Ukrainian Journal «Health of Woman»

Vaccination against the human papillomavirus as a component of the prevention of cervical dysplasia: analysis of age and regional trends in Ukraine

P.Yu. Tokar — 2025-09-28

The introduction of vaccination against the human papillomavirus (HPV) in Ukraine remains insufficiently studied, especially taking into account age and regional characteristics. Analysis of the coverage of the female population with HPV vaccination is necessary to assess the potential impact of preventive measures on the incidence of cervical dysplasia.

Aim - to assess the age and regional characteristics of vaccination against the human papillomavirus among the female population of Ukraine in 2021-2025 and to determine their significance in the prevention of cervical dysplasia.

Materials and methods. The research material was compiled from statistical data of the National Health Service of Ukraine regarding the number of administered doses of the HPV vaccine to the female population of Ukraine in 2021-2025. The analysis was carried out taking into account age groups (0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years) and administrative-territorial units. The methods of descriptive statistics, comparative and analytical analysis with an assessment of the dynamics of indicators in temporal and regional aspects were used.

Results. It was established that in 2021, vaccination against HPV among the female population of Ukraine was isolated. In 2022-2023, a gradual increase in the number of administered doses was noted, mainly in the age group of 10-19 years. The most pronounced increase in vaccination volumes was observed in 2024-2025, with the dominance of the 20-29 and 30-39 age groups. Significant regional unevenness of vaccination coverage was revealed: the highest rates were registered in the city of Kyiv and certain regions, while vaccination remained minimal or absent in a number of regions. Age groups under 9 and over 50 were characterized by consistently low rates of vaccination.

Conclusions. Vaccination against HPV in Ukraine in 2021-2025 has pronounced age and regional disparities. Insufficient coverage of prepubescent age groups limits the effectiveness of primary prevention of cervical dysplasia. The obtained data indicate the need to expand and standardize HPV immunoprophylaxis programs, taking into account the epidemiological characteristics of the regions.

The author declares no conflict of interest.

Medical and social characteristics of pregnant women giving birth for the first time in different age groups

А.V. Chernov — 2025-09-28

Aim - to assess the significance of medical and social factors for the health of women giving birth for the first time, of different reproductive ages.

Materials and methods. The medical and social factors of women's health were analyzed according to the materials of 154 pregnancy and childbirth histories (form 096/0) of women giving birth for the first time, who were divided into groups according to age: Group I of the study - 78 pregnant women aged 20-29, Group II - 76 pregnant women aged 30-40. Statistical processing of research results was carried out using standard programs "Microsoft Excel 7.0" and "Statistica 8.0".

Results. Pregnant women in group II were significantly more likely to have higher education (72.4% of cases versus 53.8% of cases in group I); incomplete higher and secondary education was observed significantly less often in group II - 1.3% of cases versus 21.8% and 10.5% of cases versus 14.1% of cases in group I. The total number of harmful habits in group II was 60.5% of cases versus 41.0% of cases in group I. 47.4% of women in group II had a complicated reproductive history compared to 17.9% of women in group I; the total number of gynecological pathologies in group II was 123.7% (one woman has several gynecological diseases) of cases, compared to 62.7% of cases in group I, which is almost 2 times more common in women over 30 years old; A burdened somatic history was observed in 100.0% (each patient had a history of extragenital pathology) of cases in group II versus 44.8% in group I.

Conclusions. The following are the medical and social risk factors for the occurrence of obstetric and perinatal complications in women over 30 years of age who are giving birth for the first time: the presence of harmful habits, unregistered marriage, a burdened reproductive, obstetric-gynecological and somatic history.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the author.

The possible role of abnormal uterine bleeding in cardiovascular health during perimenopausal age

I.V. Lakhno — 2025-09-28

The manifestation of cardiovascular disease (CVD) in women typically occurs during menopausal transition. Abnormal uterine bleeding (AUB) in perimenopausal women could capture the disaster settings during wartime.

Aim – to study the possible pathogenic peculiarities of CVD in perimenopausal women with AUB in a frontline city.

Material and methods. The 49 perimenopausal women were enrolled in the study. The 26 women without excessive menstrual loss were included in Group I. The 23 women with AUB were involved in Group II. The variables of body mass index (BMI), menopausal Cooperman’s score and anxiety and stress levels in the study groups were measured. The lipid and carbohydrate metabolism variables, C-reactive protein were detected.

