RU2284152C1 - Method for predicting the relapse of laryngeal cancer after resection - Google Patents

Abstract

FIELD: medicine, oncology.

SUBSTANCE: the present innovation deals with predicting malignant lesions due to US inspection: it is necessary to carry out ultrasound inspection of cervical area that includes cross-sectional scanning with an ultrasound sensor in frontal plane followed by ultrasound inspection of soft tissues in operated laryngeal part by applying the sensor in area of resected plates of thyroid cartilage by altering the plane of scanning and the angle of sensor's inclination at random. At detecting a contour-restricted structure being characteristic by homogeneous echogeneity at the background of a picture being chaotic by echogeneity one should diagnose the presence of a neoplasm. The innovation enables to detect and differentiate the relapse of the disease or cicatricial alterations in area of operation; specify the flow of the process in cervical soft tissues due to involving in process a nonoperated laryngeal part, cartilaginous plates; carry out nontraumatizing dynamic control for the state of resected organ in on-line mode; fulfill multiple inspections by not subjecting patient's body to negative impacts, radiation loading, among them.

EFFECT: higher accuracy of diagnostics.

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Description

The invention relates to medicine, in particular to the diagnosis of malignant lesions using ultrasound, and can be used to detect recurrence of laryngeal cancer after resection.

Malignant tumors of the larynx occupy first place among tumors of the ENT organs. Diagnosis of tumors of a given localization is usually difficult. This is especially true for monitoring in the postoperative period and the detection of recurrence of laryngeal cancer after resection.

A known method for predicting the recurrence of laryngeal cancer, based on immunological studies of tissue structures in patients with laryngeal cancer (p-t RF №2105308, publ. 02.20.98, bull. No. 5). The known method allows with a certain degree of probability to predict the development of recurrence of laryngeal cancer, but cannot be used to determine the location and boundaries of the resulting tumor.

There is also a method of x-ray diagnosis of tumor neoplasms. However, the known method does not allow a detailed assessment of the state of the operated larynx, to differentiate the elements of the remaining part of the organ, especially with perichondritis. In addition, the radiation dose to which the patient's body is exposed, using this research method, can provoke the development of the disease.

The claimed invention is directed to solving the problem of diagnosing the recurrence of laryngeal cancer after resection.

Technical (medical) results of using the proposed method in clinical practice are:

- the ability to identify and differentiate relapse of the disease or cicatricial changes in the area of surgery;

- the ability to clarify the prevalence of the process in the soft tissues of the neck, involvement in the process of not operated half of the larynx, cartilage plates;

- the possibility of not traumatic dynamic monitoring of the state of the resected organ in real time;

- the ability to repeatedly perform examinations without exposing the patient's body to negative influences, including radiation exposure.

These therapeutic results in the implementation of the invention are achieved by ultrasound examination of the neck. A feature of the invention lies in the fact that they carry out transverse scanning with an ultrasonic sensor in the frontal plane and subsequent ultrasound examination of the soft tissues of the operated half of the larynx, which is carried out by placing the sensor in the area of the resected plates of the thyroid cartilage. In this case, the scanning plane and the angle of inclination of the sensor are arbitrarily changed. If a structure limited by a contour, characterized by uniform echogenicity, is detected, against the background of a picture chaotic in echogenicity, the presence of a neoplasm is diagnosed.

The invention consists in the following.

Ultrasound of the resected larynx in accordance with the generally accepted technique by transverse scanning of the neck in the frontal plane using a surface sensor makes it possible to visually assess the state of the operated and healthy half of the larynx by comparing the degree of their echogenicity. In particular: skin, subcutaneous adipose tissue, rectus muscles of the neck, moving elements of the larynx, as well as a complex of cartilage of the non-operated side and soft tissues of the area of operation. Each of the indicated tissue layers is characterized by its individual degree of echogenicity, and is visualized differently on the monitor screen. At this stage of the study, symmetrical sections of the non-operated half of the larynx and soft tissues, which served as the material for the reconstruction of the operated half of the larynx, are evaluated.

The resected part of the larynx is predominantly filled with scar tissue. In this case, soft tissues after resection of half of the larynx are visualized in the form of hypoechoic heterogeneous areas with echopositive randomly located inclusions.

The next stage is the study of the soft tissues of the operated half of the larynx, placing the sensor in the area of the resected plates of the thyroid cartilage. Due to the absence of a cartilaginous framework on the operated half of the larynx, there is an “acoustic window” that allows you to visualize in detail the macrostructures of the soft tissues of the neck. To achieve better visualization of postoperative changes, the scanning plane and the angle of the sensor are arbitrarily changed depending on the resection method. The complex of displaced soft tissues, including cicatricially altered, loses its structure, which is reflected in the degree of its echogenicity. In particular, in a transplanted muscle, areas of hypoechoicity alternate with areas of hyperechoicity. At the same time, neoplasms have the appearance of an organized, homogeneous in echogenicity and limited by the contour structure, against the background of the picture, chaotic in echogenicity.

