Potentialities of ultrasound study in diagnosis of endophytic carcinoma of stomach

The data of studies of 45 patients with gastric cancer are used to consider the potentialities of ultrasonography (USG) in the diagnosis of its endophytic forms. Its use in the diagnosis of "small" gastric carcinomas is evaluated. The USG semiotics of endophytic tumors of the stomach, including its "small" and early forms, is presented. The place of USG in the diagnostic algorithmic of gastric cancer is specified. In the authors' opinion, gastric USG along with traditional X-ray and endoscopic studies should take an appropriate place as it is beneficial in solving a great deal of differential diagnostic problems associated with the intramural spread of tumors.     

Matters of roentgen diagnostics of idiopathic interstitial pneumonia

This article is devoted to roentgen diagnostics of idiopathic interstitial pneumonia. 7 types of idiopathic interstitial pneumonia are described, including clinical, morphological and roentgenological characteristics. X-ray methods are presented as possible techniques for determination of the type of the idiopathic interstitial pneumonia.     

Cancer of the upper stomach: current problems of its diagnosis

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.     

原发性胃淋巴瘤临床与内镜特征分析

目的:探讨影像学检查及胃镜、超声内镜对原发性胃淋巴瘤的术前诊断方法,以提高该疾病的术前诊断率。方法:总结我院经手术及病理证实的21例原发性胃淋巴瘤资料,评估胃镜活检、超声内镜及CT对该病诊断的作用。结果:21例术前CT检查,误诊为浸润型胃癌11例,间质瘤2例,未见明显异常3例。CT术前诊断率为23.8%(5/21)。全部患者均实施胃镜检查,活检病理诊断淋巴瘤14例,胃镜活检诊断率为66.7%(14/21)。其中10名患者实施超声胃镜检查,判断胃淋巴瘤6例、胃癌3例、间质瘤1例;术前诊断率为60.0%(6/10)。结论:胃镜及超声内镜是原发性胃淋巴瘤的主要术前诊断方式;CT扫描能明确有无纵隔及腹腔内淋巴结肿大,为原发性胃淋巴瘤提供诊断依据。     

Current X-ray diagnosis of stomach cancer (comparison of radiologic and morphological methods of investigation)

By using the principles of wide comparisons of the data of radiation diagnosis (routine X-ray study, ultrasonography (USG), CT, MRI) with the morphological findings of resected gastric specimens from patients with endophytic gastric cancer (EGC) (n = 85), the authors propose some points in the problem associated with its diagnosis. They believe that by taking into account the fact that there is an obvious growth of endophytic parietally growing gastric cancer with the concurrent reduction in its intestinal forms, it is necessary to restore current radiation to its leading place, along with endoscopy, in detecting the cancer. The authors makes a highly positive assessment of USG, CT, MRI in addition to routine X-ray study and endoscopy particularly in those cases when difficulties emerge in histological verification of the existing signs of parietally growing cancer. The paper makes indications for USG, CT, MRI concrete. The authors also show how to stage gastric cancer.     

Cost‐effectiveness of Endoscopic Surveillance for Gastric Intestinal Metaplasia

Background: Patients with intestinal metaplasia (IM) are at increased risk for gastric cancer. Endoscopic surveillance has been shown to anticipate cancer diagnosis in an earlier stage. Cost‐effectiveness of endoscopic surveillance in IM patients is unknown. To assess the efficacy and cost‐effectiveness of an yearly endoscopic surveillance in patients with IM. Methods: A decision analysis model was constructed in order to compare a strategy of performing an EGD every year for a 10‐year period (surveillance strategy) following a new diagnosis of IM to a policy of nonsurveillance in a simulated cohort of 10,000 American patients. A 1.8% 10‐year cumulative incidence of gastric cancer in IM patients was estimated from the literature. Endoscopic surveillance was simulated to downstage the detected cancers by 58–84%. Costs of EGD and cancer care were estimated from Medicare reimbursement data. The main outcome measurement was the incremental cost‐effectiveness ratio. Results: The number of EGDs required to detect one cancer and to prevent one gastric cancer‐related death in the surveillance arm were 556 and 3738, respectively. The incremental cost‐effectiveness ratio of endoscopic surveillance as compared to a nonsurveillance policy was $72,519 per life‐year gained (5–95% percentiles Monte Carlo analysis: $54,843–$98,853). At sensitivity analysis, cancer incidence and the rate of downstaging were the most important variables. Conclusions: According to our simulation, the relatively high risk of cancer in patients with IM and the substantial efficacy of endoscopic surveillance in reducing cancer‐related mortality would support the cost‐effectiveness of an endoscopic surveillance program in patients with IM. Further research is needed before implementing it in the clinical practice.     