Results. The data obtained showed that the variables of BMI, Cooperman’s score, metabolic markers, and CRP were almost similar in the study groups. However, the level of anxiety and stress variables was significantly higher in women with AUB. The variable of BMI demonstrated weak or moderate correlation with HOMA index, blood serum insulin concentration, and CRP. The multivariate logistic regression supported the link between AUB and the Taylor scale score.

Conclusion. The increased Spielberger scale score, Taylor scale scores, and perceived stress scale score were found in perimenopausal women with AUB. The logistic regression supported the link between AUB and the anxiety Taylor scale score. The disturbed psychological status could be a valuable addition to anti-aging programs during wartime.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Emotional responses of pregnant women and postpartum women during dangerous military events

S.R. Galych — 2025-09-28

Aim - to study the emotional reactions of pregnant women and postpartum women while staying under conditions of dangerous military events (intensive missile attacks, flights of unmanned aerial vehicles, etc.) in order to optimize their medical and psychological support in wartime conditions.

Materials and methods. An anonymous survey was conducted among 138 women (98 pregnant women at 22-41 weeks of gestation and 40 postpartum women) regarding their emotional experiences during periods of active shelling of the city of Odesa and nearby settlements in May-June 2025. The survey was carried out using an anonymous questionnaire. Differences between groups were assessed using Pearson’s χ² test; Fisher’s exact test was applied for small sample sizes. Statistical analysis was performed using SPSS 26 software (IBM, USA).

Results. It was found that the predominant cohort of patients experienced intense fear (91.0%). At the same time, the responses of the largest number of women indicated an adaptive emotional reaction to fear (58.0%). Fewer patients described their emotional state as a persistent feeling of fear (33.0%). A minimal number of respondents reported no feeling of fear (9.0%). These emotional reactions during periods of danger differed significantly (p<0.001) but did not depend on gestational age (p>0.05). The feeling of fear motivated 83.3% of the surveyed women to protect their lives by moving to a safe place (p<0.001). This indicator also did not show statistically significant differences across different gestational ages (p>0.05).

Conclusions. During dangerous military events, the vast majority of surveyed pregnant and postpartum women experienced a strong emotion of fear; most of them adapted to this feeling over time and moved to a safe place. Emotional and behavioral responses did not depend on gestational age or the day of the postpartum period.

The author declares no conflict of interest.

Comprehensive analysis of associative relationships between indicators of cellular-humoral immunity, pro- and anti-inflammatory cytokines in women with first trimester pregnancy loss depending on РАІ-1 gene polymorphism

V.V. Panov — 2025-09-28

Aim - to study the associations between cell-humoral immunity indicators, pro- and anti-inflammatory cytokines, serum PAI-1 levels, and the PAI-1 gene polymorphism variant in women with early reproductive losses.

Materials and methods. The selected patients (n=115) were divided into 3 groups according to the type of polymorphism: I - 20 patients with wild-type polymorphism of the РAI-1 gene (675 5G>5G), II - 53 women with heterozygous polymorphism of the РAI-1 gene (675 5G>4G), III - 42 women with homozygous pathological polymorphism of РAI-1 (675 4G>4G). The study was based on bibliosemantic analysis; anamnestic data were evaluated; polymerase chain reaction was used to determine thrombophilia gene polymorphisms; enzyme-linked immunosorbent assay to determine the level of РAI-1, tumour necrosis factor-α, interleukins (IL) 4, 6, 10 in the blood serum.

Results. The average age of women in the thematic groups was comparable and amounted to 32.5±0.9, 33.9±0.7 and 33.6±0.7 years, respectively. The analysis revealed certain associations between haemostasis parameters, pregnancy loss and gestational complications associated with PAI-1 gene polymorphisms. Close links were established between elevated levels of IL-4 and IL-10, their indicators with serum PAI-1 levels, and gene polymorphism. Elevated IL-4 levels were significantly associated with a history of early pregnancy loss and earlier gestation at the time of pregnancy termination. A tendency towards increased IL-6 production in the serum of women with PAI-1 gene polymorphism (675 5G>4G) and its association with a high frequency of spontaneous abortions in the history of these women was revealed.

