USE OF ULTRASOUND SCREENING IN THE DIAGNOSIS OF INTRADUCTAL BREAST LESIONS

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 227 USE OF ULTRASOUND SCREENING IN THE DIAGNOSIS OF INTRADUCTAL BREAST LESIONS F.M. Jalolova Andijan Medical Institute https://doi.org/10.5281/zenodo.17861930 Abstract. Currently, the only way to reduce breast cancer mortality is through early diagnosis, which enables the detection of cancer at the earliest preclinical stages of development. A wide range of available tests, including ultrasound, elastography, mammography (ductography), CA-15.6 tumor marker testing, and biopsy followed by histological and immunohistochemical examination, creates the preconditions for the early detection of pathological processes. Keywords: ultrasound markers, intraductal formations, calcifications in milk ducts, hypervascularization of the formation, deformation of vascular architecture. Introduction Currently, one of the most pressing issues not only in oncology but also in healthcare as a whole is the prevention of breast cancer (BC). This is due to the rapid, steady, and widespread increase in the incidence of this type of cancer, which has risen to first place in the structure of malignant neoplasms among women. One of the most urgent issues today is the problem of early diagnosis. Thus, the importance of early detection of intraductal proliferative lesions in a retrospective analysis (Meeske K. et al.) showed that up to 45% of all identified cases of breast cancer are now accounted for by cancer in situ. Despite the large number of studies devoted to improving diagnostic and treatment methods for breast cancer, the results are far from always satisfactory. The above indicates the high relevance of developing a diagnostic algorithm for intraductal breast diseases in oncology and determines the necessity of conducting the present study. Materials and Methods: The study included 144 women, of whom 77 were enrolled due to complaints of breast pain, pathological nipple discharge in the absence of hyperprolactinemia, or a palpable breast mass; and 67 women aged 40 years and older without subjective symptoms indicative of breast pathology, in whom signs of intraductal breast lesions were detected during screening mammography. Results: In all cases included in the study, breast ultrasound (US) was performed. A lesion was detected in 134 breasts, while 10 morphologically verified pathologies were sonographically “silent.” Thus, the sensitivity of ultrasound for detecting intraductal lesions was 93.06%, regardless of the malignancy of the lesion. The sensitivity of ultrasound was significantly higher than that of mammography (chi-square = 6.57, p < 0.05). Among malignant intraductal lesions, ultrasound sensitivity was 92.31% (24 out of 26 cases), and among benign lesions — 93.22% (110 out of 118 cases, chi-square = 0.13, not significant). Ultrasound evaluated characteristics such as lesion shape, margins, homogeneity, distal acoustic shadowing, lesion size, ductal dilatation, lesion orientation, presence of calcifications, disruption of vascular architecture, and vascularization status (Table 1.1). The analysis of ultrasound characteristics showed that in most cases the detected lesions had a regular shape (81.34%), smooth margins (75.37%), homogeneous SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 228 structure (59.70%), vertical orientation (62.69%), and distal acoustic shadowing (71.64%). The frequency of these features did not depend on whether the lesion was malignant or benign. The frequency of ductal dilatation detection also did not depend on malignancy and was approximately half of all cases (48.61%). Breast ultrasound allows the detection of calcifications in the ducts (in 28.47% of cases). Notably, calcifications were found in half of the patients with intraductal breast cancer, while in benign lesions they were detected in only 23.73% of cases (chi-square = 7.22, p < 0.01). In 46.15% of breasts with cancer, the vascular pattern was distorted (compared to 10.03% in the benign group, chi-square = 6.38, p < 0.05). Furthermore, in 16.67% of malignant cases, hypervascularization of the lesion was observed, whereas benign pathology was associated with hypoor normovascularization (chi-square = 18.90, p < 0.001). Table 1.1 Ultrasound results of the breast in cases of morphologically verified intraductal lesions Criteria Version All breasts with intraductal lesions (n=144) Breast cancer (n=26) Benign pathology (n=118) Significance of the difference between breasts with breast cancer and benign pathology Lesion shape Correct 109 (81,34%) 18 (75,0%) 91 (82,73%) Chi-square 2х2=0,76, nd Incorrect 25 (18,66%) 6 (25%) 19 (17,73%) Lesion margins* Regular 101 (75,37%) 17 (70,83%) 84 (76,36%) Chi-square 2х2=0,32, nd Irregular 