Introduction. 199Tl-chloride scintigraphy is used for visualization of malignant tumors and benign lesions including inflammation. Differentiating of them is performed by permanent and independent retention index, but not always effective. Purpose: improve the differentiating of malignant tumors from benign lesions using 199Tl-chloride scintigraphy. Materials and methods. Results of 97 patients’ 199Tl-chloride scintigraphy with 119 regions of hyperfixation in malignant tumors (n=68) and benign lesions (n=51) were studied. Lesions were localized in musculoskeletal system (n=89), in lungs and mediastinum (n=25) and other organs (n=5). Results. Sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 75.0%, 86.3%, 58.1%, 93.2% and 84.0%, respectively using optimal value of permanent and independent retention index RI=0.89 (RI=DR/ER). Significant correlations between retention index (RI) and 199Tl-chloride hyperfixation in early phase of scintigraphy (ER) in group with malignancies (r=-0.70, p=0.00001) and benign lesions (r=-0.76, p=0.00001) were revealed. As a consequence, method for differentiating malignant tumors from benign lesions with optimal dependent relative retention index RI(relative)=RI+0.055-ER and cut-off value RI(relative)=0.98 4 was proposed (sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 83.8%, 86.3%, 73.8%, 92.0% and 85.5%, respectively). Statistically significant (p=0.01) improvement of efficiency of 199Tl-chloride scintigraphy diagnostics in differentiating of malignant tumors from benign lesions using relative retention index (RI(relative)) compared with independent retention index (RI) were revealed by ROC-analysis. Conclusion. The optimal value of permanent and independent retention index for differentiating of malignant tumors from benign lesions are RI=0.89. Efficiency of 199Tl-chloride scintigraphy diagnostic in differentiating of these processes improves using of relative retention index.

The paper presents the results of the combined modality treatment of various malignant tumors considering the maximum medical rehabilitation of patients. There have been described peculiarities of surgery on parotid gland preserving the facial nerve, on maxilla and paranasal sinuses with the recovery of postoperative defects by endoprosthesis from the porous titanium nickelid, gastroplastic surgery and surgery on breast. Feasibility for performing a single-step reparative surgery with the use of the massive metal constructions, endoprostheses and bone plastics in conditions of high radiation dose in orthopedic oncology have been shown. The results of treating the invasive form of uterus cervix cancer with bilateral ovarian transposition, extensive radiation therapy and postoperative gamma therapy (distant neutron therapy, intraoperative electron therapy) improve survival rates and allow one to perform organ-preserving and reconstructive surgery with a high level of medical rehabilitation of cancer patients.