NEW OPPORTUNITIES OF THE QUALIFYING ENDOSCOPIC DIAGNOSTICS OF PANCREAS NEOPLASMS.

OBJECTIVE: the aim of study was testing and introduction in clinical practice combination of EUS with sonoelastography, fine-needle biopsy and needle-based confocal laser endomicroscopy in advanced diagnostic of pancreatic disease. MATERIALS AND METHODS: in the period from February 2014 to December 2015, we accumulated experience of EUS-FNA in 72 patients mostly with tumor pathology of the pancreas. In 16 cases we used 19G, in 49-22G, and in 7 patients - 25G needles. In 5 patients we used COOK Echotip Procore needle. In 8 cases we performed confocal laser endomicroscopy through the 19G needle (nCLE) in 3 patients with cystic and in 5 - with solid tumors. In 20 patients, there we used.HITA-CHI-PENTAX sonoelastography was performed. RESULTS: There were no complications in EUS-FNA. In all cases we received pathology verification of disease. nCLE results always confirmed by morphological examination of material. In elastography examination normal pancreatic tissue had a equable green-yellow color, in chronic pancreatitis on the same background there were areas of blue seal parenchyma, in the cases pancreatic adenocarcinoma it was marked predominance of blue color scale, in neuroendocrine tumors - diffuse distribution of green and blue areas. Using nCLE in patients with adenocarcinoma revealed the destruction of certain glands, polymorphic nuclei of epithelial cells, with their enlargement, deformation, loss of polarity. Appliance of Procore needle has its technical features, but allowed us to obtain more material with less bloody - due to fewer number of passes. CONCLUSION: Thus, our study confirms the effectiveness of EUS-FNA with sonoelastography and nCLE. It defines objectives for improvement and expansion of the range for their clinical use.

[Endometrial cancer: preoperative staging. The informative value of ultrasound study versus magnetic resonance imaging].

OBJECTIVE: to prospectively study and compare the capacities of magnetic resonance imaging (MRI) and ultrasound study (USS) in the preoperative assessment of the extent of endometrial cancer. SUBJECTS AND METHODS: The study covered 50 patients with FIGO stages IA-IIIA endometrial cancer. A week before surgery, all the patients underwent small pelvic MRI and USS. The results of MRI and USS were compared with the data of a postoperative histological study. RESULTS: The diagnostic value of MRI in preoperatively assessing the local extent of endometrial cancer was 82%, including its sensitivity, specificity, and accuracy; the prognostic value of a positive result and a negative one was as much as 94 and 56%, respectively. The accuracy, sensitivity, and specificity of USS were 70, 72, and 64%, respectively. Its prognostic value of a positive result and a negative one was 84 and 47%, respectively. CONCLUSION: In this study, MRI versus USS showed a higher diagnostic efficiency in the preoperative staging in patients with endometrial cancer. The former promotes the optimization of assessment of the local extent of the tumor, including the depth of myometrial invasion and the spread into the cervix uteri, which affects the algorithm and policy of treatment for endometrial cancer.

[On ultrasound follow-up of patients after pelvic lymphadenectomy].

Ultrasound examination of the peritoneal cavity, small pelvis, iliac lymph nodes and femoral blood vessels (downstream of the blood flow) was performed in 346 patients who had undergone pelvic lymphadenectomy. Post-operative lymphocele developed in 302 (7.2%). However, treatment was required in 98 (28.3%) only. Our strategy of follow-up after pelvic lymphadenectomy facilitated diagnosis and effective excision of lymphocele without resorting to laparotomy due to an improved procedure of ultrasound monitoring.