Creation of a robotic complex(RC) with a program for interviewing with illustrations (by the type of presence of similar forms of pathology) of large tumors, a portable USB microscope built into a flexible hose, and a complex body for transmitting pathological changes of visible localization to a touch screen. To detect the activation of early signs of pigmented nevi and superficially spreading melanomas, they were stained with picrofuxin (patent for invention No. 2716811 of March 16, 2020). The survey was conducted in 1638 patients with a trajectory for men and women on a touch screen. The use of RC allowed us to suspect the activation of pigmented nevi, tumors of the skin, oral cavity, thyroid gland and enlarged lymph nodes in 9.03%±1.3 patients, of which 31.08%±1.8 were able to confirm oncopathology during further examination. In the presence of complaints from the stomach on an empty stomach, 107 patients underwent a "breath test" on a Helic scan built into the RC program. The color change in the "breathing tubes" was scanned with fixation on the touch screen, in 29 of them, helicobacteriosis was detected above 10 units. with a load. 17 patients were diagnosed with metaplasia of the 1st and 2nd degree, 4-gastric ulcer and 3-malignant tumor. The results of the survey under the complex program with recommendations were sent via an online connection to the general practitioner.
robotic complex, survey with illustrations, "breath test", USB microscope, picrofuxin
And although malignant tumors are extremely diverse and difficult to diagnose, a lot is known about the risk factors and mechanisms of cancer development, so that now in most cases, not only timely diagnosis and treatment, but also taking an active position in assessing the specific risk, successfully conduct prevention. Тhe doctor should conduct a systematic examination of the patient not when something "hurts", but regularly, when nothing hurts, taking into account the risk groups, gender and age when contacting the doctor for any reason.
Early forms of cancer are preceded by a long period of carriage of oncogenic viruses, Helicobacter pylori and dysplasia, which can be established and cured. With a large flow of information during mass screening, asymptomatic signs of an early focus of developing cancer in organs and systems, the doctor's time limit, often limited to one question "What is Bothering you?". Naturally, asymptomatic pathological processes with this approach, against the background of concomitant diseases, go into the background. And this is the weakest link in primary diagnostics, which requires the creation and implementation of digital technologies that increase "oncological alertness" at the primary stage [1,2].
The goal is to find solutions to the problems of increasing the effectiveness of detecting oncological pathology and risk factors by using a robotic complex for a system survey-examination of the main localizations to reduce the time spent by the doctor prior to his appointment.
Material and methods. Robotic intelligence is a technique that allows you to implement algorithms for multi-purpose and system analysis in an expert program. The study of the effectiveness of the robotic complex was carried out on the basis of the created program of a system survey with illustrations, a touch screen, magnifying diagnostics (including a portable USB microscope with an LED) of visual localities (skin, oral cavity), determination of the "respiratory urease test", evaluation, formation of recommendations for further tactics and transfer to the doctor for an appointment.
Previously, a large-format digital television screen is installed in the waiting hall of the polyclinic, which is associated with the prevention program and explains the tasks of the need to pass the robotic complex ( like a slide show). The survey program of the robotic complex is carried out on the touch screen. At the beginning, the passport data is filled in Fig. 1 (a).
а) б)
Fig 1. Touch screen: a) keyboard for filling in passport data; b) Questions with illustrations of pigmented tumors.
Then follow the questions on the main localizations with illustrations of (melanoma and non-melanoma) tumors (Fig. 2b), precancerous skin conditions, risk factors and other conditions, organ systems, lifestyle and habits
For example:
1. Do you have any skin problems ( sores, cracks, or others)?) formations that have recently:
1. Yes, it is possible to change the shape, color or size
2. Yes, there was a tumor spreading over the skin, in places with raised edges
other changes, sometimes itching
3. Yes, there is an ulcer on the skin that does not heal for more than 3-4 weeks*
4. Yes, there is a formation in the form of a skin-colored plaque with a depression in the center, raised shiny pearlescent edges
5. Yes, there are, but I do not know how to evaluate
6-Yes, there are several signs
7. No, nothing
Fig.2. Precancerous changes and basal cell forms of cancer.
2. Do you have a pigmented spot(s) in the area of the face,back, neck, including the nail bed (without bruising) or other places, including under magnification ?
о Yes о No
Fig.3. Do you have a pigmented spot(s) in the area of the face, back, neck, including the nail bed or other places, including under magnification?
Given the extremely high rate of advanced cases of oral cancer, we integrated a portable USB microscope with an LED into a flexible hose that enters the side of the body of the robotic complex to transmit pathological changes in the skin and oral cavity to the touch screen. Suspicious areas can be zoomed in or out on the screen to detect signs of malignancy.
Fig. 4. Examination of the oral cavity (under the tongue).
On the front panel of the case, a ring is fixed for a container with disposable spatulas in sterile bags in order to displace the mucous membrane of the cheek and tongue for examining the hidden places of the oral cavity.
Для точности оценки пигментных невусов произведена замена увеличительной лупы и зеркала на USB портативный цифровой микроскоп с предварительной окраской пикрофуксином на 7-10 мин [3], позволяющим после впитывания через эпителий выявлять нарушения ромбовидности коллагеновых волокон, появление пигментных глобул и др. выявить первые признаки трансформации пигментного невуса в меланому на экране компьютера.
