и BI-RADS 4 (42%). Ультразвуковое исследование МЖ является первым методом визуализации. Биопсию с помощью иглы использовали чаще в группе В, чем в группе А. Фиброаденома диагностировалась чаще в группе В (79%), чем в группе А (56%). Рак МЖ был диагностирован в 17 случаях в группе А и в 2 случаях в группе В. При доброкачественных заболеваниях в группе А в большинстве случаев выполнялись хирургические вмешательства: эксцизионная биопсия – у 59% пациенток (59%), тогда как в группе В основной процедурой являлось широкое местное иссечение (86% случаев).

При злокачественных заболеваниях в группе А было больше операций по удалению рака (17 случаев) по сравнению с группой В (2 случая), при этом онкопластическое широкое местное иссечение было наиболее распространенным методом в группе А (у 16 из 17 пациенток). Показатели мастэктомии были очень низкими в обеих группах – по 1 случаю в каждой.

Заключение. Таким образом, в большинстве случаев в обеих группах имели место доброкачественные заболевания молочной железы, причем наиболее часто регистрировалась фиброаденома. В большинстве наблюдений диаметр обнаруженных опухолей не превышал 30 мм. Более 40% случаев, по данным визуализации молочной железы, были оценены по шкале Bi-Rads 2 в группе А и по шкалам 3 и 4 – в группе В. Хирургические вмешательства в основном включали эксцизионную биопсию при доброкачественных новообразованиях и широкую местную резекцию – при злокачественных.

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