Radiation diagnosis of tumors at four sites (the lung, breast, stomach, and large bowel) in the organizational and methodological standpoints of practical public health of the Russian Federation

The basic idea of the paper is to put forth today's vision of detecting tumors at four sites (cancer of the lung, breast, stomach, and large bowel) at the level of municipal and regional public health systems. Based on their many years' experience in "contacting" this pathology, the authors characterize the role and significance of basic radiation techniques applied to each of these four tumors, which should be used in their diagnosis. The authors also underline the need for reasonably certifying radiation diagnostic apparatuses for municipal and regional public health systems, which would efficiently combine their diagnostic and economic profitability, which will be able to avoid materializing the potential of expensive radiation equipment by just 15-20% of its built-in efficiency. By taking into account the present epidemiological situation with each of the tumors in question and scientific-and-technological achievements of current diagnostic equipment, the authors underline the need for correcting diagnostic approaches applied in their detection. The paper also presents the opinion of the authors as to selective screening. They are sure that it is impossible without its use to gain even some moderate improvement of the results of diagnosis and hence those of treatment of tumors at four sites, which are all responsible for 50% of all malignancy. The idea that it is necessary to actively return radiation studies to the diagnosis of cancer of the lung, breast, stomach, and large bowel runs throughout the paper. As applied to tumors at each of these sites, the authors express their opinion as to their radiation diagnosis. Naturally, they could not ignore the fact that the authorities of medical industry in our country should take an active part in the solution of organizational problems touched upon in the paper.     

Outpatient screening and its place in better detection of breast tumors

The authors state their opinion on this problem by analyzing their 5-year use of their programme specially developed for detection of breast disease, mainly cancer, among females visiting specialized rooms of non-mammological profiles (gastroenterology, endocrinology, rheumatology, pulmonology, neurology, cardiology, hematology, nephrology, etc.) in the consulting polyclinics of regional (territorial) hospitals and large city hospital-polyclinic complexes. In this period, mammographic studies were made in 9169 women included into a breast cancer-risk group. Of them 1370 young female patients with well-developed glandular tissue that makes mammographic diagnosis of presumed masses difficult underwent breast ultrasonography. Abnormalities were found in 6092 (66.44%) patients. Breast cancer and nodal benign masses (including cysts and fibroadenomas) were detected in 278 (3.03%) and 669 (7.30%) women, respectively. The detection rates of unpalpable breast malignant and benign masses carcinomas were 0.4 and 3.03%, respectively. The findings allow the authors to recommend their proposed screening programme for wide use in large regional (territoreal), city, and town polyclinic complexes.     

Potential use of radiation diagnosis of esophageal achalasia

The prime objective of the paper is to attempt to reevaluate the potentialities of current radiation diagnosis of esophageal achalasia. Moreover, its main idea is to assess the procedure of a traditional X-ray section of radiation study. In the authors' opinion, the main motivation of writing this paper was the emergence of new recent potentialities of radiation diagnosis, including its traditional X-ray section in gastroenterological pathology, as well as a considerable body of information on esophageal achalasia (144 cases). The tasks to be solved in the paper include the differential diagnosis of esophageal achalasia and cardioesophageal cancer, as well as the basic capacities of radiation diagnosis to help clinicians in characterizing the changes caused by medical and surgical treatments for this disease. The authors consider that the obtained volume of necessary information on this abnormality rather frequently encountered in esophagogastroenterological pathology can be increased by applying the current possibilities of radiation study and mainly its traditional X-ray section.     

Current problems in the diagnosis of gastric cancer

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.     

Methodological features of magnetic resonance imaging mammography

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.     

