RU2607956C1 - Method for noninvasive diagnosis of genital warts of the external genitalia in women - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynecology, and can be used to diagnose genital warts of the external genitalia in women. Carry out high-frequency ultrasound examination of the external genitalia. In identifying homogeneous hypoechoic or anechoic structures with deformed outer contour in the form of pyramids, waves or flanges, clearly limited from the underlying tissues, and with a decrease in ultrasound density of underlying tissues diagnose genital warts.

EFFECT: method allows to increase the effectiveness of non-invasive diagnosis of genital warts, detect subclinical damage invisible with the naked eye, determine the depth of damage due to usage of high-frequency sensor.

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Description

The invention is intended for non-invasive diagnosis of genital warts (OK) of the external genitalia in women. OK (condylomata acuminata) - a disease transmitted primarily through sexual contact, is caused by the human papillomavirus (HPV). More than half of women and men are infected with HPV from the first 2-3 sexual partners. Autoinoculation and contact-household transmission of infection are allowed, but not well understood. OK appear in the form of exophytic growths mainly in places of maceration - on the internal or external genital organs, perineum and perianal region [1, 2]. In recent decades, the frequency of OK has increased significantly. In Russia, according to TsNIKVI, in 2011 anogenital warts were detected with a frequency of 29.4 per 100,000 population [3]. The etiological factor of OK in 96-100% of cases is HPV 6, 11 types [4].

OK are growths of the papillary dermis of the connective tissue with blood vessels, covered with a flat epithelium with morphological signs of human papillomavirus infection (PVI). They protrude above the surface of the skin and mucous membranes, have a leg, can have a wide base. More often, OK is represented by multiple growths, but can be single. The base is not fused with the surrounding tissues, it is mobile, it can be either soft or dense, the color on the skin is whitish or brown, on the mucous membranes - from pale pink to reddish. On the surface, signs of keratinization are possible. Often all this is accompanied by inflammation, impaired microcirculation, edema.

The clinical-visual method is leading in the diagnosis of skin manifestations of PVI genitalia. Typical OCs are finger-shaped outgrowths of the epithelium with a well-vascularized connective tissue stroma on a thin stalk or wide base in the form of a single nodule or multiple epithelial outgrowths resembling a cockscomb or cauliflower.

Colposcopy (CS) is a highly informative, widely available and inexpensive method for the diagnosis of diseases of the vulva, vagina and cervix, which significantly increases the effectiveness of examination of women. CS should ideally be an integral part of every gynecological examination. CS is considered as the most sensitive method for determining the subclinical form of PVI [5]. The possibilities of CS are limited by false positive (from 4 to 33%) and false negative results (from 15 to 62%) [6].

Examination of the vagina would be more correct to call vaginoscopy, vulva - vulvoscopy, neck - cervicoscopy, but in practice all 3 concepts are combined under the name "colposcopy" [7]. OK have a characteristic colposcopic picture. The lesion is a whitish epithelial formation with finger-shaped outgrowths, giving them an irregular shape. The most important diagnostic criterion is the presence of the correct capillary network in the outgrowths, which is detected after treatment of the lesion with a 3% solution of acetic acid [8]. OK vessels after treatment with a solution of vinegar usually contract evenly and become less visible.

The histological method could serve as the "gold standard" in the diagnosis of subclinical and clinical manifestations of PVI, but it is limited by technical difficulties and invasiveness. Material for the study is obtained by biopsy of tissue OK, which can be performed using an electric or radio wave loop, or by surgical excision [3]. The main cytomorphological signs of HPV are coylocytosis and dyskeratosis, as well as transepithelial lymphocytic infiltration and basal cell hyperplasia and edema of the dermis with expansion of capillaries. In some cases, only secondary signs of HPV are noted: parakeratosis and hyperkeratosis, which can occur in other pathological processes. Coilocytosis is a consequence of the cytopathogenic effect of HPV on keratinocytes, especially on the surface layers (prickly and granular). Coilocytes are oxyphilitic stained epithelial cells with clear boundaries, a pronounced perinuclear clearing zone and numerous vacuoles in the cytoplasm [9, 10].