Conclusions. Pregnancy loss in the first trimester should be considered as the result of a complex interaction of genetic, immune and haemostatic factors. PAI-1 is not only a key antifibrinolytic factor, but also an acute phase protein and mediator of immune-inflammatory reactions that affects cell migration, extracellular matrix remodelling and tissue invasion.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Features of the third stage of labor and postpartum period in women with uterine leiomyoma: a comparative analysis with somatically healthy parturients

I.M. Morokhovets — 2025-09-28

Aim - to compare the characteristics of labor and the early postpartum period in women with uterine leiomyoma with similar indicators in somatically healthy parturients, taking into account the anatomical features of myomatous nodules, in order to understand the impact of uterine leiomyoma on the labor, to identify a group at increased obstetric risk, and to develop an individualize management strategy for parturients in this group aimed at reducting hypotonic uterine hemorrhage and improving the quality of obstetric care.

Materials and methods. A prospective study was conducted involving 220 women in term pregnancy, divided into two groups: the main group - 120 women with uterine leiomyomas of types 3-5 according to the International Federation of Gynecology and Obstetrics (FIGO) classification larger than 5 cm, and the control group - 100 somatically healthy women without uterine pathology. All participants underwent clinical examination, ultrasound evaluation of the number, location, and size of fibroid nodules, monitoring of labor progression (duration of labor stages, uterine contractility, and blood loss), and assessment of uterine involution during the first five days postpartum.

Results. Women of the main group had significantly longer durations of all three stages of labor compared to the control group. Abnormal labor patterns occurred much more frequently in the main group. The mean intrapartum hemorrhage in women of the main group was approximately 60% higher than in healthy parturients. Uterine involution during the postpartum period was markedly slower among women of the main group.

Conclusions. Parturients with uterine leiomyoma experience prolonged labor and have an increased risk of abnormal uterine contractility. These women more often exhibit excessive blood loss and delayed uterine involution, which underscores the need for an individualized approach to labor management and targeted prevention of hypotonic postpartum hemorrhage.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee. Informed consent was obtained from the patients for the study.

The authors declare no conflict of interest.

The role of nuclear factor kappa B in the pathogenesis of fetal growth restriction depending on vitamin D3 status

I.V. Poladych — 2025-09-28

Fetal growth restriction (FGR) is one of the most severe complications of pregnancy, associated with high perinatal morbidity and adverse long-term outcomes. Placental dysfunction plays a leading role in the pathogenesis of FGR and is accompanied by chronic inflammation and activation of NF‑κB-dependent signaling pathways. Growing evidence suggests that vitamin D₃ deficiency contributes to the development of a proinflammatory placental phenotype.

Aim - to assess the relationship between vitamin D₃ status and p65 NF‑κB activity in the placenta of pregnant women with fetal growth restriction.

Materials and methods. A total of 110 pregnant women were enrolled in the study: Group I (n=45) - FGR combined with vitamin D₃ deficiency (≤20 ng/mL); Group II (n=35) - FGR with an optimal vitamin D₃ level (>30 ng/mL). The control group (n=30) included women with physiologic pregnancies and optimal vitamin D₃ levels. Serum 25(OH)D concentrations were measured using enzyme-linked immunosorbent assay (ELISA). p65 NF‑κB activity in placental lysates was assessed by determining the ratio of phosphorylated to total p65 NF‑κB using ELISA. Statistical analysis was performed using parametric and nonparametric tests; was considered statistically significant.

Results. Women with FGR and vitamin D₃ deficiency demonstrated the highest levels of NF‑κB activation: total p65 NF‑κB - 62.2 (60.7-64.2) pg/mL; phosphorylated p65 NF‑κB - 28.8 (24.8-32.1) pg/mL; p65 NF‑κB activity - 55.8 (54.1-57.2)%, which were significantly higher than those observed in the control group. In patients with FGR and optimal vitamin D₃ levels, NF‑κB activation markers were significantly lower than in women with vitamin D₃ deficiency (p<0.05), but remained higher than in controls.

Conclusions. Fetal growth restriction is associated with pronounced activation of NF‑κB-dependent proinflammatory signaling pathways in the placenta. Vitamin D₃ deficiency markedly enhances p65 NF‑κB activation, promoting the development of a proinflammatory placental dysfunction phenotype. An optimal vitamin D₃ level exerts a partial protective effect by limiting the intensity of the inflammatory response. The vitamin D₃/VDR ↔ NF‑κB p65 axis may represent a promising pathogenetic target for the prevention and reduction of FGR severity.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics and Deontology Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

The authors declare no conflict of interest.

