ОСОБЕННОСТИ СОВРЕМЕННОЙ ДИАГНОСТИКИ МЕТАСТАЗОВ КОЛОРЕКТАЛЬНОГО РАКА В ПЕЧЕНЬ

Development of an optimal algorithm of ray diagnostic examinations in the case of colorectal cancer liver metastases is extremely important. The paper reviews the literature on the diagnosis of colorectal cancer liver metastases. Diagnosis of liver metastases is based on imaging techniques that allow you to assess the condition of the liver, the number and size of lesions and the number of parameters on which the patient is suitable for radical surgery. Described ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) semiotics of liver metastases, and reflect additional information that can be obtained using beam methods of research, which is of great importance in determining resectability and preoperative planning of surgery. We consider differential diagnosis with benign tumors of the liver. The value and priority of such methods of radiation diagnosis as ultrasound with contrast, CT and MRI contrast agents, is widely debated among experts.Разработка оптимального алгоритма лучевых диагностических обследований в случае метастатического поражения печени при колоректальном раке (КРР) является крайне актуальной. В статье дан обзор литературы по диагностике метастазов КРР в печень. Диагностика метастазов в печень основана на методах визуализации, позволяющих оценить состояние печени, количество и размер очагов и ряд параметров, по которым пациент подходит для радикального хирургического лечения. Описана ультразвуковая, рентгенологическая и магнитно-резонансная семиотика метастазов в печень, а также отражены дополнительные сведения, которые можно получить с помощью лучевых методов исследования, что имеет огромное значение в определении резектабельности и предоперационном планировании хирургического вмешательства. Рассмотрена дифференциальная диагностика с доброкачественными образованиями печени. Вопрос о ценности и приоритете таких методов лучевой диагностики, как ультразвуковое исследование с контрастированием, рентгеновская компьютерная томография и магнитно-резонансная томография с контрастными веществами, широко обсуждается среди специалистов.

Мультипараметрическая ультразвуковая диагностика измененных лимфатических узлов при первично- множественных злокачественных опухолях, включающих рак молочной железы и лимфому

In this article, based on two clinical examples, the possibilities of multiparametric ultrasound in the differential diagnosis of metastatic and lymphoproliferative changes in lymph nodes in primary-multiple malignant tumors, including breast cancer and lym - phoma, are evaluated. Multiparameteric ultrasound includes B-mode, color and energy Doppler imaging, strain elastography, shear wave elastography and contrast-enhanced ultrasound (CEUS). Standardization and reproducibility of these ultrasound techniques will allow to objectify the study, obtaining specific indicators of shear wave velocity in the zones of interest and specific signs of contrast enhancement, which can be used as impor tant differential diagnostic tool in oncology.В статье на основе двух клинических примеров оцениваются возможности мультипараметрического ультразвукового исследования в дифференциальной диагностике метастатических и лимфопролиферативных изменений лимфатических узлов при первично-множественных злокачественных опухолях, включающих рак молочной железы и лимфому. В мультипараметрическое ультразвуковое исследование входит В-режим, режимы цветового и энергетического допплеровского картирования, компрессионная эластография, эластография сдвиговой волной и ультразвуковое исследование с контрастным усилением (КУУЗИ). Стандартизация и воспроизводимость данных ультразвуковых методик позволит объективизировать исследование, получая конкретные показатели скорости сдвиговой волны в зонах интереса и специфические признаки контрастного усиления, что можно будет использовать в качестве важного дифференциально-диагностического инструмента в онкологии

Мультипараметрическая ультразвуковая диагностика измененных лимфатических узлов при первично- множественных злокачественных опухолях, включающих рак молочной железы и лимфому

In this article, based on two clinical examples, the possibilities of multiparametric ultrasound in the differential diagnosis of metastatic and lymphoproliferative changes in lymph nodes in primary-multiple malignant tumors, including breast cancer and lym - phoma, are evaluated. Multiparameteric ultrasound includes B-mode, color and energy Doppler imaging, strain elastography, shear wave elastography and contrast-enhanced ultrasound (CEUS). Standardization and reproducibility of these ultrasound techniques will allow to objectify the study, obtaining specific indicators of shear wave velocity in the zones of interest and specific signs of contrast enhancement, which can be used as impor tant differential diagnostic tool in oncology.В статье на основе двух клинических примеров оцениваются возможности мультипараметрического ультразвукового исследования в дифференциальной диагностике метастатических и лимфопролиферативных изменений лимфатических узлов при первично-множественных злокачественных опухолях, включающих рак молочной железы и лимфому. В мультипараметрическое ультразвуковое исследование входит В-режим, режимы цветового и энергетического допплеровского картирования, компрессионная эластография, эластография сдвиговой волной и ультразвуковое исследование с контрастным усилением (КУУЗИ). Стандартизация и воспроизводимость данных ультразвуковых методик позволит объективизировать исследование, получая конкретные показатели скорости сдвиговой волны в зонах интереса и специфические признаки контрастного усиления, что можно будет использовать в качестве важного дифференциально-диагностического инструмента в онкологии