Today, one of the new promising areas in the non-invasive diagnosis of OK is high-frequency ultrasound (HF ultrasound) of the skin, underlying soft tissues and mucous membranes of the external genital organs. Ultrasound is an affordable, safe, and most common non-invasive method. The most common sensors for clinical use with a frequency of 3.5-12 MHz provide visualization of structures in the deep layers of tissues and internal organs, while the resolution is insufficient to visualize the structure of the skin and mucous membranes. By increasing the scanning frequency to 20 MHz and higher, the image obtained by ultrasound becomes informative for the study of surface structures. It was found that high-frequency ultrasound allows to differentiate layers and structure of the skin. The method is widely used in dermatology [11, 12]. When diagnosing OK, RF ultrasound allows you to visualize changes in the internal structure of the skin and mucous membrane in the form of homogeneous hypoechoic or anechogenic formations with a deformed external contour in the form of pyramids, waves or crests clearly delimited from the underlying tissues, and a decrease in the ultrasonic density of the underlying tissues, which together allows identify subclinical foci of genital warts, invisible to the naked eye, and on visible foci of genital warts, determine the depth of damage, conduct more accurate destruction of genital warts om and thus reduce the number of relapses.

The objective of the invention is the identification of subclinical foci of OK, invisible to the naked eye, and an assessment of the depth of the lesion of larger OK detected during examination.

With high-frequency ultrasound, the patient is placed in a gynecological chair, after applying a special gel, the studied areas of the skin and mucosa of the external genital organs are scanned by a sensor with a frequency of 75 MHz, with OK, a characteristic picture is visualized:

1) deformation of the outer contour of the formation in the form of single or multiple waves and ridges;

2) a clear delimitation of the lesion from the stroma or dermis;

3) a homogeneous hypoechoic or anechogenic education structure;

4) a decrease in the ultrasonic density of the underlying tissues. The combination of these signs allows us to formulate a diagnosis of OK.

To assess the information content of this method, 69 women with no visible signs of OK were examined and 29 with OK. In 7 patients from the group of patients with no visible signs of OK, echoes of condylomas were detected, in 5 of them the diagnosis was confirmed by vulvoscopy after the test with acetic acid. In 3 women from the group of patients with OK, echoes of condylomas were not detected. Thus, the diagnostic sensitivity of the method was 94%. False positive results were noted in 6% of cases. The specificity of the method was 100%. No cases of false negative results were noted. Of 31 patients with detected echo-signs of OK, 15 were histologically verified. The indications for histological examination were large sizes of OK (more than 5 mm in diameter), the presence of signs of inflammation or ulceration. The following are clinical examples describing HF ultrasound OK.

Patient B., aged 23, with multiple OCs located in the vestibule region and around the urethra, was examined. During HF ultrasound scanning over a larger area of the visual field in the vestibule of the vagina and around the urethra, deformation and sharp thickening of the epithelial tissue, deformation of the outer contour of the epithelium in the form of pyramidal waves, maximum thickness (height) up to 3000 μm are visualized. Marked scattering of the signal is noted when using a 75 MHz sensor, the stroma is not visualized. When using the 22 MHz sensor, a clear boundary of the altered epithelial tissue and the underlying stroma is visualized, however, due to the pronounced scattering of the signal, the entire thickness of the unchanged stroma is not visible. Conclusion: echoes of OK vulva.

Surgical destruction of the largest OCs was carried out, followed by histological examination, during which signs of OK were detected in the preparation: coilocytosis, hyperkeratosis.

Patient B. 24 years old with a single OK located on the vulvar mucosa, complaints of itching, pain in the area of the lesions was examined. With RF ultrasound scanning on the vulvar mucosa, many homogeneous hypoechoic and anechogenic masses are visualized, located within the epithelium of the vulva. The outer contour of the formations is deformed, swells in the form of waves and ridges. The lateral boundaries of the formation within the epithelium are not visualized. In the projection of the study, the transverse size of individual formations cannot be measured due to the large size of the latter. The formation is clearly delimited from the stroma, and also slightly deforms it inside. The maximum thickness of formations in the field of research is up to 1450 microns. The internal echo structure is not visible, the ultrasonic density of 2 units, the conduct of the ultrasonic signal in the underlying tissue is reduced. The stroma under the formations is visualized less intensively than the surrounding tissue. The stroma thickness under the formations is 1450 μm. Ultrasonic density 4 units. Conclusion: echoes of OK vulva.