Pregnancy in metabolic syndrome: risks and outcomes

I.O. Adonina — 2025-09-28

Aim - to assess the impact of metabolic syndrome (MS) on the course of pregnancy and perinatal outcomes.

Materials and methods. During 2021-2024, a clinical study was conducted involving 120 pregnant women with metabolic syndrome, who were randomized into two groups: the main group (n=60), in which pregravid nutritional correction using symbiotics (Lactobacillus rhamnosus GG with prebiotic fibers) was applied, and the comparison group (n=60), which received only standard pregnancy management. The control group consisted of 30 pregnant women with normal body weight and physiological pregnancy. Examinations were performed with additional determination of leptin levels by enzyme-linked immunosorbent assay and ultrasound monitoring of fetal development. Primary endpoints included the frequency of perinatal complications, cases of intrauterine growth restriction (IUGR), and length of hospital stay.

Results. Pregnant women with MS were found to have a significantly higher incidence of endometrial hyperplastic processes (51.7% vs 16.7% in the control group), arterial hypertension (48.3% vs 13.3%), dyslipidemia, and harmful habits. The incidence of IUGR in this cohort was 40.0%, compared with only 13.3% in the control group. Correlations were identified between leptin levels, dyslipidemia, and placental dysfunction. In the main group, a reduction in the incidence of preeclampsia, labor abnormalities, and operative deliveries was recorded. At the same time, newborns from mothers with MS had lower weight-length parameters and Apgar scores.

Conclusions. MS in pregnant women is an independent predictor of adverse obstetric and perinatal outcomes, in particular significantly increasing the risk of IUGR and placental dysfunction. Hyperleptinemia and dyslipidemia were identified as key pathogenetic factors associated with gestational complications. The use of symbiotics at the pregravid and intragravid stages demonstrates effectiveness in reducing the incidence of preeclampsia and labor disorders, which substantiates the feasibility of implementing microbiome-oriented preventive strategies in the management of women with MS.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics Committee of the institution specified in the work. Written informed consent was obtained from all participants.

The author declares no conflict of interest.

Comparative analysis of neonatal outcomes in placenta previa and placenta previa with placenta accreta spectrum in women with uterine scar after previous cesarean section

V.V. Kaminsky — 2025-09-28

The increasing rate of cesarean section (CS) has led to a higher risk of abnormal placentation. Placenta previa (PP) and its combination with placenta accreta spectrum (PP+PAS) in women with a uterine scar after previous CS are interrelated conditions that significantly affect neonatal outcomes.

Aim - to compare neonatal outcomes in PP and PP+PAS in women with a uterine scar after prior CS.

Materials and methods. A total of 205 pregnant women were examined in 2022-2025: Group I - PP without PAS (n=66), Group II - PP+PAS (n=79), and Group III - control without PP or PAS (n=60). Neonatal condition at birth, perinatal complications, rooming-in, and causes of neonatal death were analyzed. Statistical analysis was performed using Student's t-test and χ²; p<0.05.

Results. The rate of emergency CS in the PP+PAS group was 32.9%. Mean birth weight was lower in PP+PAS (2610 g) than in PP (2890 g) and controls (3310 g), with lower Apgar scores. The incidence of complications in PP vs PP+PAS was: fetal distress 27.3% vs 43.0%; asphyxia 18.2% vs 36.7%; respiratory distress syndrome 21.2% vs 40.5%; hypoxic-ischemic encephalopathy 12.1% vs 26.6%; anemia 15.2% vs 31.6%; infectious complications 10.6% vs 22.8%. Transient disorders during rooming-in (low birth weight, hypoglycemia) occurred in PP in 9.1% and 15.1%, and in PP+PAS in 15.2% and 22.8%, respectively. PP+PAS was associated with a fivefold increase in neonatal mortality and severe outcomes.

Conclusions. PP+PAS is associated with earlier delivery, a higher rate of emergency CS, poorer neonatal condition, and a fivefold increase in neonatal mortality, whereas mortality was minimal or absent in isolated PP and controls.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.

The authors declare no conflict of interest.

