Lymphoscintigraphic sentinel node identification in patients with breast cancer: the role of SPECT-CT.

PURPOSE: Lymph node status is a major factor in determining the stage, appropriate therapy and outcome in patients with breast cancer. It is therefore of clinical importance to accurately identify all sentinel nodes (SNs) for each individual tumour before surgery. The purpose of this study was to assess the role of SPECT-CT lymphoscintigraphy in SN identification in patients with breast cancer. METHODS: Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 157 consecutive patients with breast cancer (mean age 54.7+/-10.6, range 27-81 years) with a palpable mass (n=100), with a non-palpable mass (n=52) or post lumpectomy (n=5). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify hot nodes. RESULTS: Planar imaging alone was negative for identification of hot nodes in 15% of the patients. SPECT-CT alone was negative in 10% and both techniques were negative in 9% of the patients. Forty-six of the total of 361 (13%) hot nodes identified by lymphoscintigraphy were detected only on SPECT-CT, including 21 nodes obscured by the scattered radiation from the injection site, nine adjacent nodes misinterpreted on planar images as a single node and 16 nodes which were missed on planar images and detected on SPECT data. SPECT-CT detected additional sites of drainage unexpected on planar images, including axillary (n=23 patients), internal mammary (n=5 patients), interpectoral (n=3 patients) and intramammary (n=2 patients) lymph node sites. Fourteen of the 329 (4%) hot lesions seen on planar images were false positive non-nodal sites of uptake that were accurately assessed by SPECT-CT and further validated by surgery. In a single patient, SPECT-CT was negative while planar images identified the SN. CONCLUSION: SPECT-CT may improve the preoperative localisation of draining nodes in patients with breast cancer. It may detect hot nodes missed by planar imaging, exclude non-nodal false positive sites of uptake and accurately localise axillary and extra-axillary nodes.

Spontaneous regression of retroperitoneal metastases from a primary pure anaplastic seminoma: a case report.

Spontaneous regression of pure seminoma metastases is a rare phenomenon, with only a few cases reported to date. To the best of our knowledge, this is the first report of regression of anaplastic pure seminoma metastases located in the retroperitoneum. We present a 27-year-old man, a marihuana smoker, with metastatic pure anaplastic seminoma in the high retroperitoneal lymph nodes. After orchiectomy, his metastases regressed with no medication. Several mechanisms are suggested to explain this phenomenon, which still remains elusive.

Elevated breast cancer serum markers in otherwise healthy women.

A high value of mucin-like carcinoma associated antigen (MCA), CA-15.3 or H23, in a woman known to have a diagnosis of breast cancer, may reflect presence of disease. A low level in a breast cancer patient may be accepted for remission, but a false negative result cannot be excluded. On the other hand, a low level of serum tumor marker in the general population actually lacks any significance. However, what is the meaning of an elevated level of marker, known to have a relatively high sensitivity and specificity, in an otherwise healthy woman? Does it mean an occult breast cancer or a false positive? Sera samples were obtained from 155 consecutive, otherwise healthy women, who were referred for mammography, and assayed for tumor markers. MCA was elevated in 15-24% of patients with normal mammogram, depending on their ages. Lack of elevation of a second marker in most of the cases supported the assumption that the elevation of the MCA was insignificant. Elevation of H23 occurred more frequently in younger women than in the elders, but was not associated with elevation of a second marker. In the cases with abnormal mammogram due to histologically proven benign disorders, serum tumor markers were generally within the normal ranges. Our results pointed to the lack of diagnostic significance of an elevated level of serum tumor marker, as far as the mammogram was normal or benign, there was no history of cancer nor any other systemic disease (including malignancy), and a second tumor marker was within the normal range. The women with presently false positive marker level may, however, be followed, because of the possible risk for future development of breast cancer.

The effect of anesthesia type on needle localization breast biopsy: another point of view.

BACKGROUND: Efforts directed at early detection of breast cancer have resulted in an increased incidence of nonpalpable mammographic lesions that warrant excisional biopsy. The most common localization method is by use of the hook wire technique, or needle localization biopsy. Although much has been written about the localization technique, the impact of the method of anesthesia on the accuracy of the biopsy and especially on the completeness of the excision has not been clarified. PATIENTS AND METHODS: We studied 450 needle localization breast biopsies to determine whether the type of anesthesia (local versus general) influenced the accuracy and completeness of the biopsy. We compared 153 biopsies performed under local anesthesia to 297 done under general anesthesia. RESULTS: The use of local versus general anesthesia did not affect accuracy; however, it did determine the inability to achieve clean margins (27.6% versus 7.3%, respectively, P <0.02). It was more difficult to excise completely specimens located deeper than 3 cm in the breast, when the localizing needle travelled more than 3 cm, and when the lesions were of the microcalcification mammographic pattern. CONCLUSIONS: For lesions mammographically suspicious for malignancy, mainly those located deeper than 3 cm, general anesthesia is preferred.

Ulnar translation of the scaphoid: an early X-ray sign of rheumatoid arthritis.

The distance between the os trapezium and radius (which we called scaphoid distance) became shorter during the course of rheumatoid arthritis (RA). Measurement of this distance was performed in 600 hands (300 patients), using standard position of patient's hand in supination with permanent angle (15-20%) between the axis of the radius and the axis of the third metacarpal bone (scaphoid distance). This provided a stable distance between the most distal point of the radial styloid process and most proximal point of the os trapezium. The patients were divided into two groups: a control group consisting of 100 patients with no inflammatory joint disease, and a group of 200 patients suffering from RA. Patients suffering from RA with bone erosions had smaller scaphoid distance than those suffering from RA without bone erosions. The ratio between the distance from the distal radius to the most distal point of the third metacarpal bone and scaphoid index was called carpo-metacarpo-scaphoid index. It excluded the constitutional influence on the scaphoid distance. The shorter the scaphoid distance, the bigger the carpo-metacarpo-scaphoid index. The average indexes were: in the control group 7.8 (+/- 0.4), in group 2A with advanced RA 21.1 (+/- 4.1), and in group 2B with early RA without bone changes 12.0 (+/- 1.6). The results were statistically significant. The measurements are easy to perform and may be helpful in the early X-ray diagnosis of RA, when there are no bone erosions, or narrowing of articular spaces.

Computerized tomographic demonstration of intraorbital bone fragments caused by penetrating trauma.

Three patients with fragments of bones lodged in the orbit from apparently non-penetrating trauma, associated with cranio-cerebral injury, are reported. In all three cases the initial symptoms and signs of intraorbital or retrobulbar injury were minimal. The bone fragments were not demonstrable on plain x-ray films of the skull but were clearly shown on computerized tomographic (CT) scans of the orbit. They could easily have been overlooked had reliance been placed on plain x-ray films alone. In patients with suspected non-penetrating orbital trauma, axial and coronal CT views of the orbit are recommended.