WAYS TO IMPROVE THE EFFECTIVENESS OF SURGICAL TREATMENT OF NON-PALPABLE BREAST FORMATIONS (literature review)

Due to the progress of modern imaging methods, the number of detected non-palpable focal breast formations, including small nodular cancer and in situ cancer, has increased significantly. Surgical treatment of non-palpable breast formations is aimed at their removal in order to clarify the nature of the pathology. In clinical practice, interventions in the volume of sectoral breast resection and vacuum aspiration biopsy (VAB) are performed for this purpose. During resection operations, preoperative marking of the formation is necessary to increase the effectiveness of the operation and eliminate the situation when the formation or part of it is not removed. The standard for preoperative marking is the installation of a wire needle inside the formation under the supervision of ultrasound, X-ray mammography (RMG) or magnetic resonance imaging (MRI), followed by resection of the breast area together with the needle. In recent years, due to the disadvantages of the wire method, there has been a transition to the use of wireless technologies. The simplest and most accessible method is skin labeling after imaging of the formation with ultrasound or RMG. The use of coloring agents, in particular methylene blue, indocyanine green, charcoal suspension is the optimal method due to its high efficiency at low cost. The use of methods of radioactive labels (RSL and ROLL), magnetic and paramagnetic labels, localization using the radar reflector RRL, represent new effective approaches in the localization of non-palpable breast formation. Intraoperative ultrasound is a highly effective method of localization of non-palpable breast formations, but requires compliance with the conditions of intraoperative ultrasound and the involvement of an ultrasound diagnostic doctor in the operation. VAB has an advantage over sectoral resection due to the accurate visualization of the formation under ultrasound before and during surgery, which ensures complete removal of the formation. The use of VAB is limited by the mandatory imaging of education during ultrasound and the lack of necessary equipment in many large multidisciplinary medical institutions.