The necessity of complex use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations

The results of examination of 156 patients were used to consider whether radiation and endoscopic techniques might be used in the differential diagnosis of gastric ulcerations. The necessity of their complex use is shown. Evidence is provided for that the understanding of intramural changes at the site of ulceration should underlie the interpretation of visual changes in the gastric mucosa. An algorithm has been developed for the rational and effective use of radiation and endoscopic techniques in the differential diagnosis of gastric ulcerations. The algorithm is shown to be highly effective in the correct interpretation of the pattern of an identified ulceration (98.4% specificity). Ultrasound and computed tomographic semiotics of benign and malignant gastric ulcerations is presented.     

A Community-Based,Case-Control Study Evaluating Mortality Reduction from Gastric Cancer by Endoscopic Screening in Japan

Aims

Although the incidence of gastric cancer has decreased in the last 3 decades, it remains the second leading cause of cancer death worldwide. In Asian countries, the burden of gastric cancer has remained, and cancer screening is normally expected to reduce gastric cancer death. We conducted a community-based, case-control study to evaluate the reduction of mortality from gastric cancer by endoscopic screening.

Methods

Case subjects were defined as individuals who had died of gastric cancer between 2003 and 2006 in 4 cities in Tottori Prefecture, and between 2006 and 2010 in Niigata City, Japan. Up to 6 control subjects were matched by sex, birth year (±3 years), and the residence of each corresponding case subject from the population lists in the study areas. Control subjects were required to be disease-free at the time when the corresponding case subjects were diagnosed as having gastric cancer. The odds ratios (ORs) were calculated for those who had participated in endoscopic or radiographic screening before the reference date when the case subjects were diagnosed as having gastric cancer, compared with subjects who had never participated in any screening. Conditional logistic-regression models for matched sets were used to estimate the ORs and 95% confidence intervals (CIs).

Results

The case subjects consisted of 288 men and 122 women for case subjects, with 2,292 matched control subjects. Compared with those who had never been screened before the date of diagnosis of gastric cancer in the case subjects, the ORs within 36 months from the date of diagnosis were 0.695 (95% CI: 0.489–0.986) for endoscopic screening and 0.865 (95% CI : 0.631–1.185) for radiographic screening.

Conclusions

The results suggest a 30% reduction in gastric cancer mortality by endoscopic screening compared with no screening within 36 months before the date of diagnosis of gastric cancer.     

Role of digital X-ray study in the current diagnosis of gastric cancer

The authors attempted to assess and provide evidence for the expedience of using a digital radiography CR system in clinical gastroenterology. The prerequisite for this was the results of large-scale diagnostic studies of different organ and systemic diseases. The authors underline the specific features of application of this digital system: the latter allows several analogue X-ray apparatuses to be transformed to digital ones, provides economic efficiency as compared with apparatuses with the direct digitization of an image, shows telemedical prospects, and has low radiation loads as evidenced by research and experimental studies even in comparison with green systems, which makes the use of these digital systems in X-ray gastroenterology highly tempting. Based on a great body of data from 126 studies, the authors could show the effectiveness of the digital radiography CR system in the diagnosis of gastric cancer, demonstrate a modernized approach to formatting an obtained digital image, the possibility of postprocessor treatment that can enhance the validity of existing X-ray symptoms. This all permitted the authors to recommend using the CR systems in the diagnosis of gastric cancer, by taking into account the current obvious predominance of its morphological diffuse and mixed forms and corresponding difficulties of their endoscopic diagnosis.     

Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

窄带成像技术联合放大内镜在早期胃癌诊断中的价值

目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy,NBI-ME)在早期胃癌诊断中价值。方法:115例早期胃癌患者行NBI-ME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查。所有患者接受内镜下治疗,术后行病理活检。分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率。结果:115例患者纳入本研究,最终术后切除病理示低级别上皮内瘤变(low-grade neoplasia,LGIN)16例,高级别上皮内瘤变(high-grade neoplasia,HGIN)30例,分化型胃癌59例,未分化型胃癌10例。NBI-ME诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为98.0%、81.3%、97.0%、86.7%、95.7%,内镜活检的对应值分别为82.8%、87.5%、97.6%、45.2%、83.5%。NBI-ME诊断早期胃癌的敏感度及准确率均明显高于内镜活检(P0.05)。结论:NBI-ME对早期胃癌具有较高诊断价值。     

Early detection of gastric cancer after Helicobacter pylori eradication due to endoscopic surveillance

Background

Helicobacter pylori eradication therapy is commonly performed to reduce the incidence of gastric cancer. However, gastric cancer is occasionally discovered even after successful eradication therapy. Therefore, we examined the prognosis of gastric cancer patients, diagnosed after successful H. pylori eradication therapy.

Materials and Methods

All‐cause death rates and gastric cancer‐specific death rates in gastric cancer patients who received successful H. pylori eradication treatment was tracked and compared to rates in patients who did not receive successful eradication therapy.