УЛЬТРАЗВУКОВОЕ ИССЛЕДОВАНИЕ В КОМПЛЕКСНОЙ ЛУЧЕВОЙ ДИАГНОСТИКЕ МЕТАСТАТИЧЕСКОГО ПОРАЖЕНИЯ ПАРАСТЕРНАЛЬНОГО ЛИМФАТИЧЕСКОГО КОЛЛЕКТОРА У БОЛЬНОЙ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Background. The parasternal lymphatic collector is an important pathway of the lymph drainage from the breast in breast cancer patients. Evaluation of parasternal lymph nodes is not available during physical examination. To date, no algorithm for diagnostic imaging of the parasternal lymphatic pathway has been developed. The presence of metastases in parasternal lymph nodes upstages the breast cancer patient to a minimum of clinical stage III disease.Case description. We present the case of breast cancer progression in a 40-year-old woman. The patient received treatment for triple-negative stage IIA breast cancer (Т2N0M0) in 2018. In August, 2019, 18-FDG PET /CT images revealed a solitary metastasis in the parasternal lymph node. Ultrasound images also showed the same lymph node assessed by PET -CT and the additional parasternal lymph node metastasis. A fine-needle aspiration biopsy of both lymph nodes confirmed the specific involvement of the parasternal lymph nodes.Conclusion. Ultrasound scans are used to assess the axillary, subclavian and supraclavicular lymphatic collectors, but there is little evidence in the literature on the use of ultrasound in the assessment of parasternal lymph nodes. Our clinical case shows the feasibility of using ultrasound in assessing the status of the parasternal of lymph nodes, as well as the feasibility of performing fine-needle aspiration biopsy by ultrasound navigation.Актуальность. Парастернальный лимфатический коллектор является важной областью регионарного лимфатического оттока у больных раком молочной железы. Оценка лимфатических узлов данной группы не доступна при физикальном обследовании. Кроме того, не разработан алгоритм лучевых методов диагностики поражения этого коллектора. При специфическом поражении лимфатических узлов этой группы стадия заболевания увеличивается до стадии iiia и первым этапом лечения рекомендуется проведение химиотерапии. Описание клинического случая. Приводим собственное наблюдение прогрессирования рака молочной железы у пациентки 40 лет. Пациентка  находится на динамическом контроле после комплексного лечения, проведенного в 2018 г. по поводу рака молочной железы, Т2N0m0, iiА стадия, тройной негативный тип. При плановом исследовании в августе 2019 г. по данным ПЭТ/КТ с 18F-ФДГ у пациентки  выявлен солитарный метастаз в парастернальный лимфатический узел. Дополнительно проведено ультразвуковое исследование, при котором выявлен  описанный при ПЭТ-КТ лимфатический узел, а также дополнительный изменённый лимфатический узел парастернальной области, произведена тонкоигольная  аспирационная биопсия обоих лимфатических узлов, по результатам которой подтверждено специфическое поражение парастернальных лимфатических узлов. Заключение. Ультразвуковая диагностика используется для оценки аксиллярного,  подлючичного и надключичного лимфатических коллекторов, однако в литературе мало данных об использовании данного метода в оценке лимфатических узлов парастернальной области. На клиническом примере показана возможность использования ультразвуковой диагностики в оценке состояния парастернальной  группы лимфатических узлов, а также возможности проведения тонкоигольной  аспирационной биопсии под УЗ-навигацией

SPECIFIC FEATURES OF THE CURRENT DIAGNOSIS OF COLORECTAL CANCER LIVER METASTASES

Development of an optimal algorithm of ray diagnostic examinations in the case of colorectal cancer liver metastases is extremely important. The paper reviews the literature on the diagnosis of colorectal cancer liver metastases. Diagnosis of liver metastases is based on imaging techniques that allow you to assess the condition of the liver, the number and size of lesions and the number of parameters on which the patient is suitable for radical surgery. Described ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) semiotics of liver metastases, and reflect additional information that can be obtained using beam methods of research, which is of great importance in determining resectability and preoperative planning of surgery. We consider differential diagnosis with benign tumors of the liver. The value and priority of such methods of radiation diagnosis as ultrasound with contrast, CT and MRI contrast agents, is widely debated among experts

