Primary tumor size and the mapped sentinel node: Nuclear medicine in the management of early stage breast carcinoma

A treatment option for early stage breast cancer is nodal evaluation by axillary lymph node dissection (ALND). An alternative to ALND is sentinel lymph node (SLN) biopsy employing radionuclide SLN mapping. This study was designed to investigate the relationship between malignancy spread to the SLN and primary tumor size by reviewing the clinical profile of 20 female breast cancer patients who underwent radionuclide SLN mapping procedure, sentinel lymph node and primary tumor biopsy, as well as axillary lymph node dissection. The accuracy of radionuclide mapping in the identifying the sentinel node and determining the status of the axillary lymph nodes was reviewed. Among the mapped sentinel nodes, 15% were positive for metastatic lymphadenopathy and 85% without malignant spread. The malignant sentinel nodes had a mean size of 5.5 ± 0.87 cm and the negative sentinel nodes had a mean size of 2.95 ±2.2 cm. The SLN identified by radionuclide mapping truly represented the status of the rest of the axillary nodes for the presence or absence of metastatic lymphadenopathy. Primary tumor size is a prognostic factor for cancer spread to the sentinel node. However, the combination of primary tumor histology and tumor size may prove to be a stronger prognostic indicator malignancy spread to the sentinel lymph node.

Parathyroid scintigraphy and gamma probe-guided surgery in the management of parathyroid carcinoma

This paper aims to present one of the rarest types of malignancies, parathyroid carcinoma. Parathyroid carcinoma is an important cause of primary hyper par athyroidism. Diagnostic evaluation of patients presenting with signs and symptoms of hyperparathyroidism consists of serum calcium and parathyroid hormone determination, parathyroid imaging using ultrasound, computed tomography, magnetic resonance imaging, or Tc-99m sestamibi scintigraphy, and histopathologic evaluation of tissues after surgical intervention. Therapeutic management of an identified parathyroid tumor is by parathyroidectomy during neck exploration or radioisotope-guided with the use of a gamma probe. The histology of a resected tumor determines if the initial surgery completes the management, or, in cases of parathyroid carcinoma, if another completion surgical intervention is to be made. This paper will present a patient who has been initially diagnosed with primary hyperparathyroidism and was referred to our nuclear medicine department for parathyroid scintigraphy. The patient underwent MIRP and rapid intraoperative PTH determination. Histopathologic report on the tissues revealed parathyroid carcinoma. The patient underwent a second surgery for definitive treatment. This paper will discuss the clinical role of nuclear medicine in the diagnosis and surgical management of parathyroid carcinoma.