RU2662709C1 - Method for diagnosing dysplasia and cervical cancer in women of reproductive age - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics and gynecology, oncology, and can be used to diagnose dysplasia and cervical cancer. Evaluate microcirculation in the altered region of the mucous membrane of the cervix by laser doppler flowmetry. Arithmetic mean of microcirculation (M), mean square deviation of the amplitude of blood flow oscillations from the arithmetic average value of the microcirculation index (σ), coefficient of variation (Kv), indicators of neurogenic (NT) and myogenic (MT) tone, shunting index (PN). With a value of M – 21.18 pf.ed, σ – 24.64, Kv – 116.36 %, at normal values of NT – 2.45 Hz, MT – 3.0 Hz and PN – 1.22 Hz diagnose mild cervical dysplasia (CIN I-II). With a value of M – 29.06 pf.ed, Kv – 94.15 %; NT – 1.84 Hz at normal values of MT – 2.79 Hz and PN – 1.51 Hz diagnose severe cervical dysplasia (CIN II-III). With a value of M – 28.06 pf.ed, σ – 24.42, Kv – 94.15 %, MT – 2.56 Hz and PN – 0.99 Hz diagnose cervical cancer in situ.

EFFECT: method provides non-invasive diagnostics of dysplasia and cervical cancer, improves its accuracy.

1 cl, 4 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, oncology and can be used for the diagnosis of dysplasia and cervical cancer.

The following methods are used to diagnose dysplasia and cervical cancer: advanced colposcopy, a smear for oncological and liquid cytology, PCR diagnostics for the presence of HPV of high oncogenic genotype, cervical biopsy.

The quality of the performed colposcopy depends on the training of the obstetrician-gynecologist, the smear examination for oncocytology depends on the correct sampling of the material and the qualifications of the cytologist with errors in the direction of hyper- or hypodiagnosis up to 55% (Cervix, vagina, vulva: Physiology, pathology, colposcopy, aesthetic correction .-- Status Praesens. 2014 .-- 831 p.). The most accurate method is the histological examination of cervical tissue obtained as a result of a biopsy, the completion time of which is from 7 to 10 days.

Thus, at present, there remains a need to develop an effective method for the diagnosis of dysplasia and cervical cancer.

Due to the lack of effectiveness of non-invasive methods for the diagnosis of dysplasia and cervical cancer, a new diagnostic method is considered - a laser blood flow analyzer (LAKK-02) in the cervical mucosa with microcirculation assessment using laser Doppler flowmetry.

In the course of conducting patent information studies, there were no similar diagnostic methods for diagnosing cervical microcirculation using a laser blood flow analyzer in patients with dysplasia and cervical cancer.

The technical result of the proposed method is to increase the accuracy of diagnosis of dysplasia and cervical cancer according to the results of a study of microcirculation of the cervical mucosa, performed using laser Doppler flowmetry.

The essence of the proposed method for the diagnosis of dysplasia and cervical cancer is that using a computerized laser microcirculation analyzer LAKK-02 with one emitter to probe the study area with a wavelength of 0.8 μm, the microcirculation of the vascular bed of the cervical mucosa is evaluated.

An electrode is applied to the altered area of the cervical mucosa and an LDF-gram is recorded for 10 minutes, followed by analysis of the parameters of the LDF-gram and wavelet analysis: average blood flow at recording time intervals or arithmetic mean value of microcirculation index (M pf unit), standard deviation of the amplitude of blood flow fluctuations from the arithmetic mean of the microcirculation index (σ), coefficient of variation (Kv) = σ / M × 100%; neurogenic activity (ON) with reference values of the frequency range 0.02-0.052 Hz; myogenic activity (MA) with reference values of the frequency range 0.07-0.12 Hz; shunt index (PS); NT (neurogenic tone) = σ / An (the largest value of the amplitude of perfusion fluctuations in the neurogenic range; MT (myogenic tone) = σ / Am; MT (inversely proportional to the amplitude of the oscillations of the myogenic range) (Krupatkina A.I., Sidorova V.V. Laser Doppler blood microcirculation flowmetry. Laser microcirculation analyzer for general practitioners “LAKK-02.” - Scientific-Production Enterprise “LAZMA” LLC. - Moscow. - 2005. - 65 p.).