Surgical destruction of the largest OK was carried out, followed by histological examination, during which the sign of OK was revealed in the preparation: coilocytosis.

Patient G., aged 23, with OC located on the skin and mucous membrane of the external genital organs, with complaints of psychological discomfort in front of sexual partners, was examined. In the study area (vestibule of the vagina, the area around the urethra), homogeneous hypoechoic and anechogenic masses are visualized, located within the mucosa. The outer contour of the formations is deformed, swells in the form of waves and ridges. The lateral boundaries of the formation in the mucosa are not visualized. The formations are clearly delimited from the stroma, they slightly deform it inside. The maximum thickness in the field of education reaches 2500 microns. The internal echo structure is not visible, the ultrasonic density of 3 units, the conduct of the ultrasonic signal in the underlying tissue is significantly reduced. The structure of the stroma under the formations is not visualized to the full depth. Ultrasonic density of visible areas 3 units. Conclusion: echoes of OK vulva.

A vulvoscopy was performed, during which colposcopic signs of OK were revealed after a test with acetic acid: whitening of the formations. Next, surgical destruction of the largest OCs was carried out, followed by histological examination, during which the sign of OK was detected in the preparation: coilocytosis, dyskeratosis.

Description of drawings

Figure 1. Scan of the genital warts on the skin of the patient B.

Figure 2. Scan of the genital warts of patient B.

Information sources

1. Strizhakov A.N., Davydov A.I. Gynecology. Lecture course. M .: GEOTAR-Media; 2009.91-97 p.

2. Strizhakov A.N., Davydov A.I., Baev O.R., Budanov P.V. Genital infections. M .: Dynasty; 2003.136 s

3. Rogovskaya S.I., Lipova E.V. Cervix, vagina, vulva. Physiology, pathology, colposcopy, aesthetic correction. M .: Status praesens; 2014.353 s.

4. F. Xavier Bosch, Thomas R. Broker, David Forman, Anna-Barbara Moscicki, Maura L. Gillison, Jonh Doorbar, Peter L. Stern et al. Comprehensive Control of Human Papillomavirus infections and Related Diseases. Vaccine 2013; 31 (suppl.7): h1-h31

5. Gross G. E., Barrasso R. Human Papilloma Virus Infection: A Clinical Atlas. 1997.

6. Zueva, T.P., Karakhalis L.Yu., Penzhoyan G.A., Petrenko S.I. The use of colposcopy to predict dysplasia in patients with human papillomavirus. Materials of the V Regional Scientific Forum "Mother and Child". Gelendzhik; 2011.206-207 p.

7. Rogovskaya S.I. Papillomavirus infection in women and pathology of the cervix. 2nd edition, revised and supplemented. M .: GEOTAR-Media; 2014.50-51 p.

8. Prilepskaya V.N., Rogovskaya S.I., Megevitinova E.A. Colposcopy: A Practical Guide. M .; 2001.100 s.

9. Yakovleva V.A., Manykin A.A. The evolution of the cytomorphological method for indicating human papillomavirus. News wedge. cytol. Of Russia. 2005; 9 (1-2): p. 41-44.

10. Truchetet F. Verrue vulgaire. Ann. Dermatol.Venereol. - 2004. - Vol. 131. P. 217-219.

11. Kawai K. Endoscopic ultrasonography in gastroenterology. 1 ^st ed. Tokyo: NY Igaku-Shoin; 1988: p. 161.

12. Gladkova N.D. Optical coherence tomography in a number of medical imaging methods. Lecture course.

Claims (1)

A method of non-invasive diagnosis of genital warts of the external genitalia in women, characterized in that they carry out high-frequency ultrasound examination of the external genitalia and in the detection of homogeneous hypoechoic or anechogenic masses with a deformed external contour in the form of pyramids, waves or crests, clearly delimited from the underlying tissues, and reducing ultrasound density of underlying tissues is diagnosed with genital warts.

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