Role of 99mTc-sestamibi Scintimammography in Predicting Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer: A Prospective Study.

Background: Neoadjuvant chemotherapy (NACT) is the first line of management for locally advanced breast cancer (LABC). However, chemoresistance is prevalent in 18%-50% of the cases. One of the important and most studied causes of chemoresistance is P-glycoprotein (Pgp) expression. 99mTc-sestamibi scintimammography may serve as a useful imaging tool to predict Pgp expression, thereby response to NACT. Aim: The aim was to study the role of 99mTc-sestamibi scintimammography in predicting response to NACT in treatment-naive, biopsy-proven LABC patients. Materials and Methods: 99mTc-sestamibi scintimammography (early and delayed images) was performed on a total of 34 patients. Eight patients were lost to follow-up, and only 26 (25 females and 1 male) patients were available for final analysis, with a mean age of 49.7 ± 10.7 years. 99mTc-sestamibi washout rate (WOR) (%) and T/B buildup were calculated. Pre-NACT and Post-NACT tumor sizes were measured clinically, and a % decrease in tumor size was calculated. The WOR and T/B buildup values were correlated with the % decrease in tumor size. Results: We found a statistically significant negative correlation between WOR (%) and % decrease in tumor size and a statistically significant positive correlation between T/B buildup and % decrease in tumor size. Furthermore, we found a positive correlation between the early T/B ratio and the Ki-67 index (P = 0.22). Conclusion: Early categorization of responders and nonresponders can help in optimal therapy planning. 99mTc-sestamibi scintimammography can serve as an imaging marker for Pgp expression, thereby predicting clinical response to NACT in LABC patients. Further studies with larger sample sizes are warranted to consolidate the above findings.

Utility of immunochemistry in cytology.

BACKGROUND: The role played by cytology in primary diagnosis is undeniable. With improved management protocols and targeted therapy, the need for accurate diagnosis has become mandatory. Immunochemistry and molecular techniques are increasingly being used on limited tissue samples. AIMS: This study was conducted to find out the impact of immunocytochemistry (ICC) on cytology material in cytology practice. MATERIALS AND METHODS: Immunochemistry was done on alcohol-fixed smears and cell-block preparations. It was done with i6000 BioGenex autostainer using BioGenex reagents. RESULTS: A total of 148 cases occurring over a period of 3 years (September 2010-June 2013) were analyzed. Staining was done on cytology smears in 77 cases and on cell-block sections in 71 cases. ICC helped in diagnosis in 8 cases, confirmed the diagnosis in 26 cases, helped in subtyping in 60 cases, and helped in prognostication in 6 cases. ICC has altered the diagnosis in two cases. It was noncontributory in 43 cases, and the material was inadequate in three cases. CONCLUSION: In 102 cases (69%), ICC proved to be a useful adjunct in the diagnosis and prognostication; hence, its use is recommended in practice to aid in cytology services.

Significance of acellular smears in conjunctival impression cytology.

OBJECTIVES: Conjunctival xerosis is a marker for vitamin A deficiency. Conjunctival impression cytology (CIC) is a widely used technique to detect xerosis in field studies. Inadequate and acellular samples are generally considered technical failures and are treated as uninterpretable. The purpose of this study is to determine the significance of acellular smears in the detection of vitamin A deficiency. STUDY DESIGN: CIC with transfer (CICT) and blood samples were collected from freshly diagnosed cancer patients and healthy controls. CICT smears were classified as cellular or acellular. Serum vitamin A levels were tested by high-performance liquid chromatography. CICT results were compared with vitamin A levels. RESULTS: CICT was collected from 1,694 subjects. There were 118 (7%) acellular smears, i.e. 99 in patients and 19 in controls. Serum vitamin A levels were available in 112 of these subjects. Levels <20 µg/dl were seen in 82.1% of the subjects with acellular smears and in 18.9% of the subjects with cellular smears (p < 0.001). Of the gastrointestinal and hepatobiliary and hematologic cancers, 15.6% and 10.5% showed acellular smears, respectively. CONCLUSIONS: Acellular smears in conjunctival imprint cytology may indicate hypovitaminosis A, provided technical failure to obtain cellularity is ruled out.

Cytologic features of primary malignant tumors of skin and adnexae.

OBJECTIVE: To highlight the cytologic features of the cases seen in our institute. STUDY DESIGN: Cases of primary malignant tumors of skin and adnexae diagnosed on cytology with histopathology confirmation were retrieved from case records of 1998-2005. Clinical presentation was noted in all the cases. RESULTS: Thirty primary malignant tumors of skin and adnexae were analyzed. Melanoma was the most common (n=12), followed by squamous cell carcinoma (SCC) (n=5). There were 3 basal cell carcinomas and 2 cases each of sebaceous carcinoma, Paget's disease of the breast and lymphoma. There were single cases of eccrine carcinoma, malignant trichilemmal tumor, undifferentiated carcinoma and extramedullary myeloid cell tumor. All the cases of hemopoietic tumors (n=3) and the majority of the cases (4 of 7) of adnexal were seen to arise from head and neck region. Marjolin's ulcer was seen in 4 of 5 SCCs. Scrape smears were obtained from 8 patients and fine needle aspiration in 22 patients. CONCLUSION: Cytodiagnosis of primary malignant tumors of skin and adnexae is possible based on morphology and clinical presentation.

Fungal endocarditis: an autopsy study.

Between 1990 and 2002, 237 hearts were examined at autopsy, including 16 with infective endocarditis; 6 showed fungal endocarditis. The preceding pathology was chronic rheumatic heart disease in 2 patients, one of whom had undergone double valve replacement, 2 patients had been treated for acute lymphoblastic leukemia, and one had protein-energy malnutrition. The underlying cause was unknown in one case. The organisms isolated were Aspergillus in 3 patients, Zygomycota in 1, Candida in 1, and both Candida tropicalis and Aspergillus in 1 patient. Immunosuppressed states are a cause of fungal endocarditis in India, although chronic rheumatic heart disease is the preceding pathology in the majority of patients.