[The role of positron emission tomography (PET) in tumor diagnostics and therapy monitoring]. / A pozitron emissziós tomográfia (PET) helye a tumordiagnosztikában és a terápia követésében.

Positron emission tomography (PET) is a medical imaging method belonging to the realm of nuclear medicine. It has been a clinical research tool since the sixties but during the late nineties it became widely utilized in clinical practice too. PET technique requires special radioactive isotopes, which may be generated only in particle accelerators (cyclotrons) and their transport is limited owing to the short physical half-life. PET/CT was born from the combination of PET and CT (computer tomography). The first combined PET/CT scanner began to operate in 1998 and the method has been used in clinical practice since 2001. It is a hybrid (multi-modality) medical imaging equipment which can provide anatomical, morphologic (CT) and functional, metabolic information (PET) simultaneously. PET/CT imaging has gained clinical acceptance mainly in oncology - owing to the attributes of the most frequently used PET tracer, fluoro-deoxy glucose (FDG) - and in a lesser extent in neuropsychiatry and cardiology. The authors in this paper review the basics and key indications of the method, the wider used radiofarmacons, including potential neurological and psychiatric applications, and the possible causes of false positivity and false negativity.

Radioguided occult lesion localisation versus wire-guided lumpectomy in the treatment of non-palpable breast lesions.

The purpose of this study was to compare the two methods-guidewire localisation and the radioguided occult lesion localisation-used in the localisation and surgical removal of non-palpable breast tumours. This retrospective study enrolled patients diagnosed with nonpalpable malignant breast tumours. In this study either guidewire localisation (GWL, n = 69) or radioguided occult lesion localisation (ROLL, n = 321) was used for the detection and removal of the tumours. The two methods were compared with regards to preoperative localisation time, operating time, removed specimen volume, the pathological tumour size, the presence of positive surgical margins and postoperative complications. Furthermore, we have also investigated other factors that could have an impact on the frequency of positive resection margins. The localisation time was significantly shorter in the ROLL group, both with ultrasound guidance (5.7 ± 1.44 min vs. 21.6 ± 2.37 min, p = 0.05) and with radiographic guidance (21.8 ± 3.1 min vs. 41.6 ± 3.75 min, p = 0.021) as well. No significant difference was observed between the two methods in terms of operating time, removed specimen volume and pathological tumour size, or the presence of positive resection margins, or the occurrence of postoperative wound infections. The size of the tumour (ROLL, GWL grps), the presence of a multifocal tumour (ROLL grp), the presence of an extensive in situ breast carcinoma around the invasive cancer (ROLL, GWL grps) and the volume of the removed breast specimen (GWL grp) significantly increased the frequency of positive resection margins. We recommend the use of the ROLL method for the removal of nonpalpable breast tumours as it has a much shorter localisation time, and it is a simpler surgical technique as well.

Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer.

The aim of this retrospective study was to determine the rate of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal in situ cancer (DCIS) of the breast. Between October 2002 and January 2007, 57 patients with DCIS underwent wide excision after radio-guided lesion localization; 53 of them (53/57, 93%) had participated in simultaneous SLN mapping. SLNs were analysed by 250-micron step-sectioning with haematoxylin and eosin staining and immunohistochemical evaluation. The histologic investigation verified pure breast DCIS in 44 cases (44/57, 77.2%), DCIS with microinvasion in eight cases (8/57, 14%) and lobular in situ breast cancer in five cases (5/57, 8.8%). SLNs were identified in 49 cases (49/53, 92.5%) and removed in 48 cases (48/53, 90.6%), i.e. an average of 1.6 SLNs per patient. In four patients (4/53, 7.6%), the SLN biopsy was unsuccessful because of the failure of the radiocolloid substance to migrate. In these cases, axillary sampling was performed. In one case (1/53, 1.9%), only a parasternal SLN was detected; this was not removed. Histologic analysis of the SLNs and the axillary lymph nodes with haematoxylin and eosin or cytokeratin immunohistochemistry did not prove the presence of metastases. The international data and our present results suggest that routine SLN biopsy is not to be recommended in pure DCIS cases. If the final histology verifies an invasive or microinvasive tumour, or if mastectomy is to be performed, SLN mapping is suggested.

Radiopharmaceutical diagnosis of Erdheim-Chester's disease.

Erdheim-Chester's disease is a non-inherited multi-focal lipid-storing histiocytosis of unknown origin without a complete and convincing diagnostic and therapeutic protocol. We have previously suggested diagnostic methods using radioisotopes to evaluate this disseminating disease, but they are neither specific nor selective in this regard. The present hypothesis-driven paper reviewing our case proposes novel approaches involving nuclear medicine and utilizing radiopharmaceuticals to identify this potentially fatal multi-system disease.

[Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer]. / Az orszem (sentinel) nyirokcsomó jelentôsége in situ emlocarcinoma sebészi kezelésében.

INTRODUCTION AND AIMS: The aim of this retrospective study was to determine the rate of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal carcinoma in situ (DCIS). PATIENTS AND METHODS: Between October 2002 and January 2006, 47 patients with DCIS underwent wide excision after radio-guided lesion localisation; 44 of them (93.6%) had simultaneous SLN mapping. SLNs were analysed by 250 micron step-sectioning by H&E and immunohistochemical evaluation. RESULTS: The histological investigation verified pure breast DCIS in 36 cases (76.6%), DCIS with microinvasion in 7 cases (14.9%) and lobular in situ breast cancer in 4 cases (8.5%). SLNs were identified in 40 cases (91%) and removed in 39 cases: an average of 1.5 SLNs per patient. In 4 patients (9%) SLN biopsy was unsuccessful because of the lack of migration of radiocolloid substance. In these cases, axillary sampling was performed. In 1 case (2.3%), only a parasternal SLN was detected; this was not removed. Histological analysis of SLNs and axillary lymph nodes with haematoxylin and eosin or cytokeratin immunohistochemistry did not prove metastases. DISCUSSION AND CONCLUSION: On the basis of international data and our present results, routine SLN biopsy is not recommended in pure DCIS cases. If the final histology verifies an invasive or microinvasive tumour, or if mastectomy is to be performed, SLN mapping is suggested.

[Breast Center--a virtual unit for the multidisciplinary care of breast patients]. / Emlocentrum--virtuális klinika az emlo1betegek multidiszciplináris ellátásáira.

Breast cancer, the most prevalent female malignancy represents a major health problem. Breast cancer mortality may be halved by high quality mammography screening and care. The most efficient screening and the best treatment of patients are available at the breast centers that are equipped with special facilities, expertise and significant experience via the treatment of a high number of patients. Breast center is a virtual unit based on the collaboration of various professionals; a tight institutional frame is not a must. In these comprehensive centers, 150 breast cancer patients per year at a minimum are treated, and the most efficient special treatment methods are available. The core members of the staff are the breast pathologists, the mammographists, the breast surgeons, the oncologists/oncoradiologists, the breast nurses, the technicians and the data managers. An easy access to the service of the non-core members, the plastic surgeons, the psychologists, the psychiatrists and the clinical geneticists is necessary. An optimal collaboration of the various experts may be achieved by a training of the members, regular multidisciplinary meetings and guidelines developed and accepted by all. The requirements of a breast center have been published by the European Society of Mastology (EUSOMA), and a directory of the accredited European breast centers is maintained. The Breast Unit of the University of Szeged has been found eligible by EUSOMA to be included in the directory of the European breast units. Two mammographists do screening-mammography and clinical examination, 2 pathologists perform cytopathological, histopathological and immunohistochemical examinations. Three surgeons operate on more than 250 breast cancer patients per year, and apply wire or isotope (ROLL) localisation in case of non-palpable lesion. A plastic surgeon is available if necessary. In a half of all cases, sentinel mapping is performed with isotope- and blue dye-labelling. Two radiotherapists apply conformal radiotherapy in 250 cases per year, and 2 oncologists perform modern chemotherapies in 200 cases as a yearly average; 50 new advanced/metastatic cases per year require oncological treatments. Breast nurses, a psycho-oncologist and a mental hygienist nurse assist the team. There is access to lymphedema treatment and physiotherapy. The final goal of the program is to provide all women with high quality mammography screening and care, if necessary.

Sentinel node detection in malignant melanoma patients: radiation safety considerations.

BACKGROUND: The surgical management of malignant melanoma necessitates correct sentinel lymph node localization. The highest reported sensitivities are those of lymphoscintigraphy and intraoperative gamma-probe detection combined with a vital blue dye technique. OBJECTIVE: Control of the radiation doses experienced by surgical personnel untrained in the use of unsealed radioactive materials. METHODS: Sentinel lymph nodes were localized, and biopsies were performed in 25 patients with malignant melanoma. Radiation doses during surgery were determined with energy-compensated silicon pin diode detectors and LiF thermoluminescent ring dosimeters. RESULTS: In 21 cases (24%), the measured doses were less than 1 microSv, but in 4 operations (16%), 1 to 4.5 microSv was received. The equivalent dose rate was generally less than 1 microSv/h. The finger-absorbed doses for the surgeon and the assistant surgeon were (mean+/-SD) 159+/-23 and 48+/-17 microGy per intervention, respectively. CONCLUSION: Personal dosimetric survey and limitation of the number of surgical interventions do not appear to be essential.