Results

In total, 160 gastric cancer patients were followed‐up for up to 11.7 years (mean 3.5 years). Among them, 53 gastric cancer patients received successful H. pylori eradication therapy prior to gastric cancer diagnosis. During the follow‐up period, 11 all‐cause deaths occurred. In the successful eradication group, the proportion of patients with cancer stage I was higher. The proportions of patients who received curative endoscopic therapy and endoscopic examination in the 2 years prior to gastric cancer diagnosis were also higher in the successful eradication group. Kaplan–Meier analysis of all‐cause death and gastric cancer‐specific death revealed a lower death rate in patients in the successful eradication group (P = .0139, and P = .0396, respectively, log‐rank test). The multivariate analysis showed that endoscopy within 2 years before cancer diagnosis is associated with stage I cancer.

Conclusions

Possible early discovery of gastric cancer after H. pylori eradication due to regular endoscopic surveillance may contribute to better prognosis of patients with gastric cancer.     

Application of endoscopy in pediatric and adolescent gynecology

Early proper diagnostics and treatment of developmental age pathologies in most cases facilitate correct sex organ development, as well as reproductive functions formation. To make the foregoing possible, it is necessary to apply minimally invasive and safest methods like vaginoscopy, hysteroscopy and laparoscopy. The main application field of vaginoscopy and hysteroscopy in pediatric and adolescent gynecology is the diagnosis and treatment of vulvar and vaginal pathologies and developmental anomalies of sex organ. The laparoscopy is becoming a more and more popular method in the treatment of adnexal tumors in children, due to its little invasiveness, quick recovery and less severe pain complaints after the surgery. The application of these endoscopic procedures should always be preceded by the complex noninvasive diagnostics, such as ultrasonography and magnetic resonance imaging. The endoscopic procedures facilitate wide-ranging diagnostics and simultaneously therapeutic management, ensuring minimal invasion and high safety of the surgery. They should be considered diagnostics and treatment of choice in the pathology of vulva, vagina, developmental anomalies of sex organ and adnexal tumors in patients of the developmental age.     

To differential diagnosis of esophageal cancer and other diseases with the similar clinical symptoms, by using traditional X-ray study

The principal purpose of the paper is to assess the role of the X-ray section of current radiation diagnosis in obtaining objective information and interpreting it in esophageal cancer. The study was methodically based on its serial studies, by comparing the data of clinical, radiation, and endoscopic diagnosis with those of morphological studies of the biopsy specimens taken at resection for cancer of the esophagus and the upper stomach, and histologically examined them in diseases running with the similar clinical symptoms. The complex of radiation techniques included traditional X-ray study (compact filling, double contrasting). A specially developed procedure that allowed physicians the opportunity to examine the cardioesophageal area in the fragmentary fashion was used during morphological studies. In cancer of the upper stomach, the lower esophageal segments were also involved in the process in 79.9%. It should be also noted that this number of observations includes some cases that clinical symptomatology and endoscopy strongly suggest cancer of the lower third of the esophagus. The authors have arrived at the conclusion that the present-day X-ray semiotics of esophageal diseases running with the similar clinical symptomatology permits their differential diagnosis just before the use of endoscopy and histology of biopsy specimens and that the unique advantage of radiation diagnosis over endoscopy is to specify the initial site of a tumor, namely, to detect primary gastric damage in cardioesophageal carcinoma.     

Survival Analysis of Patients with Interval Cancer Undergoing Gastric Cancer Screening by Endoscopy

AimsInterval cancer is a key factor that influences the effectiveness of a cancer screening program. To evaluate the impact of interval cancer on the effectiveness of endoscopic screening, the survival rates of patients with interval cancer were analyzed.MethodsWe performed gastric cancer-specific and all-causes survival analyses of patients with screen-detected cancer and patients with interval cancer in the endoscopic screening group and radiographic screening group using the Kaplan-Meier method. Since the screening interval was 1 year, interval cancer was defined as gastric cancer detected within 1 year after a negative result. A Cox proportional hazards model was used to investigate the risk factors associated with gastric cancer-specific and all-causes death.ResultsA total of 1,493 gastric cancer patients (endoscopic screening group: n = 347; radiographic screening group: n = 166; outpatient group: n = 980) were identified from the Tottori Cancer Registry from 2001 to 2008. The gastric cancer-specific survival rates were higher in the endoscopic screening group than in the radiographic screening group and the outpatients group. In the endoscopic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer and the patients with interval cancer were nearly equal (P = 0.869). In the radiographic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer was higher than that of the patients with interval cancer (P = 0.009). For gastric cancer-specific death, the hazard ratio of interval cancer in the endoscopic screening group was 0.216 for gastric cancer death (95%CI: 0.054-0.868) compared with the outpatient group.ConclusionThe survival rate and the risk of gastric cancer death among the patients with screen-detected cancer and patients with interval cancer were not significantly different in the annual endoscopic screening. These results suggest the potential of endoscopic screening in reducing mortality from gastric cancer.     

