The diagnostic value of radiological methods in colorectal villous tumors
Science Articles / / April 27, 2016
Igumenov AV Filippov, DY, Turutin AD, GATAULLIN IG
City Clinical Hospital №1, Tolyatti Kazan State Medical Academy
Due to the high risk of malignant transformation of villous tumors of the colon, their early diagnosis and timely treatment are part of measures to reduce the incidence of colon cancer.The choice of method of treatment and outcome in patients with colorectal villous tumors, largely depend on the data obtained at the preoperative stage.Therefore, introduction of diagnostic methods that allow as soon as possible to establish the clinical diagnosis and accurately determine the prevalence of the process in the intestinal wall and beyond is important.
aim of the study: Rate diagnostic value of transrectal ultrasound (TRUS), ulgrasonografii (kolografii) colon and computed tomography of pelvic organs in colorectal villous tumors.
kolografiyu Ultrasound performed during a colon irrigation water.For the ehokolografii used transabdominal Convex probe with a frequency of 2.5 to 7.5 MHz.
The study used machines Toshiba, Aloka, Brul & amp;K, Panther 2002, HDI-4000 ATL "Philips".
The study was conducted according to the protocol, which included the following sonographic features that characterize villous colorectal neoplasm:
- irregular thickening of the intestinal wall
- a violation of the nature of layering the walls
- echo-positive education
- roughness, contour deformation
- lack of symmetry defeat
- narrowing of the intestinal lumen
computed tomography performed after preliminary comprehensive study as an additional method for suspected tumor infiltration.
Results: The method of transrectal ultrasound study examined 48 patients;of these, 40 (83.3%) showed tumor of the rectum with evidence of villous tumor in 3 (6.3%) - a neoplasm of the rectum with signs of infestation, and 5 (10.4%) patients were defined parameters unchanged ultrasound picture.Because detected
tumors of the rectum 2 (4.7%) tumors were circular in nature, 18 (41.3%) took more than half the circumference of the intestine, a 1/2 - 23 (53.4%);extent of identified tumors ranged from 2 to 6 cm
in 40 (93.1%) patients with tumors of the rectum were found with signs of villous tumor:. irregular thickening of the intestinal wall, echo-positive education, roughness, contour deformation, lack of symmetry of the lesions, luminal narrowingintestine.
have W (6.3%) patients with tumors of the rectum with signs of infestation were found: violation of nature wall layering, irregular thickening of the intestinal wall, echo-positive education, roughness, contour deformation, lack of symmetry of the lesions, narrowing of the intestinal lumen.2 of them are located in nizhneampulyarnom department, 1 in sredneampulyarnom department.
We believe that this type of ultrasound is a valuable diagnostic method to solve these diagnostic problems:
- determine the presence of intraluminal formation of 1 cm in diameter..
- to assess the extent of tumor;
- determine the degree of damage to the intestinal wall;
- determine the depth of infiltration of the bowel wall;
- identify metastases adrectal lymph nodes.
ultrasonic method kolografii examined 48 patients.Of these, 43 (89.6%) of the patients showed signs of intraluminal growths without disturbing the bowel wall lamination, 5 (10.4%) patients - symptoms of the invasive nature of colorectal neoplasms.
CT scan performed in 26 patients.The main radiographic criteria of colon cancer by computed tomography were: the presence of intraluminal formations, circular narrowing of the affected segment, rough contours in the site of the lesion.
endorectal sonography results were compared with findings operating, the results of macro- and microscopic examination of the resected drugs.Coincidence ultrasound and pathologic diagnosis of colon cancer during transrectal ultrasound was observed in two cases of 2 (100%);during kolografii - 5 out of 5 cases (100%).
coincidence of endoscopic and postoperative diagnoses were noted in 51 of the 75 cases was 68%.The most common malignancy was observed in the form of creeping villous adenoma - 25 adenomas malignancy was observed in 12 cases (48%), while, at the nodal form villous tumor of the 50 adenomas malignancy was diagnosed in 6 (12%).
choice of method of treatment and outcome in patients with colorectal tumors, is largely dependent on the data obtained at the preoperative stage.
predominant surgery in group I was endoscopic removal of the tumor - 16 (59.3%) cases in group II - transanal excision - 22 (45.7%) cases.All patients who have undergone removal of villous colorectal neoplasms was observed as outpatients.Endoscopic control was carried out as follows: 1 year - 1 every 3 months;2 and beyond - sigmoidoscopy 2 times a year, fibrocolonoscopy 1 once a year.
recurrent disease was diagnosed more frequently in group I and amounted to 40.7%, while in group II relapse noted in 8.3% of cases.A smaller percentage of tumor recurrence in patients of Group II, on - apparently due to more complete preoperative examination, including transrectal ultrasonography and kolografiyu that allowed most accurately assess the prevalence of process, both in the length and depth of invasion into the intestinal wall, which allowed us toperform a radical operation, the corresponding lesion volume.
Thus, endorectal ultrasound, ultrasound kolografiya, computed tomography can determine the presence of intraluminal formation of the rectum by 1 cm. In diameter, to evaluate the extent of tumor process, determine the degree of damage to the intestinal wall, determine the depth of bowel wall infiltration, detect metastases adrectal lymph nodes.Conducting comprehensive preoperative examination, including endorectal sonography, ultrasound kolografiyu, computed tomography and immunohistochemical methods for the study reduced the number of local recurrences from 40.7% to 8.3%;and increase the number of organ surgical interventions.
Conclusion: In a study of patients with colorectal villous tumors, it is recommended to include in the diagnostic algorithm, in addition to conventional methods, transrectal ultrasound, ultrasound kolografiyu, a CT scan of the pelvic organs to select the appropriate treatment strategy.In the presence of indirect signs of invasive growth, operative treatment in compliance with the principles of cancer.