Abstract Aim: was to evaluate possibilities of puncture biopsy under ultrasound guidance of parasternal lymph nodes in patients with breast cancer. Material and methods: study included 34 patients with breast cancer. Criteria for inclusion in the study were: primary breast cancer with a central or medial tumor localization, and patients under observation after previously undergoing surgical treatment. All patients underwent an ultrasound examination of the breast and regional zones, including the parasternal lymphatic collector. All patients underwent biopsy. Results: in total, 39 parasternal lymph nodes suspicious on secondary lesion were detected, of which 17 (43,5%) lymph nodes had a specific lesion, 22 (56,5%) lymph nodes showed cystological signs of hyperplasia according to results of cytological examination. Parasternal lymph nodes metastases were detected in 16 (47,1%) of 34 patients included in our study. In all cases of specific lesion, lymph nodes were rounded, there was a violation of differentiation of anatomical structures, the absence of a central echo complex, a violation of differentiation and thickening of the cortical layer. In the group of primary patients, 3 (27,3%) patients with metastases in parasternal lymph nodes had distant metastases, remaining 8 (72,7%) patients, due to the lesion of the parasternal lymphatic collector, the stage of the disease were adjusted upwards (stage IIIA). Conclusion: fine-needle aspiration biopsy under ultrasound-guidance in case of suspected secondary lesion of parasternal lymph nodes, can be successfully used to obtain morphological material with minimal traumatic impact, without the use of anesthesia, which will more adequately assess the state of parasternal lymph nodes at the preoperative stage, correctly set the stage of the disease and prescribe the appropriate treatment. References 1. Хоперия В.Г. Тонкоигольная аспирационная пункционная биопсия узлов щитовидной железы: показания, техника, клиническое применение. Украинский научно-практический центр эндокринной хирургии и трансплантации эндокринных органов и тканей МЗ Украины. Номер: 1 (35), 2011 г. С. 57-67. 2. Федотов Ю.Н., Воробьев С.Л., Черников РА. Тонкоигольная аспирационная биопсия в диагностике заболеваний щитовидной железы. Корреляция между заключением цитолога и гистолога, технические аспекты. Клиническая и экспериментальная тиреоидология. 2009. Т. 5. № 4. С. 28-32. 3. Бурдюков М.С., Нечипай А.М. Тонкоигольная пункция под контролем эндоскопической ультрасонографии: осложнения и альтернативы. Российский электронный журнал лучевой диагностики. 2013. Т. 3. № 2. С. 26-37. 4. Марченко М.Г., Трофимов Е.И., Виноградов В.В. Современные методы выявления метастазов рака гортани и гортаноглотки в лимфатические узлы шеи. Российская оториноларингология. 2011. № 1 (50). С. 114-117. 5. TNM Classification of Malignant Tumours, 7th ed. Sobin L.H., Gospodarowicz M.K., Wittekind Ch., eds. New York: Wiley-Blackwell; 2009. 6. V. L. Kovalenko, M. F. Musafirov, R. V. Experience of video-assisted thoracoscopic parasternal lymph node dissection in breast cancer. Dal'nevostochnyj medicinskij zhural 2014 g. [In Russ.] 7. Ujmanov V.A., Nechushkin M.I., Trigolosov A.V.. Petrovskij A.V., Vishnevskaya YA.V., Zajceva A.A. Surgical techniques for morphological assessment of the state of the parasternal lymphatic collector as part of organ-preserving treatment in patients with breast cancer. Vestnik RONTS im. N.N. Blochina RAMN. Tom 23: 3(89), 2012: 29 34. [In Russ.] 8. McDonald E, Haagensen C.D. In: Diseases of the breast. 2nd ed. Philadelphia: W. B. Saunders; 1971. 9. Letyagin V.P., Laktionov K.P, Vysockaya I.V., Kotov V.A. Breast cancer. - M., 1996. - 150 s. [In Russ.] 10. Sinyakov A.G. Videothoracoscopic parasternal lymphadenectomy in the treatment of breast cancer. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. №10, 2014. [In Russ.]
