RU2119767C1 - X-ray method for diagnosing vulva cancer - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves taking radiogram of vulva tumor by pressing air into soft tissues through syringe needle, making a set of injections in radial direction at 3-4 points 2-3 cm distant from visual boundary of the tumor at 1-4 cm in depth followed by X-ray radiograms in sagittal and both semilateral projections. EFFECT: enhanced accuracy in measuring tumor dimensions; reduced risk of complications after operation; simplified and safe method.

Description

 The invention relates to medicine, namely to x-ray studies in oncology, and can be used in oncogynecology to determine the extent of invasion of vulvar cancer into soft tissues.

 It is known that the inaccuracy of the visual assessment of the degree of spread of the tumor process in vulvar cancer complicated by concomitant inflammatory changes (swelling, nonspecific infiltration, hyperemia) makes it difficult to choose the tactics of surgical treatment. The operations planned for vulvar cancer - vulvectomies - are not always justified. In this regard, there is a need for an accurate diagnosis of the extent of vulvar cancer.

 A known method of pneumotomography of soft tissues (see Wintergalter S.F., Vesnin A.G., Murzin B.A. Radiological diagnosis of soft tissue tumors. - M .: Medicine, 1979, S. 20-22), which consists in the fact that after contrasting with gas, from two opposite points, a study is carried out at a maximum angle of swing of the tube to reduce the thickness of the cut, under the generally accepted regimes of voltage and exposure. On tomograms performed in this direction of "smearing" there is less layering of gas bands on the image of the tumor.

 There is a known method of pneumoentgenography, which we have chosen as a prototype (see Stein F.M. To X-ray diagnosis of soft tissue tumors. Abstract of thesis. Rostov-on-Don, 1966, p. 14-16), including radiography of soft tissues of the trunk, head and neck using carbon dioxide as a negative contrast medium. The introduction of gas was carried out by a specially developed system for one-way gas supply, consisting of a 20 g syringe, a gas reservoir, and an adapter. The needle was inserted into the boundaries of healthy tissues, slightly departing from the edge of the palpable formation, the depth of injection depended on the depth of the location of the tumor. Then, a gas supply system was connected to the needle and gas was injected from two opposite points with respect to the object under study. Gas introduced into the deep layers of soft tissues spread both intramuscularly and in the muscles themselves. In this case, individual muscle bundles exfoliated and a characteristic layered or cirrus pattern was revealed, depending on the structure of the muscles. Against this background, the shadows of pathological formations, bordered by layers of gas, clearly stood out. After the gas was introduced and the needle was removed, a series of radiographs was performed in different projections.

 However, the known methods of pneumoentgenography, despite the information content, safety and simplicity of the study, have drawbacks that limit the possibility of their use.

 The system for introducing gas is rather cumbersome and requires sterilization. Studies are performed only with tumors of the extremities and subcutaneous tumors of the trunk, head and neck. A negative point is the ingress of gas into the subcutaneous fat when gas is injected from two points, since local contrasting causes additional shadowing, with the appearance of subcutaneous emphysema, which lubricates the radiological picture and complicates the interpretation of radiological changes. The aim of the invention is to determine the degree of invasion of vulvar cancer into soft tissues.

 This goal is achieved by the fact that X-rays of the vulva tumors are performed with injection of air into the soft tissues of the vulva through a syringe needle by radially chipping the tumor from 3-4 points at a distance of 2-3 cm from its visual border to a depth of 1-4 cm, followed by radiography in the sagittal and both semi-side projections.

 The invention is new, since it is unknown from the level of medicine in the field of radiography of soft tissues, namely, an X-ray examination of the soft tissues of the vulva was not carried out. The novelty of the method lies in the fact that a tumor that is visually determined on the surface of the vulva is radially chipped in 3-4 places, pumping air through a syringe needle. Air introduced into the layer of soft tissues creates the conditions for the detection of pathological formations, which is especially important for deeply located tumors and the detection of their boundaries.

 The invention has an inventive step, since for a specialist oncologist, the radiologist does not explicitly follow from the level of development of medicine in this area of radiography. Known methods of pneumo-Ro-graphy are limited to the diagnosis of only tumors of the extremities and subcutaneous tumors of the trunk, head and neck. The authors for the first time proposed a method for pneumo-x-ray diffraction of vulvar tumors, both of the surface part of tumors and deeply located in soft tissues, which makes it possible to evaluate the contours of the tumor and to choose the optimal volume of operation in each case.

 Therefore, the proposed technical solution does not obviously follow from the level of development of X-ray diagnostics in this area of oncology; it is unknown in the world or in the Russian (ONG) medical literature.

 The invention is industrially applicable, as it can be used in healthcare for X-ray diagnosis of soft tissue tumors, in particular for pneumo-radiography of vulvar cancer.

 The method is as follows.

 X-ray studies were performed on TUR-1000, TUR-1500, and Hirolux devices. The average technical conditions are 85-80 kV, 10 mA, 0.8-1.0 s, and the focal distance is 100 cm.

 The patient was placed on the table for pictures in the supine position, with her thighs apart. Prior to the study, a 24x30 cm cassette was inserted into the cassette in such a way that the upper edge of the cassette was 2-3 cm above the pubic joint.

