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EndoUSI: an important argument for effective treatment

January 11, 2019

Endoscopic ultrasonography, or endo-USI is a study combining two different methods carried out simultaneously and with one device.

During endoscopy, the doctor can bring the sensor closer to the object of study and, using ultrasound, obtain a clear picture of the pathology of the digestive tract. Other diagnostic methods, such as CT, MRI or traditional ultrasound, do not allow obtaining images with the same high information content and clarity as with endoUSI. Besides, there is another huge plus: endoscopic ultrasonography carries no risk of X-ray exposure and there is no risk of serious complications.

In the countries with developed medicine endo-sonography is an important study prescribed and conducted for the patients very often. And in Ukraine, unfortunately, not all the doctors know about such a method, that is why they rarely recommend it. At the same time, it is simply impossible to overestimate the effectiveness, accuracy and informational content of endoUSI for many diseases.

According to National Comprehensive Cancer Network (NCCN guidelines), endoultrasonography is a part of the list of obligatory studies for such diseases:

- stomach cancer. It is applied for specification of the disease stage. Further treatment tactics depends on this, the need for preoperative (neoadjuvant) chemotherapy is determined, the amount of surgical intervention is calculated, the possibility of tumor excision endoscopically with full preservation of the stomach is being studied;

- oesophageal cancer. It helps specifying the disease stage. At confirmation of the early stages the treatment is in endoscopic tumor removal;

- rectal tumors. The need for preoperative radiotherapy is considered. In cancer of the initial stage, the possibility of endoscopic removal of the tumor instead of an operation with stoma removal is determined.

A very important direction of endoultrasound application is diagnostics of submucosal masses, - Vadim Korpyak, LISOD endoscopist, says. – These are benign or malignant tumors that are often detected during endoscopic examinations in the esophagus, stomach, duodenum or rectum. Submucosal formations are located in the depth of the organ wall, endoscopically such a tumor looks like a small wart or thickening, platform (mucosa) above which is absolutely not changed. When biopsy of such formations often get a conclusion about the normal mucous on the surface. And what is hidden in the depths - remains a mystery. As far as the majority of these tumors are benign ones, the patients are most often recommended follow-up. However, if it is malignant, this tactic leads to the fact that the formation easily curable at the initial stage becomes incurable over time.  Endosonography gives the possibility to differentiate benign formations from malignant ones, to evaluate the possibility and to define the way of endoscopic excision, as well as to take biopsy from formation”.

To confirm the diagnosis in most cancer diseases, a biopsy is required, that is, obtaining a fragment of tumor tissue. Study results allow specifying the formation origin and the stage of its differentiation (aggressiveness). An immunohistochemical analysis is also conducted, thanks to which chemotherapy can be selected more accurately, focusing on the sensitivity of the tumor to certain groups of chemotherapy drugs or to targeted therapy - the most effective way to treat common cancer processes. For most tumors, biopsy is easy. But with a number of tumors (pancreas, lymph nodes of the mediastinum and retroperitoneal space), endosonography is practically the only or the least invasive way to obtain material.

Often, such a biopsy is performed during a low-impact surgical intervention (laparoscopy, mediastino- or thoracoscopy). But if the medical institution does not have the opportunity to conduct the procedure, then without histological verification the patient loses his chance for high-quality treatment, and with it for recovery or long-term remission. It happens so only because neither the patient, nor his doctor know about the possibility of conducting endoultrasonographic fine-needle aspiration (EUS FNA).

If to prescribe treatment only taking into account the patient’s medical history without conducting biopsy, you can make a mistake,”   Vadim Stepanovich emphasizes. – And this can be confirmed by the example. Three patients, each of whom had a history of treatment for cancer of different locations (skin, colon and breast cancer), turned to control CT or PET-CT, and a mediastinal tumor was found in each of them.

The majority of oncologists under such circumstances will suspect the tumor metastasis, the patient was treated from. But after execution of EUS FNA a previously known cancer was confirmed only in one case (rectum). In the second case a new tumor was detected – lungs cancer, and in the third case – not a tumor process at all (sarcoidosis)”.

Taking into account the level of endoultrasonographic diagnostics in Ukraine, it can be safely called the criterion of modernity and progressiveness of a medical institution. Indeed, only in those clinics where endoUS is used, doctors can follow international recommendations for treating oncological diseases without amendments and various “BUT”. Every patient must obligatory bear in mind not only the specialists’ promises but also take into account the technical capabilities of a particular hospital. It remains to hope that Ukrainian doctors will adopt methods that help save lives all over the world.

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