Abstract: Aim: was to evaluate the use of intraoperative ultrasound in examination of patients with liver cancer compared with preoperative diagnostic methods. Materials and methods: the study involved 650 patients who received surgical treatment for the period 1998-2013 years. During surgical intervention, all patients underwent intraoperative ultrasonography (IOUS) of the liver. Results: results of preoperative examination methods were compared with intraoperative data, IOUS and histological examination. Sensitivity and accuracy of IOUS is above all methods of preoperative diagnosis, surgical palpation and is 99.7% and 94.9%, respectively Analyzed causes of mistakes of preoperative methods. These related: long time interval before surgical intervention, diameter of formations less then 2 cm, chemotherapy, presence of concomitant cirrhosis, different location of lesions (subcapsular, on the capsular and on the diaphragm of the liver), benign or non-tumorous liver lesions. Changes of operation volume occurred in 38 % cases, 20 % of them - on the base IOUS data. Conclusions: IOUS provides decisive diagnostic information for the surgeon during the operation which may lead to changes of operation volume, and thus affect outcomes of the disease. Contrast resolution IOUS is actual when oncological operations on the liver are made. Ultrasound professionals should be master of IOUS techniques due to the increasing necessity of its use in clinics dealing with oncological surgery of the liver. References 1. Machi J., Oishi A.J., Furumoto N.L., Oishi R.H. Intraoperative ultrasound. Surg. Clin. North. Am. 2004; 84:1085-1111. 2. Torzilli G., Makuuchi M. Intraoperative ultrasonography in liver cancer. Surg. Onco.l Clin.N Am. 2003; 12: 91-103. 3. Komarov I.G., Komov D.V., Metastazy zlokachestvennyh opuholej bez vyjavlennogo pervichnogo ochaga. [Metastases of malignant tumors without identified primary lesion.]. M, «Triada H», 2002, 63-105 [InRuss]. 4. Kruskal J.B., Kane R.A. Intraoperative US of the liver: techniques and clinical applications. Radiographics. 2006 Jul-Aug; 26(4):1067-84. 5. Silas A.M., Kruskal J.B., Kane R.A. Intraoperative ultrasound. Radiol. Clin. North. Am. 2001; 39:429-448. 6. Lordan J.T., KaranjiaN.D. ‘Close shave’in liver resection for colorectal liver metastases. Eur. J. Surg. Oncol. 2010; 36:47-51. 7. Tinkle C.L., Haas-Kogan D. Hepatocellular carcinoma: natural history, current management, and emerging tools. Biologics. 2012; 6:207-19. 8. Xu L.H., Cai S.J., Cai G.X., Peng W.J. Imaging diagnosis of colorectal liver metastases. World J. Gastroenterol. 2011; 17(42):4654-9. 9. Schmidt J., Strotzer M., Fraunhofer S. et al. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis. World J. Surg. 2000; 24:43-47. 10. Kulig J., Popiela T., Ktek S., et al. Intraoperative ultrasonography in detecting. Scand. J. Surg. 2007; 96: 51-5. 11. Hata S., Imamura H., Aoki T., et al. Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma. World J. Surg. 2011 Dec; 35(12):2779-87. 12. Patel N.A., Roh M.S. Utility of intraoperative liver ultrasound. Surg.Clin. North Am. 2004 Apr; 84(2):513-24. 13. Kaczmarek B., Petka B., Ostrowski M. Usefulness of intraoperative ultrasonography of the liver in patients with colorectal adenocarcinoma. Pol. Merkur. Lekarski. 2003 Mar; 14(81):229-32. 14. Spiliotis J., Rouanet P., Deschamps F., et al. Accuracy of intraoperative ultrasonography in diagnosing liver metastasis from colorectal cancer: evaluation with postoperative follow-up results. World J. Surg. 1992 May-Jun; 16(3):545-6. 15. Piccolboni D., Ciccone F., Settembre A., Corcione F. Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases. Surg. Endosc. 2008; 22:1421-1426. 16. Lordan J.T., Stenson K.M., Karanjia N.D. The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer. Ann. R. Coll. Surg. Engl. 2011 Apr; 93(3):246-9. 17. Yang S., Hongjinda S., Hanna S.S. et al. Utility of preoperative imaging in evaluating colorectal liver metastases declines over time. HPB (Oxford). 