Method for diagnosing laryngeal endophytic malignant tumors

FIELD: medicine.

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.

 

The invention relates to medicine, in particular for the diagnosis of malignant lesions by ultrasound, and can be used for detecting lesions of the larynx lesion with soft tissue and/or plates of the thyroid cartilage.

Currently, malignant tumors of the larynx occupy the first place among tumors of ENT-organs. Diagnosis of this tumors in most cases, presents certain difficulties. This applies particularly to the diagnosis of malignant endophytic tumors localized in the anterior sections of the larynx with the spread on the soft tissue of the neck, as well as in the hypopharynx and trachea.

There are different ways of diagnosing tumors of the specified locale.

In the case of exophytic and mixed forms of growth, the prevalence of the process are estimated by mirror examination and fibroadipose. However, endophytic nature of tumor growth and no change on the part of the mucous membrane of data research methods ineffective. The disadvantage of these diagnostic methods is the probability of rejecting a local anesthetic and injury stenosis of the larynx.

At the same time, there is a method of diagnosing adenomas and hyperplasia of the parathyroid glands (RF patent No. 2169526, publ. 27.06.2001, bull. No. 18), which carry put the m ultrasound examination of the neck with the surface of the sensor. However, the mode ultrasound, is given in the description of this invention, there can be effectively used to perform diagnostics of malignant endophytic tumors of the larynx.

The claimed invention is directed to solving the problems of diagnostics of malignant lesions of the soft tissues and organs of the larynx.

Technical (medical) resulting from the use in clinical practice, the proposed method is the possibility of visual detection volume of the tumors in the throat, in particular destruction of soft tissues, cartilage, elastic fibers and mucous membranes.

The specified medical outcome by carrying out the invention is achieved due to the fact that just as in the known method, diagnosis endophytic malignant tumors of the larynx is carried out by ultrasound of the neck. A feature of the invention lies in the fact that ultrasound is carried out in a sequential scan in the frontal and frontolateral planes with surface sensors with wavelength of 5.0 MHz and 7.5 MHz by changing the angle sensor 45° 135°and when the detection zones, echo is different from the echogenicity of normal tissues, diagnose the presence of tumor growths.

The invention consists in the following.

When assests the research Institute of ultrasound of the neck using surface sensors in order to visually determine the presence of bulky tumors in the throat, a need arises consistent layered evaluation of soft tissue (skin, subcutaneous adipose tissue, elastic fibers and moving parts of the larynx), and complex cartilage. Each of the identified tissue layers is characterized by its individual degree of echogenicity and different is visualized on the monitor screen. In particular:

the skin under compression sensor is visualized as hyperechoic line thickness 3,0-5,0 mm;

- subcutaneous fat has a low echogenicity. Fat is visualized as hypoechoic structures oval elongated shape, separated by hyperechoic linear strands - layers of connective tissue that creates the impression of delicately;

muscles adjacent to the side plates of the thyroid cartilage and is defined as a solid hypoechoic layers, oriented with the original neck with mixed linear alternating regions of low and increased echogenicity, which creates the impression of iscertainly;

- thyroid cartilage located between the muscles of the neck and movable elements of the larynx. The right and left plates of cartilage are visualized in the form of echopositive continuous structure is angled about 45° and a thickness of 1-3 mm;

- movable elements of the larynx is visualized in the form of two hypoechoic symmetric structures of triangular shape with two sides of the lateral plates of the thyroid is Rama. The vertices of the triangles facing the corner of the thyroid cartilage, and the base - to the peripheral sections of the side plates of cartilage;

the lumen of the larynx has the appearance of an anechoic mass with patterns.

The study of soft tissues and organs of the neck is carried out by exposure to ultrasonic waves with a frequency of 7.5 and 5.0 MHz sequentially in scan mode. Make a comparison of the degree of echogenicity of the studied organs in relation to the echogenicity of others is not affected tissues and organs visually in the research process.

Changing modes of ultrasonic influence, in particular the change of the sensors, allows to obtain a more detailed picture of the anatomy and pathology of the soft tissues of the neck, to assess the degree of tumor. The alternate use of sensors with different frequency allows to find a compromise between the highest frequency and penetration. In particular, the use of a sensor with a frequency of 7.5 MHz with less penetrating power compared to the probe 5.0 MHz, decreasing the grain of the image can improve the differentiation of tissues and facilitates the detection of small tumors.

Repeated transition of research from the frontal plane scanning in frontolateral with individual choice of the angle sensor 45° 135° d who has the power to avoid errors in the assessment of the patterns of the soft tissues of the neck.

The presence of a tumor characterized by a change in the degree of echogenicity in relation to the echo characteristic of normal tissues. A malignant tumor can be identified as areas of decreased echogenicity (hypoechogenicity), increased echogenicity (hyperechogenicity) or as a structure consisting of patches of varying degrees of echogenicity.