When using the inventive methodology with a high degree of probability, tumor or fluid formations can be detected. Repeated transition of the study from one scanning plane to another with an individual choice of the sensor tilt angle makes it possible to avoid errors in assessing the structure of soft tissues after surgery. To clarify the nature of the neoplasm, instrumental palpation is performed using an injection needle under ultrasound control through a defect in the plates of the thyroid cartilage, followed by aspiration biopsy.

Ultrasound in accordance with the claimed methodology should be carried out in the monitoring mode after surgery with an interval of one to three months.

The advantage of the proposed method is the absence of a negative effect on the body, which allows multiple inspections. The inventive diagnostic method can find application in medical practice, as an independent method of research, and in conjunction with other methods.

The method is as follows.

The study of soft tissues and organs of the neck is carried out by exposure to an ultrasonic wave with a frequency of 7.5 MHz. The study is carried out on an ultrasonic diagnostic apparatus operating in real time. In particular, the universal ultrasonic diagnostic apparatus of Biomedica can be successfully used. The study is carried out in a horizontal position of the patient lying on his back. To ensure contact between the surface of the sensor and the skin surface, an ultrasonic gel is used.

A linear sensor with a frequency of 7.5 MHz is installed in the chin area above the notch of the thyroid cartilage plate along the midline of the neck in the frontal plane and is moved downward along the angle of the thyroid cartilage at an angle of 90 degrees. By means of multiple minimal changes in the angle of inclination of the sensor around its axis, the visualization effect of each of the elements of the larynx is achieved: vocal and vestibular ligaments, arytenoid cartilage, moving elements. At the same time, in the transverse plane, symmetric sections of the soft tissues of the operated half of the larynx are evaluated. Thus, they constitute an idea of the structure of the not operated half of the larynx and soft tissues of the resected side.

Then, the ultrasound transducer is moved to the area of the resected plates of the thyroid cartilage, where an “acoustic window” is formed due to the removal of the cartilage tissue fragment. By repeatedly changing the angle of inclination of the sensor, as well as the scanning plane, a detailed study of the resected part of the larynx is performed. If an organized, homogeneous in echogenicity and limited by contour structure is detected, against the background of a picture chaotic in echogenicity, an assumption is made that a relapse of the cancer occurs. To clarify the nature of the neoplasm, instrumental palpation is performed using an injection needle under ultrasound control through a defect in the plates of the thyroid cartilage, followed by aspiration biopsy.

Clinical example.

Patient V., 75 years old, was examined in the Department of Head and Neck Tumors of the Moscow Oncology Clinical Dispensary No. 1 with a diagnosis of laryngeal cancer T1N0M0. Condition after surgical treatment in 1991. Complaints of hoarseness, difficulty breathing, the presence of a tumor on the front of the neck. Inspection and fibrolaryngoscopy data were uninformative. When fibrolaryngotracheoscopy revealed deformation of the larynx, swelling of the mucosa. The sections of the larynx are thickened, the glottis is passable, the lining space is not changed, the trachea is of a normal form. Conclusion: the inflammatory process in the larynx. According to the ultrasound of the soft tissues of the neck, carried out by the claimed method, the larynx is deformed, the moving elements of the left half of the larynx are clearly differentiated. The scaly cartilage is mobile. In the soft tissues of the opposite side, volumetric tumor formation, heterogeneous structure, mixed echogenicity, spreading to the soft tissues of the neck in the upper third of the right and left, the plates of the thyroid cartilage are destroyed, the contours of the tumor are uneven. The size of the tumor is 7.0 × 4.5 × 4.6 cm. The glottis is narrowed to 0.2 cm. Heterogeneous lymph nodes have been identified on the right neck. Tumor aspiration biopsy was performed. Cytologically: poorly differentiated cancer. With a clinical and ultrasound picture, a diagnosis was made - relapse of laryngeal cancer.

Thus, the claimed method has significant advantages compared with known methods of the same purpose and meets the criteria of patentability.

Claims (1)

A method for diagnosing recurrence of laryngeal cancer after resection by ultrasound examination of the neck region, including transverse scanning with an ultrasound probe in the frontal plane and subsequent ultrasound examination of the soft tissues of the operated half of the larynx, which is carried out by placing the probe in the area of the resected thyroid cartilage plates by arbitrarily changing the scanning plane and the angle of the sensor, when revealing a structure limited by a contour characterized by uniform echogenicity, in e paintings chaotic for echogenicity, diagnose the presence of tumors.