The way to diagnose breast cancer
(57) Abstract:The invention can be used in medicine, namely in Oncology. When questionable results of ultrasound examination of the breast prescribe oxytocin. Oxytocin dose of 5 IU of applied oral dose and after 1 min after its application carried out for the second study. The changes in the contours and internal structure of pathological education diagnose breast cancer. The method improves the accuracy of diagnosis. 3 Il. The invention relates to medicine, namely to breast cancer diagnosis by ultrasound, and can be used to improve the accuracy and reliability of ultrasonic diagnosis of breast cancer.The challenge of improving the diagnosis of breast cancer (BC) is extremely important in connection with the steady growth trend of this pathology in women in Russia and around the world, and therefore this issue has acquired social value. In Russia in the incidence of malignant tumors of all sites breast cancer came in first place, making in 1997 18,42%, i.e. in comparison with 1980 increased by 42% (at annual the x neoplasms women every seventh died from breast cancer. While the mortality rate from breast cancer is highest in Russia: in Moscow (21,7) and in St. Petersburg (21,3), while the average rate in the 90-ies in Russia - 14,3 (per 100,000 female population). In St. Petersburg annually about 2,000 new cases of breast cancer. Now at this rate of increase in the incidence of breast cancer predicts the likelihood of breast cancer every 15 women from Saint Petersburg (during life).Literature: Selected lectures on clinical Oncology. - M.:, 2000. - 736 S.,: Il. (under. Ed. by Acad. The RAMS Century. And. Kissova, Professor C. L. Jaralovoj); B. F. Semiglazov, the magazine "World of medicine", St. Petersburg, 7, 1997, pages 30-32; B. N. Kharchenko, N. I. Rozhkov, I. M. Frolov, and others, journal of Mammology, Moscow, 4, 1996, S. 36-40; Basset L. V. analysis of Mammographic calcifications. // Radiol.Clin.North Am. - 1992/ - 30/ - P. 93-105.There is a way to diagnose breast cancer, consisting in carrying out ultrasonic examination of the breast (breast ultrasound) using high-frequency linear transducers 5,0-7,5-13,0 MHz with a focal length of 0.5 to 2.5 cm and width fields 5,05,0 see If this ultrasound breast produced by well-known methods, with the most important value in the differential diagnosis of cystic and solid tumors in the breast, does not have the proper samestate the breast, because of the major drawbacks of this method in the diagnosis of breast cancer, namely:
- lack of clarity about the definition of the contours of abnormal formations in the breast;
- difficult to detect infestations (infiltration) of breast tumor in the surrounding tissue of the gland;
- lack of clarity about the definition of the internal structure of pathological education (in the case of breast cancer) and the uncertainty of teleopathy for breast tumor.Literature: N. In.Zabolotskaya, C. S. Zabolotskaya. Ultrasound mammography (teaching Atlas), M, 1997, 104 S.; Diagnostic ultrasound (edited by Professor A. C. Zubarev), M: Real-time, 1999, 176 S., ill.; A. C. Choline. Diagnosis of breast cancer: prospects. The magazine "Mammography", Moscow, 1996, 4, S. 33-35.Thus, ultrasound of the breast produced for the purpose of diagnosis of breast cancer and performed by well-known methods, it is not possible with the proper degree of accuracy and reliability to diagnose breast cancer and needs further improvement.There is also a method of diagnostic radiology, breast cancer is x-ray mammography (RMG), which has a high diagnostic accuracy, reaching 83-95%. However, this method Puccinia interpretation of mammograms and comparison of the individual parts of the image, as a rule, produce x-ray examination of both Breasts in two mutually perpendicular, standard projection - frontal and lateral, as well as complementing the study if necessary atypical (aimed) shots, which greatly complicates the methodology RMG, increases the economic cost of the research and increases the radial load on the breast and the body of the patient, which is especially beneficial for women young and middle-aged;
approximately 20% of malignant breast tumors (medullary, slimy cancer and others) in the x-ray image give oval, round shadow with a clear and not always polycyclic circuits, which greatly complicates the differential x-ray diagnosis of breast cancer with breast fibroadenoma, other benign lesions;
- in the presence of diffuse mastopathy, and dense breast tissue in younger women is significantly reduced x-ray efficiency of RIS in the diagnosis of breast cancer;
when RIS is completely absent functional component of the study, achievable with ultrasound breast in real-time (what is significant about diagnosis of breast cancer);