2010 Nov; 12(9):605-9. 18. Lin L.W., Ye Z., Xue E.S., et al. Intraoperative ultrasonography in hepatobiliary surgery. Hepatobiliary Pancreat Dis Int. 2002; 1:425-8. 19. Van Vledder M.G., Pawlik T.M., Munireddy S. et al. Factors determining the sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann. Surg. Oncol. 2010 Oct; 17(10):2756-63. 20. Stone M.D., Kane R., Bothe A. Jr., et al. Intraoperative ultrasound imaging of the liver at the time of colorectal cancer resection. Arch. Surg. 1994; 129:431-435. 21. Sahani D.V., Kalva S.P., Tanabe K.K. et al. Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging. Radiology. 2004 Sep; 232(3):810-4. 22. Bloed W., van Leeuwen M.S., Borel Rinkes IH. Role of intraoperative ultrasound of the liver with improved preoperative hepatic imaging. Eur. J. Surg. 2000; 166:691-695. 23. D'Hondt M., Vandenbroucke-Menu F., Preville- Ratelle S. et al. Is intra-operative ultrasound still useful for the detection of a hepatic tumour in the era of modern preoperative imaging? HPB (Oxford). 2011 Sep; 13(9):665-9. 24. Kruskal J.B., Kane R.A. Intraoperative US of the liver: techniques and clinical applications. Radiographics. 2006 Jul-Aug; 26(4):1067-84. 25. Cabula C., Nicolosi A., Calo P.G., et al. Intraoperative ultrasonography in the diagnosis of liver metastasis from gastrointestinal neoplasms. Minerva Chir. 1993; 48:1189-92. 26. Boutkan H., Luth W. Meyer S., et al. The impact of intraoperative ultrasonography of the liver on the surgical strategy of patients with gastrointestinal malignancies and hepatic metastases. Eur. J. Surg. Oncol. 1992; 18: 342-346. 27. Clarke M.P., Kane R.A., Steele G. Jr., et al. Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors. Surgery. 1989 Nov; 106(5):849-55. 28. Kruszewski W.J., Walczak J., Szajewski M., et al., The value of intraoperative liver ultrasound assessment using an intraabdominal probe during laparotomy performed for oncological reasons. Pol. Przegl. Chir. 2013 Feb 1; 85(2):78-82. 29. Liu L., Miao R., Yang H., et al. Prognostic factors after liver resection for hepatocellular carcinoma: a single-center experience from China. Am. J. Surg. 2012, 203:741-750. 30. Liska V., Treska V., Holubec L., et al. Recurrence of colorectal liver metastases after surgical treatment: multifactorial study. Hepatogastroenterology. 2007 Sep; 54(78):1741-4. 31. Tao L.Y, He X.D., Qu Q., et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a case-control study in China. Liver Int. 2010; 30: 215-221. 32. Kane R.A., Hughes L.A., Cua E.J., et al. The impact of intraoperative ultrasonography on surgery for liver neoplasms. J. Ultrasound Med. 1994; 13:1-6. 33. Solomon M.J., Stephen M.S., Gallinger S., White G.H. Does intraoperative hepatic ultrasonography change surgical decision making during liver resection? Am. J. Surg. 1994; 168:307-310. 34. Cervone A., Sardi A., Conaway G.L. Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions. Am. Surg. 2000; 66:611-615. 35. Conlon R., Jacobs M., Dasgupta D., Lodge J.P. The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur. J. Ultrasound. 2003; 16:211-216. 36. Zacherl J., Scheuba C., Imhof M., et al. Current value of intraoperative sonography during surgery for hepatic neoplasms. World J.Surg. 2002; 26:550-554. 37. Luck A.J., Maddern G.J. Intraoperative abdominal ultrasonography. Br. J. Surg. 1999 Jan; 86(1):5-16. 38. Paul M.A., Mulder L.S., Cuesta M.A. et al. Impact of intraoperative ultrasonography on treatment strategy for colorectal cancer. Br. J. Surg. 1994; 81:1660-1663. 39. Leen E., Angerson W.J., O’Gorman P., et al. Intraoperative ultrasound in colorectal cancer patients undergoing apparently curative surgery: correlation with two year follow-up. Clin. Radiol. 1996; 51:157-159. 40. Stone M.D., Kane R., Bothe A. Jr., et al. Intraoperative ultrasound imaging of the liver at the time of colorectal cancer resection. Arch. Surg. 1994; 129:431-435.