Comparison of ultrasound and MRI informativeness for detection and treatment monitoring of cervical cancer metastases in the vagina.

AIM: To assess ultrasound (US) method informativeness in the recurrence detection and treatment monitoring of patients with cervical cancer metastases in the vagina via comparing the US and magnetic resonance imaging (MRI) data. MATERIALS AND METHODS: 42 patients with recurrence of cervical cancer were examined by transvaginal US and MRI. Data on radiation diagnostics of cervical cancer metastasis in the vagina were compared with pathomorphological data. US and MRI data on the metastatic tumors size were compared. RESULTS: The diagnostic efficiency of US and MRI for recurrence detection was determined. The sensitivity, specificity and accuracy of US were 92.8; 93.3 and 93.3%, respectively, and of MRI - 95.2; 96.6 and 95.8%, respectively. The informativeness of MRI was higher than US in cervical cancer recurrences detection, but the difference was not significant (p > 0.05). US can provide data as informative as MRI for estimation of metastases sizes in the vagina. The mean difference between MRI measurements and US measurements of the metastases volume was 0.79 mm (95% CI 0.62-0.95 cm3). CONCLUSIONS: US as a cheaper and simpler method could be an alternative for metastases detecting and treatment monitoring, especially if there are contraindications to MRI.

Radiation research to determine local tumor invasion in patients with cervical cancer.

The main task of radiation study of verified cervical cancer (CC) is tumor spread assessment because of its profound effect on the treatment tactics choice and prognosis. The Aim of the study was radiation study optimizing for tumor local spread assessment in patients with CC via comparing the usefulness of different magnetic resonance imaging (MRI) based approaches. MATERIALS AND METHODS: 62 patients with CC were examined by MRI on tomograph 1.5 Ð¢ using contrast enhancement and diffusion-weighted imaging (DWI). Pre-operation data on radiation diagnostics of tumor spread were compared with surgical and pathologic data. RESULTS: The diagnostic efficiency of different methods of radiation testing for assessment of local tumor spread in patients with CC was determined. The use of contrast enhancement didn't increase an informative value of МRI in assessment of local tumor spread. False overestimation of tumor spread was caused by intense accumulation of contrast substance around the tumor due to inflammation. Use of DWI allowed to reduce the number of false positive results, and significantly increased the efficiency of MRI (p < 0.05): the positive predictive value, sensitivity, specificity and accuracy were 83.3; 90.9; 96.0 and 95.1%, respectively. CONCLUSIONS: The use of DWI increases informativeness of МRI in assessment of local tumor spread.

[SYNDROMAL APPROACH IN ULTRASONOGRAPHIC DIAGNOSIS OF THORACIC TRAUMA].

Diagnosis of the thoracic organs injuries constitute an actual problem of modern medicine. Results of examination of 96 injured persons, suffering thoracic cavity organs trauma, were analyzed. Ultrasonographic investigation conduction in complex with radiological methods, basing on syndromal diagnostic approach, have permitted to enhance diagnostic informativity significantly, to obtain objective data about character of the injury, and to establish adequate tactics of treatment for the injured persons, basing on analysis of the results achieved.

Use of elastography for cervical cancer diagnostics.

UNLABELLED: The aim of the study was to investigate the use of elastography for cervical cancer diagnostics. MATERIALS AND METHODS: The ultrasonic study with use of sonoelastography involved 87 patients with cervical pathology (cervicitis, n = 11; dysplasia, n = 14; cervical cancer, n = 62). RESULTS: At non-malignant pathology elastic types of elastograms prevailed while the tumors were characterized by images of stiff type formations. Present study has demonstrated an effectiveness of sonoelastography for valuation of tumor process invasion levels. At detection of tumor invasion into parametrium, the test sensitivity increased from 77.1 to 91.4%, specificity - from 85.1 to 96.2%, accuracy - from 80.6 to 93.5%; in case of tumor invasion into vagina these parameters correspondently changed: from 75.0 to 83.3%, from 76.9 to 88.4%, from 75.8 to 85.4%, respectively; and in case of uterus: from 82.9 to 85.3%, from 85.7 to 95.2%, from 83.8 to 88.7%, respectively. CONCLUSIONS: Inclusion of elastography into ultrasound examination of cervical pathologies could significantly improve diagnostic quality of the method.

Treatment of large osteosarcoma in children: new approach.

AIM: To improve the treatment results of patients with locally advanced osteosarcoma with large volume using neoadjuvant chemotherapy (NACT) (ifosfamide at a dose of 18 g/ml) and planning of organ-conserving surgery by evaluating the state of tumor pseudocapsule. PATIENTS AND METHODS: A study group included 46 children aged from 7 to 18 years, mean age - 12 years. In 68% of the patients tumor volume was larger or significantly larger than 200 ml (from 27 to 2400 ml), mean tumor volume was 342 ml. All patients have been examined by X-ray radiography, CT, Doppler ultrasound. Convenient chemotherapy consisted of methotrexate at a dose of 12 g/ml, cisplatin (120 mg/ml) in combination with doxorubicin (75 mg/ml). If such chemotherapy was considered ineffective with the use of an algorithm for determination of chemotherapy efficacy, 2 cycles of chemotherapy with ifosfamide at a dose of 18 g/ml per course have been applied. At the stage of planning of organ-conserving surgery, the state of tumor pseudocapsule was analyzed. In 6 months post-operative chemotherapy was carried out with the use of methotrexate, cisplatin with doxorubicin, ifosfamide at the same doses. RESULTS: Myelotoxicity of ifosfamide treatment at a dose of 18 g/ml is comparable to that of to a course of doxorubicin + cisplatin: the depth of leucopenia was significantly higher (p < 0.05), the duration of agranulocytosis is similar after such therapies. In the study group, 69.6% patients have reached grade 3-4 pathomorphosis. Organ-conserving surgery was performed in 86.9% of the patients. Local tumor recurrence was registered in 15.2% patients of the study group. 5-year relapse-free survival was achieved in 62 ± 10% (p = 0.02), the overall 5-year survival - 76.5 ± 9% (p = 0.02). CONCLUSIONS: Introduction of ifosfamide at a dose of 18 g/ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-operative chemotherapy, pre-operative analysis of NACT efficacy and the state of tumor pseudocapsule during planning stage of organ-conserving surgery significantly improves efficacy of the therapy in patients with large tumor volume.