Objective: to compare the data of computed tomography (CT) and diagnostic laparoscopy (DL) in the preoperative estimation of the extension of gastric cancer.Material and methods. Data on 51 patients with a histologically confirmed diagnosis of gastric cancer were analyzed. CT and DL were performed in all the patients at an interval of 1–2 days during their preoperative examinations to determine the stage of a tumor process. Of the 51 patients, 34 (66.7%) were found to have no distant abdominal metastases and underwent radical surgery. CT and DL revealed distant abdominal organ metastases in 17 (33.3%) of the 51 patients. To evaluate the diagnostic efficiency of CT and DL, the investigators calculated the main characteristics (sensitivity, specificity) and auxiliary criteria (accuracy, positive (PPV) and negative (NPV) predictive values.Results. The findings suggested that the diagnostic efficiency of CT in determining the T category was a sensitivity of 86% and a specificity of 92%; and that of DL was 83% and 87%, respectively. CT in diagnosing a regional lymph node metastasis had a higher sensitivity than DL (88% vs. 63%), but a lower specificity than DL (80% vs. 90%). CT diagnosis of peritoneal carcinomatosis exhibited a sensitivity of 46%, a specificity of 97.4%, an accuracy of 84.3%, PPV of 85.7%, and NPV of 84.1%. The symptoms of peritoneal carcinomatosis were ascites, soft tissue nodules along the peritoneum, diffuse induration and thickening of abdominal tissue planes, and increased mesenteric vascularity.Conclusion. The combined use of CT and DL is a current algorithm for examining patients with gastric cancer. It makes it possible to obtain complete information about the extension of the process, to increase the accuracy of preoperative diagnosis and to form a group of patients to undergo radical surgery.
Purpose of the study. To study the patterns of forming an MRI picture of a complete pathological morphological response (pCR) of colorectal cancer a er neoadjuvant chemoradia on therapy (NHLT) based on comparisons with the pathomorphological picture. Patients and methods. Among 130 patients with locally advanced colorectal cancer who received a combined treatment with NHL at A. Tsyb MRRC clinic — a Branch of HMRRC of the Ministry of Health of the Russian Federation within the period 2012–2017 thirteen patients were selected for the study, in whom pCR was achieved, according to the pathological analysis of surgical specimen. MRI was performed on all patients before the NHLT and atier the end (atier 6–10 weeks) of treatment. We analyzed the MRI fi ndings from case histories (prospective assessment) on degree of tumor regression (mrTRG) using a fi ve-point grading scale. Ten of these patients had MRI examinations available for re-review (retrospective assessment), which allowed for a qualitate ve assessment of the signal intensity in T2 mode on a nominal scale, according to which low, medium, moderately elevated and high MR signals were discerned; signal localization was determined relative to the intestinal lumen with conditional selection of the inner and outer layer of the wall, and the outer contour was charactezied (smooth or uneven due to hypointense spicules). The obtained data on the localization of the MR signal of varying intensity were compared with the data of the pathological description of the operating drugs.Results. A prospective MRI assessment of pCR in 77% of cases corresponded to TRG2 and in 92% — y N0. Macroscopically, the pCR in all patients had an appearance of an ulcerative defect of the intestinal wall, to which on T2-WI in 80% of cases corresponded to a moderately elevated MR signal from the inside of the wall, due to necroti c changes and granulations, and in 100% of cases — a low MR signal from the outer layer of the intestinal wall, caused by a more mature connective tissue, the outer contour in 50% of cases was tight due to the desmoplastic reaction; hypo-intensive inclusions corresponded to lime deposits, and “mucous lakes” — inclusions with high signal intensity and clear contours.Conclusion The features of forming MRI picture of the pCR are due to a range of radiation pathomorphosis manifestations, including destructive, regenera ve and infl ammatory processes in the tumor stroma.
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