- by RMG on radiographs MF presents too generalized features the key research breast.Literature: Selected lectures on clinical Oncology. - M.: 2000, - 736 S.: ill. (Ed. by Acad. The RAMS Century Imperial Cisowa, Professor C. L. Jaralovoj); N. Rozhkova.And. X-ray diagnosis of diseases of the breast. - M.: Medicine, 1993, 222 S. ; A. C. Choline. Diagnosis of breast cancer: prospects. The magazine "Mammography", Moscow, 1996, 4, S. 33-35.The aim of the invention is to improve the accuracy and reliability of diagnosis of breast cancer (breast cancer) at her ultrasound investigation (USI). The goal is as follows. When questionable data ultrasonography of the breast (mammary gland), produced by well-known methods (N. In.Zabolotskaya, C. S. Zabolotskaya. Ultrasound mammography (teaching Atlas), M, 1997, 104 S. ; Diagnostic ultrasound (edited by Professor A. C. Zubarev), M: Real-time, 1999, 176 S., ill.;), prescribe oxytocin is a tool that helps reduce myoepithelial cells surrounding the alveoli of the mammary gland (which in physiological conditions, stimulates the production of milk in the mammary glands) - (M. D. Mashkovsky. - Medicines - M.: Medicine, 1993, T. 1, 622 S.; Reference Vidal - drugs in Russia (Handbook), M: OVPEE Estrofem Service, 2000, 1408 S.). These actions of oxytocin mediated by specific recesses Res., 1998, 18, 3, p. 2181-2186).To achieve the objectives of the invention is used and 1 ml (5 IU) of oxytocin used oral (sublingual), which is sufficient for the manifestation of his actions on myoepithelial cells of the breast, expressed in changes of the structure elements of MFS registered with subsequent ultrasound. The use of oxytocin in such dosage is not associated with the risk of any side effects (see pharmacological sources listed above) on the breast and the woman's body. To improve the accuracy and reliability of ultrasound diagnosis of breast cancer oxytocin in the specified dosage (1 ml, 5 ED) apply sublingual, once when the preliminary ultrasound certain area of the breast does not it is safe to speak about the possibility of breast cancer and, after the commencement of oxytocin on myoepithelial elements of MF (after 1 minute after application) produce repeated ultrasound spot on breast, doubtful about the possibility of breast cancer. In this case, before and after the use of oxytocin in breast ultrasound uses ultrasound sensor type linear with frequency of 7.0 MHz, giving the best opportunity to visualize the structure of the breast. The image of the investigated area MF (before and after applying oxytocinergic the study area breast before application of oxytocin, and in the right half of the monitor the same area of the MF, but after the beginning of the action of oxytocin on myoepithelial cells of the mammary gland, with subsequent comparison of images of the same area of MFS on the subject occurred in it structural changes after application of oxytocin. Any special preparation of the patient to the way ultrasound breast with the use of oxytocin is not required. However, the use of oxytocin in this way should be consistent with existing contraindications for its use is pregnancy, postoperative scars on the uterus (M. D. Mashkovsky. - Medicines - M.: Medicine, 1993, T. 1, 622 S.; Reference Vidal - drugs in Russia (Handbook), Moscow: OVPEE Estrofem Service, 2000, 1408 S.).The results of the ultrasound examination of the breast in this way, fixed on the monitor in a variant of "2B", can then be documented in various ways, in particular photography with the subsequent production of photographic prints and slides.When implementing our method of an ultrasonic diagnostic of breast cancer the use of oxytocin in a dose of 5 IU (1 ml), oral (sublingual), causing a reduction myoepithelial breast cells, allows for an ultrasound with the use of the line is the first diagnosis of breast cancer (compared with the known method ultrasound of the breast without the use of oxytocin) due to: better define the contours of abnormal formations in the breast; signs of infestation (infiltration) education into the surrounding breast tissue; a clearer definition of the internal structure of abnormal formations in the breast and ultrasound phenomenon of "teleopathy" for abnormal area in the breast. When using our method ultrasound breast cancer decreases the possibility of false-positive and false-negative ultrasound diagnosis of breast cancer. Single use of oxytocin has a short duration of action (within 4 minutes), but it is sufficient for the breast ultrasound to diagnose breast cancer.The above sequence of actions in achieving the objectives of the invention creates the possibility of improving the accuracy and reliability of ultrasonic diagnosis of breast cancer, which is of great clinical significance in breast care and Oncology. Evidence of achievement of the objectives of the invention are given in examples 1, 2, 3.Used in the proposal abbreviations:
Ultrasound - ultrasound
Breast - breast
Breast cancer - breast cancer
Examples of a specific implementation method