а) б) в)
Рис 5. Пигментные образования под микроскопом с окраской пикрофуксином: а) USB микроскоп х100; б) Волокна ромбовидно отходят от простого невуса; б) коллагеновые волокна отходят хаотично с точечными включениями.
The survey organizer is a specially trained nurse operator or midwife of the examination room. which includes a robotic system and code registration. The nurse operator helps to answer questions, signs or factors that cause difficulties for the patient. The survey trajectory is based on gender and clarifying factors .
As you know, stomach cancer occupies a leading place among other malignant tumors. The proven cause of stomach diseases is the bacterium Helicobacter pylori. In the presence of the slightest complaints from the stomach and other digestive organs, it is recommended to conduct a sensitive "breath test" based on the "Helik-Scan" (AMA company), built on the front panel of the robotic complex.
Fig.6. Stomach with Helicobacteriosis.
Two "breath tests" were performed on an empty stomach : before taking urea (basal test) and after (with exercise). In case of infection with Helicobacter pylori, a second test (with a load of urea or urea) on the screen, the blue bar in comparison with the basal test significantly increased in proportion to the percentage of ammonia in the exhaled air. The program in the "on line" mode reflected the change the length of the second sample on the screen, respectively, is the infection of the stomach with Helicobacter pylori.
Fig.7. Results of patient P., 42 years old.
In Figure 6-On the right in the upper rectangle, two yellow stripes are visible (the upper one-one end turned blue after basal respiration -4.9 units; the lower one-after exercise-10.8 units).
Results. The studies were conducted in 1,638 patients who applied to the regional clinical oncology dispensary on the "Open Day" and after advertising exhibitions. The use of the robotic complex is suspected: tumors of the skin, oral cavity, thyroid gland, enlarged lymph nodes in (148 patients) 9.03%±1.3, of which (46 patients) 31.08%±1.8 with further examination, oncopathology was confirmed, including 3 patients with melanoma, 5 with basal cell carcinoma and in one case with thyroid cancer and in two with oral cancer. In addition, 8 patients were found to have melanoma-like nevi.
Table 1. Survey results with illustrations and chromo microscopy
|
Localization |
Number of patients with suspected pathology |
Installed |
|
|
Precancerous changes, milano- dangerous nevi |
Malignant diseases tumors |
||
|
Skin |
16 |
8 |
8 |
|
Oral cavity |
11 |
9 |
2 |
|
Lymph Nodes |
19 |
19 |
- |
|
Shields. iron |
44 |
43 |
1 |
|
Moloch. iron |
58 |
56 |
2 |
|
Total |
148 |
135 (8,2%) |
13 (0,79) |
58 patients with complaints of certain phenomena of stomach discomfort were given a "breath test" for 6 minutes the next day, 29 of them had helicobacteriosis above 10 units. with a load. All these patients underwent fibrogastroscopy (FGS) with biopsy for atypical cells and Helicobacter pylori for reliability. 17 patients had metaplasia of the 1st or 2nd degree, 4 had gastric ulcer and 3 of them had malignancy.
All results of the RC program via the local Internet system and recommendations for further tactics should be sent to the attending physician, who, after the necessary additional examination of the patient, established the final diagnosis or referred to the necessary specialist.
Discussion
The RC and preliminary results described in this paper, taking into account the methods of targeted survey with illustrations used in the screening of persons who applied in terms of experimental examination, showed that the detection rate of malignant tumors was 0.79±1.2%, precancerous changes and melanoma-threatening pigmented nevi-8.2± 2.2%. For the accuracy of the assessment of pigmented nevi, the magnifying glass was replaced with a USB portable digital microscope with pre-staining with picrofuxin. Moreover, the melanoma can not be injured and perform a biopsy.
The use of a Helik scan in a complex digital program allows you to determine the causes of gastric discomfort. When the level of Helicobacter pylori infection exceeds 10 units, eradication and fibrogastroscopy are required, in which the detectability of grade 1-2 metaplasia and peptic ulcer disease was 64.7%, including malignancy in 3 cases.
Conclusions:
1. Conducting explanatory preventive work on digital television screens like a "slide show" in the halls of polyclinics increases the cancer literacy of patients, the purposefulness of passing their dispensary examination and the need for screening.
2. The results of the introduction of the robotic complex at the pre-medical stage allows you to save the time of a general practitioner for a systematic examination and identification of cancer risk factors and early forms of cancer (0.79%±1.2), precancerous changes and melanoma-prone pigmented nevi-8.2± 2.2%, the treatment of which is less expensive.
3. Digital intelligent examination is a real breakthrough in the primary diagnosis of risk factors and early forms of cancer, requiring adaptation for each polyclinic and even FAP with some improvement of the program and organization of production of robotic complexes.
1. Cherenkov V. G., Makarov V. A., KostyukovA . Ways of creating artificial Intellect in education and carrying out cancer component ofmedical examination (screening) of the population// MOJ Tumor Research, Wachngton. August 07, 2018, p. 136-138.
2. Cherenkov V. G., Pasevich K. G., Gudkov I. V. Robotic intelligence in the organization of pre-medical diagnostics of the risk of tumor diseases// Russian Journal of Oncology, vol. 25, no. 2,2020, p.72-75.
3. Cherenkov V. G., Pasevich K. G. art. Riss M. E., Naumenko E. S. Method for diagnosing surface-spreading milanomas// Patent for invention No. 2716811 dated March 16, 2020. VNIIGPE.