The impact of military actions on the psycho-emotional state of pregnant displaced women

M.Y. Malachynska — 2025-09-28

Pregnancy is a critical period in a woman’s life, and the risks to physical and mental health increase substantially under conditions of armed conflict. Pregnant women who are forced to leave their homes because of hostilities experience heightened stress, which may be accompanied by sleep disturbances, anxiety, somatic complaints, and reduced overall well-being, and may increase vulnerability to anxiety and depressive disorders as well as post-traumatic manifestations.

Aim - To study the clinical and epidemiological characteristics of pregnancy during the armed conflict in Ukraine, with a focus on the psycho-emotional state, war exposure and their connection with somatic complaints and the course of pregnancy..

Materials and methods. A prospective cohort study was conducted in the Lviv region. A total of 1,000 pregnant women were examined: group 1 - internally displaced women from areas of active hostilities (n=333), group 2 - internally displaced women from other regions of Ukraine (n=333), and group 3 - permanent residents of the Lviv region (n=334). Data were collected using a standardized questionnaire covering sociodemographic characteristics, living conditions, and war-related exposures. Psychoemotional status was assessed using the SRQ-20 (20 items, yes/no responses). Group differences in proportions were tested using the chi-square test or Fisher’s exact test; effect sizes with 95% confidence intervals were estimated; statistical significance was set at p<0.05.

Results. A pronounced gradient of emotional distress was identified. In group 1, women more frequently reported anxiety/nervousness (58.3%), difficulty falling asleep/insomnia (51.6%), tension/worry (75.7%), low self-esteem (55.1%), and somatic complaints including headaches (46.9%), fatigue/exhaustion (49.7%), poor appetite (75.8%), and poor digestion (78.8%), whereas in group 3 these indicators were low (mostly 0.9-3.9%). Group 2 showed intermediate levels but remained substantially higher than the group 3. War-related exposures (material losses, housing damage, exposure to shelling/occupied territories, and violence) were more common in the displaced groups.

Conclusions. War and forced displacement are associated with sharply increased psychoemotional distress and somatized complaints in pregnant women, most notably among those displaced from areas of active hostilities. The findings support the need for comprehensive medical, psychological, and social support programs, including routine distress screening.

The author declares that there is no conflict of interest.

The impact of sleep quality and anxiety levels during pregnancy on the risk of preterm birth

E.V. Petrenko — 2025-09-28

Sleep quality and anxiety levels in pregnant women are important predictors of obstetric complications. In today's world, with the increasing psycho-emotional stress on women of reproductive age, studying its impact on the course of pregnancy, in particular the risk of preterm birth (PTB), is extremely relevant.

Aim - to assess sleep quality and anxiety levels in pregnant women before delivery and determine their impact on the risk of PTB.

Materials and methods. Sixty-one pregnant women were examined, of whom 31 gave PTB at 24–36 weeks (main group) and 30 gave birth at term (control group). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and anxiety levels were assessed using the Spielberger-Hanin anxiety scale. Statistical data processing was performed using the licensed Statistica 6.1 package.

Results. We found significantly higher total sleep quality index scores ≥5 points in 77.4% of women in the main group compared to 33.3% in the control group, which showed severe sleep disorders. Significant differences were found between the study groups in the severity of anxiety scores. The level of state anxiety (SA) in patients in the main group averaged 36.7±5.7 points, compared to an average of 33.8±4.9 points in the control group. Trait anxiety (TA) in the control group, with an average score of 34.8±6.3 points, was lower than in the main group (average 37.2±7.8 points). Unlike the control group, significant correlations were found in women in the main group between components of sleep quality before childbirth and indicators of SA and TA.

Conclusions. The study confirmed that patients with PTB are significantly more likely to have sleep disorders and increased anxiety levels compared to women who had term births. This highlights the need for routine screening for sleep disorders and anxiety levels during antenatal care, which will facilitate early identification of risk groups and reduce the incidence of PTB and other obstetric complications.

The authors declare no conflict of interest.

Thrombophilia testing: evidence-based feasibility and clinical benefit

V.I. Medved — 2025-09-28

Aim - to analyze current recommendations from the American and British Societies of Hematology regarding the feasibility and clinical indications for thrombophilia testing in patients with venous thromboembolism, with an emphasis on identifying situations in which testing may impact further diagnosis, treatment, and prevention of thrombotic complications.