Preventive health care, 1999 update: 3. Follow-up after breast cancer

OBJECTIVE: To make recommendations to physicians who provide follow-up care for women who have been treated for early-stage breast cancer. OPTIONS: Combination of blood tests, bone scans, liver echography and chest radiography for detection of distant disease; physical examination with or without mammography for detection of contralateral breast cancer; and physical examination with or without mammography for detection of ipsilateral recurrent disease after breast-conserving therapy. OUTCOMES: Survival, disease recurrence and quality-of-life measures for distant disease, local recurrence of disease and disease in the contralateral breast. EVIDENCE: A MEDLINE search for relevant articles published between January 1966 and January 1998 with the MeSH terms "breast neoplasms" and "neoplasm recurrence" (local and distant) with limits to "human" was done. A subsequent MEDLINE search using the MeSH terms "breast neoplasms," "neoplasm recurrence," "local/diagnosis" and "mammography" was done to address issues of mammography. The literature search was reviewed by a medical librarian and 2 breast cancer specialists to ensure completeness. BENEFITS, HARMS AND COSTS: Breast cancer is the most common cancer in Canadian women and is the second leading cause of death after lung cancer. Even with early-stage breast cancer, recurrence after treatment for primary breast cancer is frequent. Traditionally, follow-up has been felt to facilitate early detection and improve survival. Randomized controlled trials (RCTs) have shown that routine screening (blood tests and diagnostic imaging) for distant disease does not alter survival or quality of life over routine physical examination. In an underpowered secondary analysis of RCT data, the detection of contralateral breast cancer did not affect survival. However, there have been no RCTs examining the role of mammography and physical examination and their effect on survival in the detection of contralateral breast cancer. The sensitivity and specificity of mammography after local excision and radiotherapy is unknown. There have been no RCTs examining the role of mammography or physical examination, or both, and their effect on survival in the detection of ipsilateral breast recurrence. VALUES: The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care. A high value was placed on interventions that changed survival. When evidence was available, high value was also placed on interventions that affected quality of life. RECOMMENDATIONS: There is good evidence not to include blood work and diagnostic imaging as part of screening for distant disease (grade E recommendation). There is no evidence to suggest that mammography decreases mortality by detecting ipsilateral disease in the conservatively treated breast; however, there is indirect evidence that it may be beneficial (grade C recommendation). There is no direct evidence to suggest that physical examination or mammography, or both, should be used to detect contralateral breast cancer; however, there is indirect evidence that it may be beneficial (grade C recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care.     

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.     

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.     

Age as a factor in breast cancer knowledge,attitudes and screening behaviour.

OBJECTIVE: To determine whether there are age-related differences in knowledge, attitudes and behaviour with respect to breast cancer and whether the differences reflect the age-specific Canadian recommendations on breast cancer screening. DESIGN: Telephone survey. SETTING: Two cities and five towns and their surrounding areas in Alberta. PARTICIPANTS: The age-specific, randomly selected sample comprised 1284 women aged 40 to 75 years who did not have breast cancer. Of the 1741 eligible women who were contacted, 1350 (78%) agreed to participate; 66 were excluded because of age ineligibility or a history of breast cancer. MAIN OUTCOME MEASURE: Frequency of knowledge, attitudes and behaviour with respect to breast cancer, by age group. RESULTS: Knowledge of breast cancer risk factors was generally low and decreased with age. Few women were aware of the Canadian recommendations on breast self-examination, physical examination of the breasts by a health care practitioner and mammographic screening. Older women believed they were less susceptible to breast cancer than younger women and were less likely to have positive attitudes toward screening. Self-examination was performed 9 to 15 times per year by 424 women (33%), and 810 (63%) had been examined by a health care professional in the past year. Although 664 (52%) had undergone mammography, the proportion decreased with age after age 59. The main barriers to mammography were lack of physician referral and the woman''s belief that the procedure is unnecessary if she is healthy. CONCLUSIONS: Education is needed to increase breast cancer knowledge, promote the Canadian recommendations for early detection of breast cancer and decrease negative beliefs about the disease. Changes in the behaviour of women and physicians are needed to increase the use of breast self-examination, clinical breast examination by a health care professional and mammographic screening. Reaching women in the upper range (60 to 69 years) of the target group for mammographic screening should be a focus in promoting early detection of breast cancer.     

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.     

Some problems of radiation diagnosis of colon cancer

The paper gives the view of the author who is based on his many-year experience in studying a role of radiation diagnosis of colon cancer. It shows it necessary to enhance the significance of radiation diagnosis. More attention should be given to the traditional section on the current radiation study of the large bowel: to irrigoscopy and single double contrasting. By taking into account the labor-consumption of irrigoscopy, the author suggests that the procedure should be simplified without losing its diagnostic capacities. However, he considers single double contrasting of the bowel to be the optimum technique of traditional X-ray study of the bowel in detecting its tumors. Pneumocolonoscopy and iliocecal node study of the ileocecal angle are given in the paper as supplementary techniques of traditional X-ray study of the large bowel. Emphasis is also placed on the role of radiation diagnostic techniques, such as ultrasound diagnosis, X-ray computed tomography, and magnetic resonance imaging. By highly appreciating their significance in the diagnosis of colon cancer, the author believes that they should play a role of important, but additional ways of detecting this pathology. By pointing out the excellent capacities of fibrocolonoscopy, as applied to the problem discussed in the paper, the author does emphasize the certain limitations of this technique, by taking into account that its application can cause some complications. The author's opinion that the obvious increase in the incidence of endophytic carcinomas drastically enhances the role of their radiation diagnosis, but by obligatorily correcting currently available principal methodic and semiotic directives, runs through the entire paper.     