Clinical example 1

Patient X. 38 years old: Ectopia of the cervix.

From the anamnesis: sexual debut at the age of 18, 1 sexual partner, for 6 years used oral contraceptive logest, there were no pregnancies, suffered chronic bilateral adnexitis. Has no bad habits.

A smear for oncocytology from the cervical transformation zone: atypical cells are absent.

According to the results of a laser analyzer of blood flow of the cervical mucosa at 15, 18, 12 and 21 hours, an LDH-gram was obtained with the arithmetic mean values of microcirculation (M-8.0 pf units), the coefficient of variation (Kv - 190.49%), average the quadratic deviation of the amplitude of blood flow fluctuations from the arithmetic mean of the microcirculation index (σ - 15.23), neurogenic (NT - 2.60 Hz) and myogenic (MT - 3.25 Hz) tone, shunt index (PN - 1.25 Hz) corresponding to a healthy cervix.

Conclusion: Almost healthy.

Example 2

Patient M., 28 years old, is concerned about abundant mucous discharge, carriage of HPV 33 serotype.

From the anamnesis: a sexual debut at the age of 18, 4 sexual partners, 2 pregnancies, one timely independent delivery, underwent laparoscopy tubotomy for ectopic pregnancy on the left (2013) and resection of the left ovary for rupture of the corpus luteum cyst (2015), ectopia of the cervix, for 6 months she used KOC yarin. Smokes up to 12 cigarettes per day.

A smear for oncocytology from the transformation zone: changes in the epithelium characteristic of HPV infection, proliferation of the glandular epithelium, groups of ASC-H cells. An extended colposcopy with loop electroexcision of the cervix was performed followed by histological examination of the tissue of the cervix uteri: endocervicosis with epidermis, changes in squamous epithelium, characteristic for mild CIN I-II dysplasia.

When conducting LAC of the cervical mucosa, an LDH-gram of blood flow was obtained with an increase in the arithmetic mean of the microcirculation index (M-21.18 pF units) and the mean square deviation of the amplitude of blood flow oscillations from the arithmetic mean of the microcirculation (σ - 24.64), a decrease the coefficient of variation (Kv - 116.36%), unchanged indicators of neurogenic (NT - 2.45 Hz) and myogenic (MT - 3.0 Hz) tone and shunt rate (PN - 1.22 Hz), corresponding to stagnant blood flow at mild cervical dysplasia ki (CIN I-II).

Conclusion: Moderate cervical dysplasia (CIN I-II). Stagnant type of blood flow.

Example 3

Patient A., 25 years old, turned to a gynecologist for a routine examination.

From the anamnesis: Menarche from 14 years old, established immediately, after 28 days for 5 days, moderate, painless; over the past 2 years, notes abundant and prolonged mucous intermenstrual discharge from the genital tract; sexual debut at 18, is in the first registered marriage, 3 sexual partners. Smokes from 18 years from 10 to 15 cigarettes per day. Repeatedly, bacterial vaginosis, chronic cervicitis, colpitis caused by opportunistic microflora (Streptococcus viridians et agalactiae), sexually transmitted infections (Ureaplasma urealyticum, HPV 16 and 18 serotype) were treated. When viewed in the mirrors revealed an ectopia of the cervix. In smears from the zone of cervical transformation to oncocytology, a cytogram of a pronounced inflammatory process with mild dysplasia (CIN I) was detected, with extended colposcopy, HSIL was diagnosed, loop cervical electroexcision was performed with diagnostic curettage of the cervical canal and endometrial aspiration biopsy. As a result of histological examination of cervical tissue, endocervicosis with epidermis, severe dysplasia (CIN II-III) of the integumentary epithelium and reserve cells was revealed; scraping of the cervical canal - fragments of endocervix without tumor growth; scraping of the uterine cavity - secretory endometrium.