EFFICIENCY OF ULTRASOUND STUDY IN THE DIAGNOSIS OF CHOLANGIOCELLULAR CARCINOMA

Objective: to evaluate the efficiency of ultrasound diagnosis in detecting and staging cholangiocellular carcinoma.Material and methods. An ultrasound study (USS) was conducted in 120 patients aged 19 to 84 years with cholangiocellular carcinoma. The patients were divided into 3 groups by the location of a tumor process: 1) 47 (39.2%) patients with intrahepatic tumor; 2) 49 (40.8%) with portal duct or Klatskin’s tumor; 3) 24 (20%) with distal one. Ninety (75%) patients were operated on; the others underwent minimally invasive X-ray surgical interventions as percutaneous transhepatic cholangiostomies. The data of ultrasound diagnosis were compared with the results of other studies, intraoperative assessment and morphological examination of a removed gross specimen.Results. A tumor was detectable by USS only in 90 (75%) patients; its sensitivity was 100% for intrahepatic cholangiocellular carcinoma; 69.4 and 37.5% for portal duct and distal ones, respectively. It is most difficult to diagnose distal carcinomas of the common bile duct. USS reveals no semiotic signs of intrahepatic cholangiocellular carcinoma, which could distinguish the latter from other liver cancers. The specific features of the infiltrative growth of a bile duct tumor, such as hyperechoic infiltration along the external outlines of the ducts or hypoechoic infiltration during thickening of the duct walls, were ascertained. The sensitivity of intraoperative USS in identifying intrahepatic and portal duct cholangiocarcinoma was 100%. That of USS in detecting lymph node metastases was 61%; we developed the semiotics of altered metastatic lymph nodes.Conclusion. The findings have indicated the high informative value of ultrasound diagnosis in determining the dilatation of the bile ducts and the spread of a tumor to the liver and lymph nodes. It is recommended that the indications for intraoperative USS should be expanded in intrahepatic cholangiocellular carcinoma to define the extent of duct carcinoma

Microwave radiothermometry in the diagnosis and evaluation of the neoadjuvant treatment of patients with breast cancer

Microwave mammography permits thermal changes to be estimated both within the breast and onto its surface. It is obvious that ireplace X-ray mammography or ultrasonography (USG) since it gives no information on breast structural changes, which is very nefor a physician.At the same time microwave mammography can yield additional information on the magnitude of proliferative processes and on the thermal activity of tissue. In many cases, this information may be decisive in elaborating treatment policy.Due to its simplicity , non-invasiveness, and safety , decimetric microw ave radiothermometry may be a promising method for diagno sing breast cancer and evaluating the efficiency of its treatment. When used in combination with X-ray study and USG, this technique provides incomparable assistance in defining the management of patients. The concurrent use of mammography , USG, and radiothermometric d iag- nosis of the breast assists in reducing the level of diagnostic errors to 1-3%

Contrast Enhanced Ultrasound in the Diagnosis and Evaluation of the Efficiency of Chemotherapy in Patients with Colorectal Liver Metastases

Objective: to determine the possibilities of contrast-enhanced ultrasound (CEUS) in identifying and evaluating the efficiency of chemotherapy in patients with colorectal liver metastases (CLM).Material and methods. The investigation enrolled 28 patients with CLM. The patients were divided into two groups: Group 1 – 15 pretreatment patients; Group 2 – 13 posttreatment patients with process stabilization. All the patients underwent standard B-mode ultrasound of the liver and that using the contrast agent SonoVue ® (Bracco, Italy), by recording and estimating the parameters of the intensity-time curve (CIV). Liver CEUS assesses the nature of contrasting metastases in three phases (arterial, venous, and delay ones).Results. The investigators identified three types of contrast agent accumulation in CLM in the arterial phase: along the periphery of the lesions (in 60% of the patients of Group 1, in 76.9% in Group 2), homogeneously over the entire volume (in 26.7% in Group 1 and in 0.08% in Group 2), in parallel with intact liver parenchyma (13.3% in Group 1 and 23.02% in Group 2). In the delay phase, more metastases were detected in 4 cases (14.3%). Estimation of CIV parameters showed a difference at the beginning of contrast enhancement stages between the patients in both groups. Group 1 exhibited the early contrasting of liver metastases (19.3 sec); Group 2 displayed the late washout of a contrast agent (65.9 sec).Conclusion. CEUS versus B-mode ultrasound improves the imaging of liver metastases. The change in the vascular architectonics and hemodynamics in CLM after chemotherapy is reflected in the alteration of the rate of contrast accumulation and washout from the metastases, which allows CEUS to be used in the evaluation of the efficiency of this treatment

Utility of ultrasound examination in the diagnosis of laryngeal and hypopharyngeal cancers

The study objective is to evaluate the utility of ultrasound (US) examination in the diagnosis of laryngeal/hypopharyngeal squamous cell carcinoma and in the assessment of tumor spread.Materials and methods. We performed US examination in 100patients (7 females and 93 males) with laryngeal/hypopharyngeal cancer aged between 36 and 85 years. We evaluated vocal cord mobility, condition of the laryngeal cartilages, and tumor invasion to the adjacent tissues within the larynx and beyond it. In all patients, the diagnosis was confirmed by histological examination.Results. Seventy-five patients had primary laryngeal/hypopharyngeal tumors, whereas the remaining 25patients presented with recurrent cancer. Eighty-one participants were found to have laryngeal cancer; of them, 13 patients had tumors in the supraglottis; 67 patients had tumors located in the glottis; and 1 patient had a tumor of the subglottis. Nineteen patients were diagnosed with hypopharyngeal tumors. We have identified the most typical US signs of laryngeal/hypopharyngeal tumors considering their location and compared the results of US examination with histology of surgical specimens. US examination demonstrated a sensitivity of 94.1 %, accuracy of 91.9 %, efficacy of 47.0 %, and positive predictive value of 97.5 %. Specificity was not evaluated since we had no negative results.Conclusion. US examination is a highly accurate methodfor the diagnosis of both primary and recurrent laryngeal/hypopharyngeal tumors