Ruken YÜKSEKKAYA, Fatih ÇELİKYAY, Mehmet YÜKSEKKAYA, Fazıl DEMİRTÜRK, Mehmet Can NACAR

Alterations in terminal duct diameter and blood flow in the breasts of subjects with polycystic ovary syndrome

ABSTRACT INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most common gynecological and endocrinal disorder amongst women of reproductive age. The aim of this study was to investigate the changes in the diameter of the terminal ducts and resistive index (RI) values of the breasts in subjects with PCOS using gray-scale ultrasonography (US) and Color Doppler Ultrasonography (CDUS). METHODS: The study and control groups consisted of 39 subjects with PCOS and 22 age-matched, healthy volunteers, respectively. Body mass index and the parity history of all of the participants were recorded. The diameters of the terminal ducts of the both breasts were measured with gray-scale US and the RI values were evaluated at the medial, lateral, and retroareolar regions of the breasts with CDUS. The mean values of RI were calculated for each participant. RESULTS: The diameter of the terminal ducts were statistically significantly increased in subjects with PCOS (range, 0.80-4.4 mm vs. 1-2.95 mm and mean ± standard deviation (SD), 2.04 ± 0.73 mm vs. 1.65 ± 0.64 mm, respectively; p = 0.04). However, there was no statistically significant difference between PCOS and control groups regarding the mean average RI values (mean ± SD, 0.68 ± 0.06 vs. 0.66 ± 0.06, respectively; p = 0.432). DISCUSSION AND CONCLUSION: There was no difference regarding the blood flow between two groups, but the diameters of the terminal ducts were increased in PCOS group.

Polikistik over sendromu olgularında meme terminal duktus çapları ve kan akımında değişiklikler

ÖZ GİRİŞ ve AMAÇ: Polikistik over sendromu (PKOS) doğurganlık çağındaki kadınlarda en sık karşılaşılan jinekolojik ve endokrin bozukluktur. Bu çalışmanın amacı PKOS olgularında meme dokusunda terminal duktus çapları ve rezistivite indeks (RI) değerlerinde olan değişiklikleri gri skala ultrasonografi (US) ve renkli Doppler US (RDUS) ile değerlendirmektir. YÖNTEM ve GEREÇLER: Çalışmaya 39 PKOS olgusu ile aynı yaşlardaki 22 sağlıklı ve gönüllü kontrol olgusu dahil edildi. Tüm katılımcıların vücut kitle indeksleri ve parite sayıları kaydedildi. Gri skala US ile terminal duktus çapları ve RDUS ile memenin iç, dış ve retroareolar bölgelerinden RI değerleri ölçülerek her olgu için ortalama RI değeri hesaplandı. BULGULAR: PKOS olgularında terminal duktus çapları istatistiksel olarak anlamlı şekilde artmıştı (Dağılım; 0,8- 4,4mm &1-2,95 mm, Ortalama (Ort) ± Standart Sapma (SS); 2,04 ± 0,73 mm &1,65 ± 0,64 mm; p = 0,04). Bununla birlikte gruplar arasında ortalama RI değerleri arasında istatistiksel anlamlı farklılık saptanmadı (Ort ± SS; 0,68 ± 0,06 & 0,66 ± 0,06; p = 0.432). TARTIŞMA ve SONUÇ: PKOS olguları ile kontrol grubu arasında meme dokusunda RI değerleri arasında fark yok iken terminal duktus çapları arasında istatistiksel anlamlı farklılık saptandı.

PDF

___

1. Fauser BCJM, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS consensus workshop group. Fertil Steril 2012; 97: 28-38.

2. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approaches to PCOS and other forms of anovulation. Obstet Gynecol Surv 2002; 57: 755–67.

3. Tarlatzis BC, Fauser. BCJM Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 8: 19-25.

4. Fanta M. Is polycystic ovary syndrome, a state of relative estrogen excess, a real risk factor for estrogen-dependant malignancies? Gynecol Endoc 2013; 29: 145-7.

5. Thalabard JC, Sitruk-Ware R, Kuttenn F, Mauvais-Jarvis P. Endocrine markers in benign breast diseases. Zentralbl Gynakol 1986; 108: 354-8.

6. D’Amelio R, Farris M, Grande S, Feraudo E, Iuliano A, Zichella L. Association between Polycystic Ovary and Fibrocystic Breast Disease. Gynecol Obstet Invest 2001; 51: 134–7.

7. Gumus II, Koktener A, Dogan D, Turhan NO. Polycystic ovary syndrome and fibrocystic breast disease: is there any association? Arch Gynecol Obstet 2009; 280: 249–53.

8. Engmann L, Sladkevicius P, Agrawal R, Bekir J, Campbell S, Tan SL. The pattern of changes in ovarian stromal and uterine artery blood flow velocities during in vitro fertilization treatment and its relationship with outcome of the cycle. Ultrasound Obstet Gynecol 1999; 13: 26-33.

9. Ozkan S, Vural B, Caliskan E, Bodur H, Turkoz E, Vural F. Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome. J Clin Ultrasound 2007; 35: 305-13.

10. Gorins A, Denis C. Effects of progesterone and progestational hormones on the mammary gland. Arch Anat Cytol Pathol 1995; 43: 28–35.

11. Soran A, Talbott EO, Zborowski JV, Wilson JW. The prevalence of benign breast disease in women with polycystic ovary syndrome: a review of a 12-year follow-up. Int J Clin Pract 2005; 59: 795-7.

12. Yen SS, Vela P, Rankin J. Innappopriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease. J Clin Endocrinol Metab 1970; 30: 435–42.

13. Homburg R. Polycystic ovary syndromefrom gynaecological curiosity to multisystem endocrinopathy. Hum Reprod 1996; 11: 29–39.

14. Schmillevitch J, Filho HAG, De Nicole H, Gorski AC. Utilization of vascular resistance index in the differentiation between benign and malignant breast nodules. Radiol Bras 2009; 42: 241-4.

15. Youssefzadeh S, Eibenberger K, Helbich T, Jakesz R, Wolf G. Use of resistance index for the diagnosis of breast tumours. Clin Radiol 1996; 51: 418-20.

16. Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N. Color Doppler sonography of the normal breasts: Detectability of the arterial blood vessels and typical flow patterns. Ultrasound Med Biol 1998; 24: 1307-11.

17. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41.

18. Robyn C. Endocrinological aspects of breast physiology. New York: Raven Press; 1993. Endocrinology of Cystic Breast Disease. p. 25–34.

19. Withworth NS. Lactation in humans. Psychoneuroendocrinol 1988; 13: 171.

20. Dogliotti L, Orlandi F, Angeli A. The endocrine basis of benign breast disorders. World J Surg 1989; 13: 674-9.

21. Panaritis V, Despotidis P, Kyriakidis A. Diameter of mammary terminal ducts as an additional tool in evaluation of women with polycystic ovarium disease. Arch Gynecol Obstet 2004; 270: 252–4.

22. Milliken EL, Ameduri RK, Landis MD, Behrooz A, Abdul-Karim FW, Keri RA. Ovarian hyperstimulation by LH leads to mammary gland hyperplasia and cancer predisposition in transgenic mice. Endocrinology 2002; 143: 3671–80.