拉曼光谱技术在肿瘤检测中的应用

癌症是威胁人类健康和生命的严重疾病之一,早期诊断与及时治疗是提高癌症患者生存率的最有效途径。激光拉曼光谱技术作为一种非侵入性的检测技术,可以无损伤地提供丰富的分子结构特征和物质成分信息,从分子水平上反映癌变组织与正常组织之间的结构差异,从而可用于癌症的早期诊断。综述了激光拉曼光谱技术在皮肤癌、鼻咽癌、肺癌、胃癌、结肠癌、乳腺癌及前列腺癌诊断中的研究进展,并对拉曼光谱技术在癌症诊断中的发展方向和应用前景作了进一步的展望,为癌症的早期检测和诊断技术的应用研究提供参考依据。     

The state of the veins of the esophagus and the stomach in chronic diffuse liver diseases (based on data from a combined roentgeno-endoscopic and echographic study)

Combined roentgenological and endoscopic investigation was used to study the state of the esophageal submucous veins. Echography was used for investigation of the gastric subserous veins and esophageal abdominal veins. The results obtained indicate that in the presence of portal hypertension there are two types of shunting: via the esophageal submucous (82%) and subserous (18%) veins. In patients with the predominant affection of the esophageal subserous veins x-ray investigation and endoscopy do not allow correct estimation of the presence and a degree of the gastroesophageal shunt. Echography results enable one to arrive at a correct conclusion in all patients.     

Gastric cancer & prospects of cancer in Saudi Arabia peninsula

Gastric cancer is classified to be an aggressive disease with poor treatment outcome, as most cases remain undetected until later stages, wherein surgery and few chemotherapeutics become the only recommended treatment course. The process of cancer development is multistep involving many stages and types of precancerous lesions, and hence, routine monitoring becomes a necessity in those detected with these or exposed to risk factors. Studying the pattern of gastric cancer for any geographical region is also important to control mortality and focus on implementation of efficient management and treatment guidelines. The cause for gastric cancer can be genetic, racial as well as environmental, and hence the pattern of this malignancy differs across geographical regions and between the developing and the developed nations. In case of the Kindgom of Saudi Arabia, very few hospital-based reports have been published highlighting the pattern of gastric cancer, and the associated incidence and mortality rates. However, classified to be one of the most crucial cancer forms in Saudi Arabia, research pertaining to epidemiology, presentation and pathological features are limited. Studying gastric cancer occurrence from public health viewpoint is important also because eradication of causative agents like those that H. pylori has also shown been not reduce the risk of cancer development among individuals with atrophic metaplastic gastritis. In case of Saudi Arabia, many inherent risks for this malignancy exists like waterpipe smoking and shift in diet pattern from the traditional Mediterranean diet. Our review focusses on pattern of gastric cancer on a global scale in comparison to scenario in Saudi Arabia. The aim is to encompass all of the less stressed upon facts about this malignancy in the Kingdom, paving way for future work in this regards.     

胃癌腹膜转移的细胞学及分子生物学检测进展

胃癌是常见的肿瘤之一,在消化道肿瘤中占首位。胃癌的临床病变缺乏特异性,大部分患者就诊时已发生了转移,多数病例就诊时已为进展期或晚期。腹膜转移是胃癌最常见的转移形式,胃癌的腹膜转移是造成患者预后差的主要原因,因此,及时地诊断腹膜转移,从而采取相应治疗,对提高患者术后生存率具有重要意义。     

To the ways of the most reasonable implementation of digital radiography into the practical public health of the Russian Federation

The main idea of the authors' paper is to propose the most reasonable way of actively introducing the digital principle into the traditional roentgenological section of radiation diagnosis. For this, a luminophore digital radiography system has been chosen. The authors of the paper give a full-scale assessment and appropriate recommendations for its use. The paper essentially discusses the entire complex of matters that permit assessment whether its sound use is possible in regional and municipal health care systems. This is both a section devoted to a dose load, by making a comparative assessment of luminophore radiography and "the green system" and a study of different clinical diseases (456 cases). In their study, the authors have applied an original principle in the formation of an image obtained and some other approaches in order to make a comprehensive assessment of this method. In the authors' opinion, luminophore radiography has a variety of advantages. Firstly, this technique can be simultaneously applied to several nondigital apparatuses, including those available in the ward and it shows a rather diagnostic effectiveness and economic profitability, yields a qualitative image of varying density tissues upon single exposure, and has some other capacities of the CR system as a digital technique. All this things considered, the authors consider that luminophore radiography may be one of the main ways of introducing a digital technique into the conventional roentgenological section of radiation diagnosis at the level of regional and municipal heath care systems.