For example, an ultrasound of the thyroid cartilage korkiala the lamina of the thyroid cartilage in the norm is defined as echopositive not intermittent linear structure. When the tumor spread on plates of the thyroid cartilage identifies fragments in the form of a discontinuous linear ekopozytywny structures.

Clinical applications of the proposed method achieves the effect of visualization of body affected by the tumor, to assess the extent of the disease, to assume organ identity and to verify diagnosis using fine-needle aspiration biopsy under ultrasound control. In particular, this method gives the opportunity

diagnosis of the anterior larynx cancer, tumors, growing into the lumen of the body, and the thickness of the thyroid cartilage

- clarify the distribution process in the soft tissues of the neck and involvement in the process vessels and tissues of the thyroid gland

- differential diagnosis of tumors that originate in the larynx and thyroid gland

- clarify the availability of the inflammatory component or infiltrative tumor growth.

The advantage of the proposed method is the lack of negative effects on the body that allows you to repeatedly perform the inspections. The inventive diagnostic method may find application in medical practice as an independent research method, and in combination with other methods.

The method is as follows.

The study was conducted in an ultrasonic diagnostic apparatus, operating in real time. In particular, can be successfully used universal ultrasonic diagnostic apparatus Biomedica company.

The study was conducted in the horizontal position of the patient lying on his back. To ensure contact between the surface of the sensor with the surface of the skin use gel, conductive ultrasound.

Linear transducer with a frequency of 5.0 MHz with a short focus set in the right and left chin areas alternately and smoothly move along the trachea down to the level of the upper pole of the right and left thyroid lobe and isthmus perpendicular to the trachea. Then make the change of the sensor and perform the same procedure using a sensor with a frequency of 7.5 MHz dinamicheskoi focus. So make an idea about the structure of soft tissues of the neck cross-section (frontal plane).

In the next step, conducting a study in frontolateral plane. For this purpose, the sensor is returned to 90° and perform a scan parallel to the trachea. The scan angle is chosen in the range from 45° 135° depending on the individual anatomical features of the structure of the thyroid cartilage and modify the study to achieve a clear visualization. This position is optimal for macro-structural assessment of the soft tissues of the neck. As in the previous step, research, produce a change of sensors.

Clinical examples.

1. Patient W., 71 years old was admitted to the Department of head and neck tumors Cancer clinical hospital №1, Moscow, diagnosed with a tumor of the larynx, suspected cancer. After tracheostomy. According to the inspection and examination of the array of the larynx increased due to the phenomenon expressed hendropriyono. Amid swelling of the mucosa of the lumen of the larynx completely obturated by tumor originating from the left half. Conducted 5-fold biopsy of tumors of the larynx are not allowed to obtain verification process. The patient underwent ultrasound of soft tissues of the neck of the inventive method, in which it is established, that in the soft parodentium who has a tumor mass of heterogeneous structure, associated with the larynx and trachea, breaking plates of the thyroid cartilage and reaching vascular and nerve bundles on both sides on the sides. Cytology of soft tissue derived cells squamous cell cancer. Thus diagnosed with larynx cancer with spread to the hypopharynx, soft tissue neck T4N0M0.

2. Patient M., 61 years was admitted to the Department of head and neck tumors Cancer clinical hospital №1 of Moscow with complaints about the presence of tumor on the anterior surface of the neck in the throat, shortness of breath during physical activity. Data inspection and fibroadipose was uninformative. According to the ultrasound, soft tissues of neck, conducted by the present method, in the soft tissues of the neck to the left region of the larynx is determined by the bulk tumor mass of irregular shape without clear boundaries, located posterior and anterior to the left lamina of the thyroid cartilage, decreased echogenicity, size HH mm Lamina of the thyroid cartilage fragments visualized in the form of intermittent ekopozytywny structures were destroyed. Regional lymph nodes are not changed. Performed fine needle aspiration biopsy of the tumor. Cytologically: squamous cell carcinoma. When clear clinical and ultrasound picture of the disease was diagnosed with larynx cancer, stage T3N0M0

Thus, the set of essential features of the claimed invention, namely the alternation of scanning in the frontal and frontolateral planes, the use of two surface sensors with wavelength of 5.0 MHz and 7.5 MHz, the change of the angle sensor 45° 135° provides significant advantages over known methods of the same purpose.

Method for the diagnosis of endophytic malignant tumors of the larynx, including ultrasound examination of the neck, characterized in that the ultrasound is carried out by rotation of the scanning in the frontal and frontolateral planes with surface sensors with wavelength of 5.0 MHz and 7.5 MHz by changing the angle sensor 45° 135° from the chin along the trachea down to the level of the top of the poles and the isthmus of the thyroid gland, and in the detection zone, the echo is different from the echogenicity of normal tissues, diagnose the presence of tumor growths.



 

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