Assessment the diagnostic accuracy of sentinel lymph nodes lymphoscintigraphy using technetium-99m phytate in breast cancer

Technetium-99m phytate [[99m]Tc-ph] is a readily available radiopharmaceutical and has been suggested as a suitable agent for sentinel lymph node [SLN] detection. In this study, the diagnostic accuracy and false-negative rate of radionuclide SLN mapping using [99m]Tc-ph were investigated. Forty three women [mean age 52.3 years, range 31-74 years], who all had been diagnosed with breast cancer were enrolled in the study. All patients had no palpable axillary lymph nodes and had not undergone exploratory tumor resection or any drug treatment, previously. [99m]Tc-ph was injected peri-tumorally at four sites. Following SLN scintigraphic imaging, the patients were operated. Intraoperatively SLN were detected by a scintillation probe and a blue dye technique. Modified radical mastectomies with radical axillary dissection were performed with excision of the lymph nodes, to evaluate the accuracy of the SLN technique. Intraoperative scinti-mapping identified SLN in 40 of the 43 patients [detection rate: 93%]. Scintigraphically, none of the patients had internal mammary drainage or contralateral axillary involvement. The blue dye detection rate in 23 patients under study was 87% and all lymph nodes detected by the blue dye technique were also detected as "hot" spots in the lymphoscintigraphy. Using pathology as the gold standard, the sensitivity and negative predictive value of scintigraphic lymphatic mapping in detection of SLN by [99m]Tc-ph were 90% and 90.9%, respectively. The same values for blue dye lymphatic mapping were 84.6% and 77.7%, respectively. [99m]Tc-ph used for SLN mapping is readily available, has low cost and gives better results than the blue dye technique. Long-term follow-up is required to assess accurately the incidence of failure in patients with negative SLN and the overall diagnostic accuracy and efficacy of the SLN mapping using [99m]Tc-ph as the radioactive tracer

[Radioiodine treatment effect on lacrimal glands function in patients with thyroid cancer]

There is a limited number of case reports published in the past decade confirming the radio-iodine presence in the tear. These observations as well as reported cases of salivary and lacrimal gland dysfunction after radioiodine therapy stimulated investigators to clarify whether lacrimal gland function can be affected post-radioiodine therapy. Hence we planned a historical cohort study to evaluate this effect. We studied 100 eyes of 50 patients who were referred to the nuclear medicine department of Dr. Shariati hospital from 01.1383 to 02.1384 and had received high doses [accumulative dose: 100-450mCi] of I-131 treatment of differentiated thyroid carcinoma with their latest admission at least 3 months previously. Dry eye symptoms [obtained via a standard questionnaire] and Schirmer I test results [mm/5min] of this group were compared with those of an unexposed group [100 eyes of 50 individuals] matched by sex and age. Cases with another known cause[s] of dry eye were not included in either group. 51% of the exposed eyes and 50% of the unexposed ones revealed at least one of the dry eye symptoms in the questionnaire. Data analysis showed no significant difference between the number of symptoms of two groups, but 2 symptoms [burning, unrelated to light and erythema] were significantly higher in the exposed eyes. From 9 exposed eyes complaining of erythema, Schirmer test result was abnormal only in 2 [one patient]. Also among the 10 eyes with burning symptom [unrelated to light] one patient [2 eyes] revealed abnormal Schirmer test result. The study also demonstrated a significantly lower wetting amount of the Schirmer paper in exposed group compared to others. In the patients undergone radio-iodine therapy, results were 0-4 mm in 21%, 5-9 mm in 20% and 10 mm or more in 59%. These results were seen in the unexposed group in 6%, 17% and 77%, respectively. File review of the 21 exposed eyes with 0-4 mm Schirmer test results revealed presence of the migraine history in five [4 woman] surprisingly and 131I-avid skull metastasis in another patient [2 eyes]. Long-term reduction in the tear secretion from major and/or minor lacrimal glands is seen after high-dose radio-iodine therapy, which seems to be severe in the majority of patients; however these patients complain of dry eye symptoms no more than unexposed population. Conditions such as migraine may be unknown causes of impaired tear secretion and need further investigation

Tc-99m-MIBI in evaluation of myocardial perfusion

Tc-99m-MIBI is an isonitrile derivative used for evaluation of myocardial perfusion in recent years. In this preliminary report, 7 patients with coronary artery disease are evaluated with Tc-99m-MIBI stress planar and spect studies. Good correlation with coronary angiography is observed in these cases. In view of inherent technical problems present with thallium 201, Tc-99m-MIBI is a good alternative in evaluation of myocardial perfusion