When conducting LAC of the cervical mucosa, an LDH-gram of blood flow was obtained with an increase in the arithmetic mean of the microcirculation index (M - 29.06 pf units), a decrease in the coefficient of variation (Kv - 94.15%) and neurogenic tone (NT - 1.84 Hz), unchanged myogenic tone (MT - 2.79 Hz) and shunt rate (PN - 1.51 Hz), corresponding to stagnant blood flow in severe cervical dysplasia (CIN II-III).

Characteristic signs of severe cervical dysplasia, unlike mild, are an increase in the arithmetic mean of the microcirculation index, a decrease in the coefficient of variation and neurogenic tone, which corresponds to a severe violation of the microcirculation of the cervical mucosa with a stagnant type of blood flow.

Conclusion: Severe cervical dysplasia (CIN II-III). HPV carrier 16 and 18 serotype. Stagnant type of blood flow.

Example 4

Patient S., 41 years old, was referred to a gynecologist-oncologist for cervical dysplasia, with complaints of copious mucous discharge from the genital tract and carriage of HPV 16, 31, 33 serotypes.

From the anamnesis: sexual debut at the age of 18, 2 sexual partners, during the last 6 months she took KOC Janine, 5 pregnancies, 2 independent timely deliveries, 3 medical abortions; gynecological diseases: cervical erosion, small uterine fibroids, internal endometriosis.

The patient underwent rectovaginal gynecological examination, smears were taken from the cervical transformation zone for oncocytology, an extended colposcopy with loop electroexcision and histological examination of the obtained material was performed. Examination in a smear for oncocytology revealed changes in the epithelium due to HPV infection, proliferation of the glandular epithelium, groups of cells with severe dysplasia (CIN III). Histological response of cervical tissue: Cancer in situ.

When conducting LAC, an LDH-gram was obtained with a pronounced stagnant type of blood flow with an increase in the arithmetic mean of the microcirculation index (M-28.06 pf. Unit) and the mean square deviation of the amplitude of the blood flow from the arithmetic mean of the microcirculation (σ-24.42) , a decrease in the coefficient of variation (Kv - 94.15%), myogenic tone (MT - 2.56 Hz) and shunt index (PN - 0.99 Hz).

Characteristic features of cervical microcirculation with Cr in situ were an increase in the arithmetic mean of the microcirculation index and the mean square deviation of the amplitude of blood flow oscillations from the arithmetic mean of the microcirculation index, a decrease in the myogenic vascular tone coefficient and shunt rate, corresponding to stagnant blood flow in Cancer in situ colli uteri.

Claims (1)

A method for the diagnosis of dysplasia and cervical cancer, including the assessment of microcirculation in an altered area of the cervical mucosa by laser Doppler flowmetry, characterized in that the arithmetic mean value of the microcirculation index (M), the mean square deviation of the amplitude of blood flow oscillations from the arithmetic mean value of the microcirculation index (σ ), coefficient of variation (Kv), indicators of neurogenic (NT) and myogenic (MT) tone, shunt index (PS), and with a value of M - 21.18 pF. units, σ - 24.64, Kv - 116.36%, with normal NT indicators - 2.45 Hz, MT - 3.0 Hz and PN - 1.22 Hz, diagnose moderate cervical dysplasia (CIN I-II); with a value of M - 29.06 pF. units, Kv - 94.15%; NT - 1.84 Hz with normal MT - 2.79 Hz and PN - 1.51 Hz; diagnose severe cervical dysplasia (CIN II-III); with a value of M - 28.06 pF. units, σ - 24.42, Kv - 94.15%, MT - 2.56 Hz and PN - 0.99 Hz diagnose cervical cancer in situ.