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

[Preparation of fetal calf serum alternatives and their effects on growth and secretion of hybridoma cell lines]

Providing fetal calf serum [FCS] alternatives as cell culture supplements is an important field of research to compensate for the FCS supply shortage.This study focused on preparation of fetal calf serum alternatives and their effects on growth and secretion of hybridoma cell lines.Outdated human platelet units undergo extraction for its growth factors to be obtained. Human AB blood group plasma was also converted to serum and its growth effect was compared to FCS, hypoxanthine-thymidine [HT] and RPMI1640 as cell culture media and supplement. Cell growth indices were preliminary counting of cells, confluency as surface area of plates filled with cells, and titration of monoclonal anti-A and anti-B blood group antibodies collected from cultured mouse hybridoma cells. Statistical analysis including one sample t-test, logarithmic multiple regression curve fit, and factor analysis was done by SPSS v12 software. The four nutritional supplements of [1] human serum AB [AB], [2] human platelet extract [PLT], [3] equal mixture of AB and PLT [ABP], and [4] fetal calf serum as cell culture were examined on mouse hybridoma anti-A and anti-B monoclonal antibody producer cell lines for cell growth indices and compared with the same indices on RPMI1640 media. The growth-stimulating effects in descending order of values were [1] ABP5%, [2] FCS10%, [3] ABP10%, [4] AB5%, [5] AB10%, [6] PLT5%, [7] ABP20%, [8] PLT10%, [9] PLT20%, and [10]HT; but AB20% inhibited growth of mentioned hybridoma cell lines. The titer of anti-A and anti-B monoclonal antibodies produced by cultured hybridoma on 5 and 10 percent concentration of AB, PLT and ABP compared to FCS5-10% at descending order were [1] PLT5%, [2] PLT10%, ABP5%, ABP10%, AB10%, and [3] AB5%. In general FCS had the following effects on curves of cell growth: [1] the highest increase on slope of multiplication [ascending] phase, [2] the highest increase on slope of death [descending] phase, and [3] the lowest duration of stationary phase. Then, FCS can be appropriate for growth of cells at initial low cell count. Human serum AB, human platelet extract, and equal mixture of both at optimum concentrations [these supplements at high concentrations killed cells] compared to FCS showed [1] decreased slope of multiplication phase, [2] decreased slope of death phase, and [3] increased duration of stationary phase. Thus, AB and PLT may be suitable for continuous cell culture systems in which cell survival during longer times is required. Factor analysis was introduced as a model to evaluate kinetics of cell growth at different supplements

Catheter related artifacts on bone scans: report of two cases

Bone scanning using the 99mTc-phosphate analogs is an established diagnostic modality and a commonly requested radioisotope examination for a variety of pathologies involving the skeleton, such as osteomyelitis, bony metastases, and occult fractures. The bone scan is one of the most commonly requested procedure in most nuclear medicine department. The images show areas of increased and decreased activity usually related to the bone turnover. The bone scan is interpreted by evaluating the pattern of radioactive localization in the skeleton and identifying areas of increased uptake [hot spots] or, less frequently, decreased or absent activity [1]. Unfortunately, the findings are most often very nonspecific and do not tell us the exact underlying cause of the abnormal activity. A variety of factors may change the normal distribution of bone-seeking radiopharmaceuticals. Although most of the times these areas of abnormal radiotracer activities are due to true pathologic bone states, however, it is not infrequent that they are caused by technical errors such as urinary contamination, nonuniformity of gamma camera, and attenuation of activity by foreign bodies. These artifactual causes warrant careful attention to prevent unnecessary interventions. In certain conditions, nonosseous structures other than the urinary tract are seen on the bone scan. For example, there may be localized muscle uptake, such as myositis ossificans, or localization in a pleural effusion. Such serendipitous findings may constitute welcome diagnostic information [1]. On the other hand, soft-tissue uptake may at times hamper interpretation of the study by bringing in artifacts that degrade the quality of the images. Therefore, recognition of patterns of nonbony uptake is important for correct identification of artifacts and accurate interpretation of the scan [1]. This paper presents two cases of artifactual causes of odd radiotracer activity in bone scans. In both cases the artifact is at least somewhat related to an indwelling catheter

[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