This article provides recommendations from the British and American Societies of Haematology for testing for thrombophilia in patients with venous thromboembolism (VTE), particularly if they are young, have recurrent episodes, thrombosis in unusual sites, or have a family history of the disease. Hereditary and acquired thrombophilias are risk factors for VTE that can be identified in many patients with VTE. Currently, the most common tests performed are for hereditary thrombophilias, which include antithrombin, protein C, or protein S deficiency, as well as the presence of genetic mutations in factor V Leiden and prothrombin G20210A. Lupus anticoagulant, anticardiolipin antibodies, and antiβ2-glycoprotein-1 antibodies, which are laboratory markers of antiphospholipid syndrome, are also included in the thrombophilia testing panel. These guidelines are intended to assist in making decisions about thrombophilia testing. First of all, the expert group does not recommend routine testing of clotting factors to assess risk of thrombosis and genetic testing to predict a first episode of VTE. Instead, thrombophilia testing should be performed in patients who have had symptomatic venous thromboembolism related to pregnancy or combined oral contraceptive use. Testing for genetic variants responsible for phenotypic deficiencies of antithrombin, protein C, and protein S should be performed when the results will impact treatment, and screening for antiphospholipid antibodies is appropriate after an episode of unprovoked VTE, as it is important for the choice of antithrombotic therapy. However, testing for hereditary thrombophilia after a venous thrombotic event as a routine method for making treatment decisions is not appropriate.

The authors declare that there is no conflict of interest.

Functions of extracellular vesicles in the female reproductive system and prospects for their use in clinical practice (literature review)

V.V. Radchenko — 2025-09-28

A summary of the latest research on the current thinking about the role of extracellular vesicles in the female reproductive system is provided. The importance of extracellular vesicles, and in particular, the role of the exosome, has been highlighted by a resurgence of interest in recent studies. The main focus is on studies that have investigated physiological and pathological conditions related to reproduction, as well as mother–fetus communication during normal and complicated pregnancies.

Aim - to highlight the current scientific knowledge regarding the importance of extracellular vesicles in the development of obstetric and gynaecological pathologies and reproductive issues, and to outline new possibilities for diagnosis and treatment.

Interest in extracellular vesicles, particularly exosomes, has been revived following studies indicating their importance in numerous intercellular interactions. The main focus has been on studies investigating physiological and pathological conditions related to reproduction, as well as communication between the mother and fetus during normal and complicated pregnancies.

The relationship between exosomal microRNA (miRNA) and physiological and pathological processes in the female reproductive system is summarised.

Conclusions. There are scientific, technical and economic reasons why the use of exosome is limited. The purity of isolated exosomes must be enhanced, a process that demands the development of advanced technologies and equipment. Studying the role of exosomes could provide a foundation for a better understanding of the processes of conception, implantation and normal pregnancy development, as well as the development of complications. This is important because it paves the way to working with patients for whom traditional methods are ineffective.

The authors declare no conflict of interest.

Ultrasound descriptors of pathological changes in the breast

O.O. Karlova — 2025-09-28

The article provides a detailed analysis and practical aspects of implementing the BI-RADS (Breast Imaging Reporting and Data System), developed by the American College of Radiology (ACR).

Aim - to standardize the description and stratification of pathological changes in the breast during ultrasound (US) examination to ensure unambiguous communication between medical specialists, including radiologists, oncologists, and gynecologists.

It has been established that the implementation of the standardized BI-RADS lexicon eliminates ambiguity in result interpretation and minimizes the need for histological interpretation by diagnostic physicians. The paper thoroughly examines the algorithm for analyzing masses based on five key descriptors: shape, orientation relative to the skin, margins (contours), echogenicity, and posterior acoustic features. Particular attention is paid to the differential diagnosis between solid masses and non-mass findings, as well as the assessment of tissue architecture and the state of the ductal system. The study analyzes additional evaluation criteria that increase the specificity of the method: the presence of micro- and macrocalcifications, vascularization patterns in color Doppler and power Doppler modes, and the use of shear-wave elastography to determine tissue stiffness. A list of the most suspicious ultrasound signs of malignancy has been compiled, including vertical orientation ("higher-than-wide"), spiculated margins, marked hypoechogenicity, and intranodular vascularization.

Conclusions. The use of the BI-RADS system in daily clinical practice increases the sensitivity of ultrasound diagnostics, allows for a justified reduction in the number of unnecessary invasive procedures (biopsies), and provides a clear algorithm for choosing patient management tactics — ranging from dynamic monitoring to urgent surgical intervention.

The authors declare no conflict of interest.