Example 1. Woman, 43g. Education is palpable in the right breast."a" - 3,42,0 cm are likely to be heterogeneous internal structure and indistinct contours. To clarify the structural features of education in the breast produced ultrasound breast cancer using samples with oxytocin.b - ultrasound of the breast after 1 minute after application of oxytocin on specified in the application technique: dimensions of education are more reliable - 3,11,9 cm; contours of a more pronounced structural characteristics: polycyclic on the rear contour of education, front - rough and fuzzy. Revealed the plot of invasion /infiltration/ education in the subcutaneous tissue of the breast. The internal structure of education has been defined as a heterogeneous predominantly hyperechoic /dense/ sites.Based on the above picture (Fig. 1, "b"/, obtained by ultrasound examination of the breast using samples with oxytocin, the detected ultrasonic signs of breast cancer, which subsequently confirmed by pathological /after surgery/.Example 2. Female 46 years old. Education is palpable in the left breast."a" - ultrasonography of the breast to the use of oxytocin. Is determined by education with vague contours approximately 2,81,5 cm; with uncertain echogenicity within the intramural cancer using samples with oxytocin.b - ultrasound of the breast after 1 minute after application of oxytocin on specified in the application technique: dimensions of education - 2,11,5 cm, contours more accurately defined as rough with elements of polycyclical; the internal structure of education was defined as a combination of small rounded hypoechoic hyperechoic areas and /dense/ elements with irregular contours.Based on the above picture (Fig.2, "b"/, obtained by ultrasound examination of the breast using samples with oxytocin, the detected ultrasonic signs of breast cancer, which subsequently confirmed by pathological /after surgery/.Example 3. Woman, 39 years. Education is palpable in the right breast
"a" - ultrasonography of the breast to the use of oxytocin. Identified education in the gland with ill-defined peripheral boundary, approximate size 1,21,0 cm, with mixed echogenicity internal structure requiring differential ultrasonic diagnosis with benign tumor of the breast - fibroadenoma. To clarify the structural features of education in the breast, its differentiation with fibroadenoma produced ultrasound is oxytocin on specified in the application technique: dimensions of education are more reliable - 1,51,2 cm; paths, especially along the upper edge of education, uneven; expressed infiltrative component of the pathological process for education /about the circumference of 6-9 "hours"/. After the samples with oxytocin for education did not appear acoustic shadow side, so characteristic of the true fibroadenoma (see Fig.3 "in"/, reflecting the presence of a capsule around the fibroadenoma of the breast.Based on the above picture (Fig.3, "b"/, obtained by ultrasound examination of the breast using samples with oxytocin, the detected ultrasonic signs of breast cancer, which subsequently confirmed by pathological /after surgery/. The way to diagnose breast cancer by ultrasound, characterized in that after the ultrasound examination of the breast used oxytocin in the dose of 5 UNITS, orally, once and after 1 min re-produce ultrasound and character changes the contours of abnormal formation in the mammary gland and its internal structure are diagnosed with breast cancer.
SUBSTANCE: method involves examining eyeball and retrobulbary space by means of ultrasonic scanner. Ultrasonic gray scale orbit scanning is applied in real-time mode to determine ultrasonic eye reposition. Positive ultrasonic eye reposition is determined and normal state is diagnosed when recording mobile unchanged shape and free oscillation orbit tissue movements. Changes in shape, contours and size of the eyeball and immobility of orbit tissues being recorded, negative ultrasonic reposition is determined and solid full-tissue neoplasms and structures are diagnosed to occur.
EFFECT: high objectivity of received data; accelerated examination; high accuracy of differential diagnosis.
SUBSTANCE: method involves applying polypositional ultrasonic scanning techniques in real time mode. Echo pattern of thinned fibrous ring to 1 mm or its rupture or anteroposterior vertebral canal size reduction by more than 4 mm, vacuum phenomenon, nerve radix compression with asymmetry more than 2 mm is to be recognized.
EFFECT: high accuracy of non-invasive, non-ionizing primary diagnosis method.
FIELD: medicine, surgery.
SUBSTANCE: one should carry out virological testing patient's blood serum and hepatic bioptates. At detecting TTVDNA and HGVRNA it is necessary to perform ultrasound survey, and at availability of biliary sludge one should conclude upon early stage of cholelithiasis.
EFFECT: higher accuracy of diagnostics.