33 (24,63%) 7 (29,17%) 26 (23,64%) Lesion structure Homogeneous 80 (59,70%) 14 (58,33%) 66 (60,0%) Chi-square 2х2=0,02, nd Heterogeneou s 54 (40,30%) 10 (41,67%) 44 (40,0%) Distal acoustic shadowing* Absent 38 (28,36%) 7 (29,17%) 31 (28,18%) Chi-square 2х2=0,01, nd Present 96 (71,64%) 17 (70,83%) 79 (71,82%) Ductal dilatation Absent 70 (48,61%) 13 (50,0%) 57 (48,31%) Chi-square 2х2=0,02, nd Present 74 (51,39%) 13 (50,0%) 61 (51,69%) Lesion orientation* Vertical 84 (62,69%) 17 (70,83%) 67 (60,91%) Chi-square 2х2=0,83, nd Horizontal 50 (37,31%) 7 (29,17%) 43 (39,10%) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 229 Ductal calcificatio ns Absent 103 (71,53%) 13 (50,0%) 90 (76,27%) Chi-square 2х2=7,22, p<0,01 Present 41 (28,47%) 13 (50,0%) 28 (23,73%) Vascular architecture Preserved 106 (73,61%) 14 (53,85%) 92 (77,97%) Chi-square 2х2=6,38, p<0,05 Distorted 38 (26,39%) 12 (46,15%) 26 (20,03%) Lesion vascularizat ion* Hypo- /normovascula rization 130 (97,01%) 20 (83,33%) 110 (100%) Chi-square 2х2=18,90, p<0,001 Hypervascular ization 4 (2,99%) 4 (16,67%) 0 (0%) Note: Only breasts with ultrasound-positive lesions were included (a total of 134 breasts, of which 24 had breast cancer and 110 had benign lesions). Statistical analysis showed that the sensitivity of all three sonographic markers that were significantly more often associated with malignant intraductal breast lesions did not exceed 50%, despite their relatively high specificity (76.27%–100%, Fig. 1.1). The sensitivity, specificity, and diagnostic effectiveness of the studied markers differed significantly, with hypervascularization of the lesion demonstrating the lowest sensitivity but the highest specificity and diagnostic significance. Sonographic criterion Risk of intraductal breast cancer if the criterion is present Risk of intraductal breast cancer if the criterion is absent Relative risk of intraductal breast cancer if the criterion is present 50 76.27 71.53 46.15 77.97 72.22 хи квадрат=6,95, p<0,05 chi square =29,95, p<0,001 chi square =8,77, p<0,05 0 20 40 60 80 100 120 Sensitivity Specificity Diagnostic accuracy % показатель Figure 1.1. Comparison of sensitivity, specificity, and diagnostic accuracy of sonographic markers associated with malignant intraductal lesions Ductal calcifications Distortion of vascular architecture Hypervascularization SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 230 Ductal calcifications 31,71% 12,62% 2,51 Distortion of vascular architecture 31,58% 13,21% 2,39 Lesion hypervascularization 100% 15,38% 6,50 Chi-square 3х2 7,83, p<0,05 0,42, nd 7,67, р<0,01 In the group of breasts with malignant intraductal pathology, the analysis of the diagnostic significance of such ultrasound criteria as the detection of intraductal calcifications, disruption of vascular architecture, and hypervascularization—regarding the differentiation between invasive and non-invasive malignant lesions—did not reveal any significant differences between glands with non-invasive intraductal carcinoma (NIIC) and those with invasive carcinoma / invasive residual breast pathology (IC/IRBP) (Fig. 1.2). Note: The relative proportion (%) of all breasts with the corresponding pathology is indicated. The size of the lesion detected during ultrasound was 1.68 ± 0.10 cm, which insignificantly exceeded the average lesion size recorded during mammographic examination (the difference between ultrasound and mammography measurements was not significant). The lesion size also did not differ between the malignant and benign pathology groups (1.67 ± 0.24 cm and 1.68 ± 0.11 cm, respectively; not significant). Overall, based on the results of mammographic and sonographic screening, all detected pathologies were classified according to the BIRADS system:  80 breasts were assigned to BIRADS-3 (55.56%),  62 — BIRADS-4 (43.06%),  and 2 breasts — BIRADS-5 (1.39%). A frequency comparison showed that lesions which were later histologically identified as breast cancer were more frequently assigned a higher BIRADS category (chi-square = 30.62, p < 0.001, Fig. 1.2). 50,0% 42,86% 14,29% 14 50,0% 50,0% 16,67% 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ductal calcifications (n=13) Distortion of vascular pattern (n=12) Hypervascularization (n=4) Ductal breast cancer (n=26) % встречаемость критериев Figure 1.2. Frequency of various ultrasound criteria in breasts with intraductal breast cancer depending on the invasive nature of the pathology NIIC + IC/IRBP (n=14) NIIC (n=12) SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 231 Conclusions: Thus, the study confirmed the importance of sonographic screening in the diagnosis of intraductal breast lesions, demonstrating higher sensitivity compared with mammographic screening. 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