钼靶X线摄片联合肿瘤相关标志物检测对乳腺癌的诊断价值

目的:探讨乳腺钼靶X射线摄片与血清糖类抗原15-3(CA15-3)、癌胚抗原(CEA)和骨桥蛋白(OPN)联合检测对乳腺癌的临床诊断价值。方法:选择在我院经手术和病理证实为乳腺癌的患者60例作为研究组,另选取60例健康体检者作为对照组。分别检测两组的血清CA15-3、CEA和OPN水平,并采用乳腺钼靶X射线检查。比较X射与血清学检测单独检测及联合检测的阳性率。结果:研究组患者血清CA15-3、CEA及OPN水平均显著高于对照组,差异具有统计学意义(P0.05);血清CA15-3、CEA、OPN和钼靶X射线摄片联合检测的敏感性显著高于单独检测,差异具有统计学意义(P0.05)。结论:对乳腺癌患者进行钼靶X射线摄片及肿瘤相关标志物检测可提高阳性检出率,有利于乳腺癌的早期诊断及治疗。     

Mainstream breast cancer radiology perspective

Clinical breast-imaging tests must be fast, sensitive, specific, add information not otherwise available to clinicians at a reasonable cost, and be biopsy-capable. Mammography, breast ultrasound and imaging guided breast core biopsies and preoperative needle localizations are most often used in breast imaging facilities around the world. This article will describe mammography and breast ultrasound in current clinical practice for breast cancer detection, diagnosis, staging, image-guided biopsy, and for evaluation of response to neoadjuvant chemotherapy.     

Cost-Effectiveness of Breast Cancer Control Strategies in Central America: The Cases of Costa Rica and Mexico

This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica''s population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50–70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40–70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible socioeconomic barriers.     

全数字化X线摄影联合MR动态增强检查诊断早期乳腺癌的临床价值研究

目的：分析早期乳腺癌的全数字X线摄影与MRI影像学表现,评价全数字X线摄影联合MRI检查在早期乳腺癌诊断中的临床价值。方法：回顾性分析2009年10月至2012年5月在我院经穿刺或手术病理证实为早期乳腺癌的42例患者的临床资料,术前均行数字X线及动态增强MR检查,比较两种方法单独使用和联合使用的诊断乳腺癌的准确率。结果：全数字化X线摄片诊断早期乳腺癌的准确率为69．0％（29／42）,动态增强MR检查为95．2％（40／42）,两者比较差异有统计学意义（P〈0．05）;两者联合使用诊断早期乳腺癌的准确率为97．6％（41／42）。结论：动态增强MR检查对早期乳腺癌的诊断价值明显优于全数字X线摄影,但后者对微小钙化显示较好,两者联合可提高诊断正确率,尤其对多腺体型和致密型乳腺的早期乳腺癌的检出具有重要的价值。     

Screening for breast cancer in females at the level of regional (territorial, republican) clinical hospitals: organizational and methodological aspects

The paper deals with a special screening for breast cancer in female visitors of the consultative-and-diagnostic units (CDU) of regional (territorial, republican) clinical hospitals in the Russian Federation. The study was conducted in the CDU of the Moscow Regional Clinical Research Institute that in addition to its clinical researches acts as a regional clinical hospital for the Moscow Region. The basic idea of this screening is firstly that specialists of such-level CDU attended by many women requiring various consultations obligatorily give multifaceted counseling. Secondly, such polyclinic complexes have a required set of technical devices, such as as radiomammographs, ultrasound apparatuses, etc. In other words, there are prerequisites for providing a present-day screening, without spending any extra money. This screening has been made at the Institute since 2002. A total of 2724 risk-group females and 4222 female patients with the clinical signs of breast space-occupying lesions were examined. Its procedure including the formation of risk groups has been developed by means of a specially designed questionnaire. A comparative analysis of the results of these examinations gives preference to the screening diagnosis of this pathology. This all makes the author recommend this screening for its use in all 89 regions of the Russian Federation, by understanding that this can partially solve the problem of a screening for breast cancer in women in general outpatient care health facilities at the municipal level. Moreover, any attempts to mage a screening diagnosis of tumorous lesions at this level of today's health care become particularly relevant in the light of the governmental program to be implemented, which focuses on municipal public health that is one of its main goals.     