SUBSTANCE: method involves measuring uniform ampoule-like enlargement area of nerve trunk smoothly transforming itself into hypoechogenic formation with smooth distinct outline of no longitudinal striation echo-structure in longitudinal projection and enlarged rounded hypoechogenic region with changed echo-structure without granularity in transverse projection observed in visualizing the nerve trunk enlargement in transverse scanning mode. Area of zone proximally located 3-4 cm far from lesion region. Asymmetry coefficient is determined as ratio of the values. The coefficient value being greater than 2.4, terminal neuroma is diagnosed witnessing complete nerve rupture. When visualizing the single side nerve boundary enlargement in both projections with hypoechogenic zone of disturbed echogenicity structure and retained nerve segment unchanged at this level under asymmetry coefficient value being less than 2.4, lateral neuroma is diagnosed to be the case witnessing partial nerve rupture. When finding zone of linear striation echo-structure in longitudinal scanning mode and showing echo-structure granularity in transverse scanning mode not greater than 1.7 times proximal zone area 2-6 months later after the operation, fascicle nerve structure recovery in suture vicinity is considered to take place. Ampoule-like enlarged, hypoechogenic formation having partially disturbed inhomogeneous heterogeneous structure 1.7 times greater than proximal zone area being found within this period, intensive nerve trunk connective tissue elements proliferation and intratrunk neuroma is proved to be the case.
EFFECT: high accuracy in determining nerve injury degree; enhanced effectiveness in controlling postoperative nerve fiber recovery.
2 cl, 3 dwg
SUBSTANCE: one should perform ultrasound testing cholecystic bile and at detecting hyperechogenic particles and decreased contractile function of cholecystic wall by 25% and more one should diagnose early stage of cholelithiasis.
EFFECT: higher accuracy of early diagnostics.
3 ex, 6 tbl
FIELD: medicine, urological ultrasound diagnostics.
SUBSTANCE: ureterectasia should be developed below prepyeloureteral department, one should cause functional obstruction in ureterovesical segment: a patients should fill urinary bladder to achieve high values of pressure in it, restrict urinary passage through ureterovesical anastomosis, perform medicinal polyuria due to intravenously introduced lasix at age dosage at simultaneous introduction of an analgesic. About 10 min after lasix introduction one should perform ultrasound testing in the course of which an increased upper third of patient's ureter enables to localize pyeloureteral segment, detect the length of obstruction and due to Doppler scanning detect either availability or absence of inferior polar vessel. The method enables to determine indications to apply open surgical techniques of hydronephrosis and endoscopic methods (endopyelotomy).
EFFECT: higher efficiency of ultrasound diagnostics.
5 dwg, 3 ex
SUBSTANCE: method involves carrying out differential diagnosis study for determining prostate tumor type. Transrectal ultrasonic examination is carried out and prostate-specific antigen density is determined in patient blood serum. Free fraction density of the prostate-specific antigen being below 0.04 ng/ml per 1 cm3, and general prostate-specific antigen concentration being equal to 0-20 ng/ml, malignant tumor is to be diagnosed. General prostate-specific antigen concentration being higher than 20 ng/ml, malignant tumor is to be diagnosed.
EFFECT: high diagnosis accuracy.
SUBSTANCE: method involves determining transformed abdominal wall region by means of ultrasound. The sclerosis focus being detected, rheopolyglukine solution is introduced into space between direct muscle belly and its posterior sheath plate before applying repeated ultrasonic examination.
EFFECT: high accuracy in measuring area occupied by structural elements and determining transformed tissue region boundary; objective muscle fiber atrophy and cicatricial sclerosis development degree estimation.
SUBSTANCE: method involves recording middle uterus echo and endometrium volume. Uterus body volume is additionally determined and endometrium volume to uterus body volume ratio index (EV/UV) is calculated. The index values within 5 to 10% are thought to be norm for reproductive age women. The EV/UV value being between 10 and 19%, the women are thought to belong to risk group and ultrasonic control is advised for being carried out within 1 year. The value being between 19 and 40%, it is advised to the female patients to pass through diagnostic endometrectomy procedure and carry out histological examination. The value being greater than 40%, the women are sent to be treated in oncological clinical centers. The EV/UV value between 3 and 7% is considered to be norm for female patients within their 5 years long postmenopausal period. The value being between 7 to 13%, the women are included into risk group and ultrasonic control is to be carried out within six months. The value being between 13 to 35% corresponding to endometrium hyperplasia, it is advised to the female patient group to pass through diagnostic endometrectomy procedure and then to carry out histological examination. The value being greater than 35%, treatment in an oncological clinical center is recommended.
EFFECT: high reliability and accuracy of diagnosis.
2 dwg, 3 tbl
SUBSTANCE: method involves carrying out ultrasonic examination of neck region. The ultrasonic examination is carried out by alternating scanning in frontal and frontolateral planes using superficial; transducers tuned at wavelengths of 5.0 MHz and 7.5 MHz in varying inclination angle from 45° to 135° from mental region downward along trachea to upper poles and thyroid gland isthmus level. Zones having echogenic parameters differing from those of normal tissues, tumor neoplasm availability is diagnosed.
EFFECT: high accuracy in visually determining laryngeal bulk neoplasms.