 The external genitalia were treated with a solution of furatsilina and alcohol, after which the area of the vulva tumor, determined visually, was easily lubricated with a solution of iodipole. This made it possible, when evaluating the X-ray diffraction pattern, to more clearly identify the boundaries of the visually determined tumor tissue against the background of shadows characterizing the soft tissues of the vulva affected by the tumor and intact (healthy) tissues.

 Then, using a regular 20-gram syringe and a thick needle, a local subcutaneous emphysema was created around the tumor visually determined on the surface of the vulva. To do this, air was injected into soft tissues not affected by the tumor in a volume of ≈20.0 from 3-4 points located at a distance of 2-3 cm from the tumor. The needle was injected to a depth of 1-4 cm. The volume of injected air and the number of injections were determined depending on the size of the tumor visually determined on the surface of the vulva, its shape. The introduction of air into the soft tissues of the vulva was not accompanied by painful sensations. Typically, patients experienced burning, itching, a feeling of heaviness, bursting in this area (perineum).

 After creating local emphysema, X-ray was performed in the sagittal and both semi-lateral projections (according to Gehman-Frumkin). After radiography, approximately one and a half to two hours after the study, the air introduced into the soft tissue of the perineum completely absorbed, the discomfort disappeared, and there was no crepitus symptom. No complications arising as a result of the study were noted.

 Materials of clinical trials for patients according to the proposed "Method for X-ray diagnosis of vulvar cancer."

 According to the above methodology, we examined 82 patients aged 58 to 74 years. In 21 patients the study was performed on an outpatient basis, in 53 in a hospital.

 Most often, the tumor was localized in the region of the labia majora (25.12%) and the labia minora (24.15%), exophytes were noted in the form of growth in 53.62%, and in 29.95% as an ulcer. In 41% of patients, the tumor was within 2-4 cm in diameter, in every 3 patients the tumor exceeded these sizes. The histological structure of the tumor in 81.6% of the patients was represented by squamous keratinizing and in 18.84% - non-keratinized cancer. All 82 patients in the preoperative period underwent endolymphatic polychemotherapy with a mixture of antimetabolites and alkylating chemotherapy drugs.

 The goal of an air-contrasted Ro-Ro study was to determine the extent of invasion of vulvar cancer into soft tissues to select the optimal tactics for surgical treatment: vulvectomy or economical resection of the vulva. All patients of the study group had concomitant diseases that significantly complicated the conduct of vulvectomy, fraught with complications both during the surgical intervention and in the postoperative period. Coronary heart disease was observed in 55.5%, atherosclerosis - 42.9%, hypertension 22.2%, every third woman had liver and biliary tract disease, every sixth osteochondrosis, deforming spondylosis, every tenth diabetes mellitus, gastroenterocolitis.

 All 82 patients were operated on in the gynecological department of the Rostov Research Institute of Oncology. X-ray semiotics of vulvar tumors was studied by comparison with surgical material (macro preparation) and histological examination data.

графия в различных режимах жесткости. После этого больным выполнялась пневмовульвография по предлагаемой методике.Pneumovulvography informativity was controlled by 30 patients of the study group, in whom, after applying contrast to the superficially located part of the tumor,

graphy in various modes of rigidity. After this, the patients underwent pneumovulvography according to the proposed technique.

 There were no complications during the study. In 18 (21.7%) of 82 patients, gas insufflation was accompanied by a burning sensation, bursting, mild itching in the perineum. These subjective sensations did not require additional drug treatment and disappeared completely 2-6 hours after the study. Of the 82 patients, the study data (pneumovulvography) completely coincided with the operational material in 71 patients, the questionable data were in 9 patients, the study was not informative in 2 patients.

 In 9 women who had dubious data (insufficient clarity of the tumor contour), there was obesity of the III-IV stage, fat deposits, which gave additional shadows on the radiographs, made it difficult to evaluate the changes obtained.

 In 2 women whose pneumovulvography turned out to be uninformative, there was also obesity of the fourth century, against which gas insufflation, in our opinion, was insufficient.

 Radiographically on the pneumovulvogram, the superficially located part of the tumor, smeared with I-containing contrast, against the background of gas-insufflated tissues — a denser tumor tissue with fairly clear bumpy contours was clearly distinguished, whereas when x-rayed in the multi-stiff regimes of the tumor border, both its surface part and deep located parts are not clearly visualized.

 The technical and economic effectiveness of the "Method for the X-ray diagnosis of vulvar cancer" is that the use of the method allows you to determine the size, shape, nature of the contours of the tumor and the connection with the surrounding tissues.

 Performing pneumoentgenography allows in each case to determine the optimal volume of the operation, that is, choose between extended and simple or excisional vulvectomy, which in turn reduces the likelihood of complications both during the operation and in the postoperative period. Pneumoentgenography may be an evaluation criterion for the effectiveness of conservative treatment of vulvar cancer. The method is simple, affordable, safe, can be applied to both superficial and deep located vulvar tumors.

Claims (1)

 A method for X-ray diagnosis of vulvar cancer, including pneumoentgenography using a negative contrast medium, characterized in that the X-ray of the vulva tumors is performed with injection of air into the soft tissue of the vulva through a syringe needle, radially chipping the tumor from 3-4 points at a distance of 2-3 cm from the visual border of the tumor to a depth of 1-4 cm, followed by x-ray in the sagittal and both semi-lateral projections.