Importance of the NLS-Method for Diagnosing Tumorous Diseases of

the Segmented Intestine

L.V. Shaposhnikov,

O.R. Kozshemyakin

We made use of the computer nonlinear diagnosis method (NLS) to identify early phases

of malignant growths in the colon. The results indicated that this method could evaluate

the infiltration depth of the tumor within the intestine wall and allow to diagnosis of

malignant adenopathy which was necessary to make a prognosis and determine tumor

resectability.

The average detection rate of tumors in the colon at the NLS-investigation is around

63%. The sensitivity of NLS in diagnosing malignant lymphadenopathy and segmented

intestine disease is about 65%. It is higher for rectal tumors because a visualizable lymph

node in the adrectal region can be regarded as a malignant one. The detection of lymph

nodes during the NLS investigation may be connected to the existence of an

inflammatory process. However, perecolonic lymph nodes can be more often diagnosed

in patients affected by colonic cancer (71%) than in cases of inflammatory lesions (45%).

The NLS-method can be useful in evaluating the spread of tumor to neighboring organs

and tissues as well as metastatic lesions of the liver, adrenals, lungs, etc. The

NLSinvestigation can be used to:

- Determine resectability and need for presurgical radiation therapy

- Plan radiation field

- Detect complications caused by the tumor such as perforation at a formed abscess or

preobstructive ischemia in patients with fully tumo-occluded intestine lumen.

The NLS-method enables to distinguish tumor and ischemic changes in the wall in 75%

of cases (D<0.425). In most cases the ischemic area is located beside (in closer

proximity) the tumor area, however occasionally an intermediate zone with normal

mucous membrane may be detected. The tumor is mostly defined as an unevenly

chromogenic area of the intestine wall (from 0.8 to 4.5 cm, 2.0 cm on the average). The

ischemic section is largely detected due to a concentric zone of a higher chromogenic

pattern (5-6 points according to Flandler’s scale), with the zone thickness varying from

0.6 to 1.5 cm (1.0 cm on the average). The timorous area is mostly heterochromatic (4 to

6 points) whereas the ischemic area is generally found to be homochromatic (in 70% of

cases).

NLS is very important for diagnosing multiple colonic cancers and has considerable

advantages over colonoscopy because it enables to detect changes more proximal to the

tumor and exactly localize the process in the colon and outside of it. NLS is the only method

to diagnose tumor relapses external to the colon.

It should be taken into account that colon tumor may be mimicked during the

colonoscopy by ileocecal valve, fecal masses, respiratory artifacts or feces-filled

69diverticulum, which is eliminated in the NLS-diagnosis. Colonoscopy does not

discriminate whether a soft tissue formation in the tumor bed is a relapse, so it is very

important that NLS be performed 4 months after the surgery and be repeated every 6

months. A scar tissue, even though it may slightly enlarge initially, should shrink some

time later (about a year after) with its outlines becoming more distinct. Enlarged scar

tissue and lymph nodes should be regarded as an indication for biopsy.

The computer NLS diagnosis method enables to judge the condition of the mesocolon

that can be found by locating mesocolon vessels as a reference point. Some pathological

changes in the mesocolon are related in the first place to organs with which the

mesocolon is linked, such as colon and pancreas.

Computer non-linear diagnosis is a very promising tool for differentiating between

malignant and precancerous colon diseases and some other changes. The NLS-diagnosis

method makes it very easy to detect adenomatous polyps over 0.7 cm in diameter.

However single polyps lower than 2 mm as measured from the colon surface are hard to

detect. Although NLS-diagnosis does not allow to differentiate between hyperplastic and

adenomatous polyps well enough, it can be very reliable in diagnosing lipomas.

In some typical cases detection of colonic cancer does not require any special

preparation, however to make the diagnosis of colon diseases more reliable, it is

advisable to evacuate the bowels by giving the patient an enema a day before and

immediately before the examination.

We performed NLS-investigation of the segmented intestine in the cases of a suspected

colon disease, where it was found difficult to carry out conventional methods of colon

investigation such as irrigoscopy and colonoscopy (because of acute painfulness, enema

incontinence, impossibility of investigating the right regions of the colon or some

suspected early post-surgical complications) and also in the cases of massive extra

organic growth in order to determine the spread of the process and extra organic relapses

in tumor.

In 10 cases we found some signs characteristic of segmental intestine cancer, like

unevenly chromogenic walls of the segmental intestine sized 1.5 to 3.5 cm (4-6 points on

Flandler’s scale) and a spectral similarity to the reference standard process, ‘colon

carcinoma’ (D<0.425). In 2 cases segmented intestine cancer was accompanied by signs of

ileus. In one case a massive tumor originated from the right kidney and involved the

ascending intestine. In other cases we diagnosed a tumor largely located extra

organically with respect to the descending intestine. In one case the dimensional scaling

imaging of the segmented intestine gave reason to suspect a cancerous lesion of the

splenic angle of the colon. To confirm it we repeated the investigation after vegetal

testing ‘colon adenocarcinoma’ which resulted in diagnosing a polyp (D=0.213). In two

cases the NLS-investigation did not produce a convincing evidence of a cancerous lesion of

the segmented intestine (D>0.425) although the colonoscopy data were indicative of a

cancerous disease or a malignant polyp.

70Conclusions

1. Computer nonlinear diagnosis should be used in the cases where a colon disease may

be suspected or where it appears difficult to carry out particular conventional methods

of colon investigation, such as irrigoscopy and colonoscopy, and also in the cases of a

massive extra organic growth in order to define the spread of the process, extra

organic relapses of the tumor and complications caused by tumor or surgical

intervention, which helps solve the issue of tumor operability and therapy approach

choice.

2. Using the NLS-method to diagnose single polyps does not appear efficient, because

for the most part they are hard to detect, and differentiation between hyper-plastic and

adenomatous polyps is impossible.