全数字化X线摄影联合MR 动态增强检查诊断早期乳腺癌的 临床价值研究

摘要目的：分析早期乳腺癌的全数字X 线摄影与MRI影像学表现,评价全数字X 线摄影联合MRI 检查在早期乳腺癌诊断中的 临床价值。方法：回顾性分析2009 年10 月至2012 年5月在我院经穿刺或手术病理证实为早期乳腺癌的42例患者的临床资料, 术前均行数字X线及动态增强MR 检查,比较两种方法单独使用和联合使用的诊断乳腺癌的准确率。结果：全数字化X 线摄片 诊断早期乳腺癌的准确率为69.0%(29/42),动态增强MR 检查为95.2%(40/42),两者比较差异有统计学意义(P<0.05);两者联合使 用诊断早期乳腺癌的准确率为97.6%(41/42)。结论：动态增强MR 检查对早期乳腺癌的诊断价值明显优于全数字X线摄影,但后 者对微小钙化显示较好,两者联合可提高诊断正确率,尤其对多腺体型和致密型乳腺的早期乳腺癌的检出具有重要的价值。     

Approaches to improving breast cancer diagnosis using a high resolution,breast specific gamma camera

Mammography remains the gold standard in breast cancer detection, although there remains a challenge for improvement in sensitivity of breast cancer detection and diagnosis. Although mammography is the most frequently utilized examination to screen for breast cancer, which has resulted in a reduction of breast cancer mortality, still some cancers are unable to be visualized on mammographic images. Mammography films are interpreted using an anatomic approach. A new approach to breast cancer diagnosis utilizes a breast specific gamma camera to measure radiotracer uptake of abnormal tissue in the breast in patients with an abnormal mammogram or palpble mass using technetium sestamibi. Images are taken using the same positioning techniques as mammography for comparison of both types of images. Multi-Institutional trials using a traditional gamma camera demonstrated potential for this approach. However, the inability of traditional gamma camera intrinsic resolution and non-optinuized breast imaging limited scintimammography. Therefore, a breast specific, high resolution gamma camera was developed to overcome these limitations.Results of clinical studies evaluating BSGI are promising and are increasingly being used. Additionally, means for minimally invasive imaging-guided acquisition of tissue are being developed so that biopsies will be avaibles for areas of interest based on radiotracer uptake.Breast specific gamma camera nuclear imaging of the breast is a developing and increasingly utilized approach to improving breast cancer detection and diagnosis.     

妊娠期乳腺癌的治疗进展

妊娠期乳腺癌是一种特殊类型的乳腺癌。妊娠对乳腺癌的生物学行为可能的影响及诊疗措施对胎儿的影响,使得妊娠期乳腺癌的临床表现、诊断和治疗等有其特殊性。由于妊娠相关的乳腺的生理改变,妊娠期乳腺癌的诊断极具挑战性,导致诊断延误非常普遍。妊娠期乳腺癌患者的治疗策略需要多学科专家一起参与决定,在考虑胎儿安全性的同时尽量与非妊娠乳腺癌患者的标准治疗一致。妊娠期间都可以安全的行乳腺手术。妊娠第一孕期和第二孕期早期可以考虑放疗,但要注意检测胎儿暴露的放射剂量。研究证据越来越支持14孕周后可以安全的行化疗。曲妥单抗和他莫昔芬有潜在的胎儿毒性,不推荐用于妊娠期患者。     

Use of radiothermometry in the screening of nonpalpable breast neoplasms

As compared with other types of malignancies, breast cancer is one of the commonest causes of female death. Mammography used for screening is associated with radiation exposure and it is of low informative value in women less than 35 years of age. Breast ultrasonography (USG) cannot be used for screening of women less than 35 years of age in whom a glandular component is prevalent in the breast structure as it takes much time and should be performed by a qualified specialist. The purpose of our study was to estimate the diagnostic capacities of microwave radiothermometry (RTM) and to determine its place in the early diagnosis of nonpalpable breast neoplasms in medical practice. An integrated study, including RTM, USG, and mammography, was conducted in women at the District Mammology Department, Diagnostic Center Five, and at Branch One of the Female Health Clinic Diagnostic Center in March 2003 to October 2006. The study covered 200 women aged 35 to 71 years who had neither complaints nor clinical signs of a breast nodule and had been found to have neoplasms after undergoing the above diagnostic studies. The studies performed showed that the sensitivity of RMT diagnosis, USG, and mammography was 86.7, 75.8, and 88.3%, respectively. The precision of these techniques was 75.2, 80.0, and 83%.