Sentinel node and radioguided surgery in breast cancer of limited size. Preliminary experience at ASL 1, Massa e Carrara.

The aim of this study was to evaluate the effectiveness of sentinel node (SN) biopsy in breast cancer. Twenty-five female patients classified as T1N0 according to the TNM system of the UICC were evaluated with this procedure from April to October 1999. The day before surgery a subdermal injection of 99mTc-nanocoll within the tissue overlying the neoplastic lesion and subsequent lymphoscintigraphy were performed. In all patients the SN was detected with a radioguided probe during scintigraphy and surgery. Histological examination of the SN for detection of metastases was positive in four patients who subsequently underwent axillary dissection. In the remaining patients with normal SNs no axillary dissection was performed. The preliminary results confirm the validity of the sentinel node procedure.

[A comparison between traditional mammography and digital with storage phosphors]. / Confronto tra mammografia tradizionale e digitale con fosfori a memoria.

Conventional and digital mammographic images obtained with storage phosphors were compared. The digital images were acquired with high-resolution 3rd-generation (HR III) screens and specifically adapted algorithms. The experience was made both on a phantom and in vivo. The phantom study was carried out by comparing conventional with digital radiographs acquired with: a) same kV (28) and same mAs; b) same kV (24) and same mAs; c) 28 kV with 30% mAs reduction, in digital images only. The results obtained upon counting the amount of recognizable details per image demonstrated slight loss of information in digital radiographs only when mAs was reduced by 30%. Two hundred patients were studied; they were divided into four groups according to the type of breast (medium inherent contrast or solid breast) and to exposure factors. After conventional mammography, an additional digital radiograph was performed using one of the three techniques previously employed on the phantom. Separately, 10 ductogalactographies and 10 magnification radiographs of microcalcifications were compared; the same exposure factors were used in these images too. The radiographs were viewed by three expert mammographic radiologists; contrast quality and spatial resolution were investigated and a score was given to each image on a 3-grade scale (insufficient, sufficient, good). The comparison of the mean values obtained showed higher contrast and better enhancement of nodular lesions on digital images, on which, however, the depiction of microcalcifications was worse than on conventional radiographs, especially with lower radiation doses, even though the number of detected microcalcifications was the same.

[Double-contrast enema. Study of the mucosal pattern and the organ profile with conventional and digital methods]. / Clisma a doppio contrasto. Studio del disegno mucoso e del profilo d'organo con le metodiche tradizionale e digitale.

A solid state digital system (FCR 101) was employed in our comparative evaluation of the image quality of conventional versus digital techniques in the study of colon by means of double-contrast enema. Sixty patients were examined with a single AP view, using digital radiography with 100% radiation dose and progressive 50% and 75% reductions; the radiographs thus obtained were then compared with the corresponding conventional ones. The examined parameters were organ profile and mucosal pattern. Each digital and conventional radiograph was evaluated by 2 independent radiologists and a value was given to each parameter i.e., 1 = good, 2 = sufficient, 3 = insufficient. Upon comparison of the average values obtained for digital and conventional radiographs in optimal conditions and with a dose reduced by 50%, the digital technique was seen to give a more detailed and accurate representation of both low-contrast mucosal pattern and of organ profile. With the dose reduced by 75%, a slight increase was observed in background noise which caused a slight loss in image definition, but this did not reduce image readability with respect to conventional radiographs. To conclude, the digital method with a 50% exposure reduction is to be preferred in the examination of the colon, especially in pediatric radiology; furthermore, since this technique allows better detailing at lower contrast, it is to be preferred in the study of the pathologic conditions affecting mainly/only the mucosal pattern--e.g., cancer, ulcerative colitis, Crohn's disease, and so on. An exposure dose reduced by 75% may be used for following lesions previously diagnosed and when a less detailed depiction of the mucosal pattern is enough.