Occult breast lesion localization and concomitant sentinel lymph node biopsy in early breast cancer (SNOLL).

AIMS: Mammographic screening and the increasing resolution output of mammography have raised the identification number of small-size mammary lesions without clinical expression. The aim of this study was to evaluate in a prospective study the localization techique and concomitent sentinel lymph node biopsy for breast cancer (SNOLL - Sentinel lymph Node biopsy and Occult Lesion Localization). METHODS: We identified by means of imaging techniques a number of 107 patients with clinically occult suspicious breast tumors. All patients preoperatively underwent a protocol in which the injection of 99mTc-nannocolloid under imaging procedures was performed. Surgical excision was performed, guided by the hand held gammaprobe. The sentinel lymph node was identified as an axillary hot spot on the probe. RESULTS: All primary lesions were identified and were clear of invasive margins needing excision. 98 tumors proved to be malignant on frozen sections. 7 lesions could not be clearly examined through frozen section and 2 proved to be benign. 6 out of 7 suspicious lesions confirmed to be malignant on parrafin embedded sections. Sentinel lymph node was identified in a number of 95 out of 98 patients. In 14 cases complete axillary lymphadenectomy was performed. The average specimen weight was 40 grams. CONCLUSIONS: Using this technique, we removed the lesions identified prior to surgery in all cases, achieving a complete pathologic diagnostic, the necessary surgical treatment and also prognostic data by axillary lymph node assessment.

Immunological aspects predicting metastatic sentinel lymph node in early breast cancer patients.

Tumour antigens are poorly expressed, heterogeneous and they modulate rapidly. As a result, their recognition and elimination by the immune system is very difficult. There are several mechanisms, by means of which, the host can neutralize oncogenesis and prevent it from occurring. The sentinel lymph node concept has brought about a revolution in the surgical treatment of the regional lymphatic basin while preserving the prognostic value of the regional lymph node status in breast cancer. This prospective study included 93 women with early breast cancer with initial indication for surgery in whom the sentinel lymph node technique was employed. Cell immune response was assessed prior to surgery by means of in vitro mononuclear cells blastic transformation assay (BLT), of immunoglobulin (Ig) and interleukin 2 (IL-2) measurements. The results were correlated with tumour size, presence of positive sentinel lymph node, tumour proliferation and growth markers (Ki-67, c-erbB2, bcl-2). Even in its less advanced stages, breast cancer is more aggressive and associates with an increased rate of sentinel lymph node metastases in patients below 50 years old, the tumour size exceeds 20 mm, with the presence of peritumoral lymphocytic infiltrate, positive Ki-67 and bcl-2, an alteration of T helper (Th) lymphocytes function, increased immune suppression through IL-2 decrease, signalled by blastic transformation indexes modifications and a drop in IL-2 production (p<0.01).

[Latest approaches in the surgical treatment of cutaneous malignant melanoma]. / Actualitati în tratamentul chirurgical al melanomului malign cutanat.

Malignant melanoma is a disease with an unpredictable evolution. Detected in stage I and II has a great chance to cure, if it is correctly treated: excisional biopsy with safety margins in accordance with tumor thickness. Lymphoscintigraphy with sentinel node identification and biopsy became compulsory for staging malignant melanoma, the role of complete lymphadenectomy would be established by publishing the MSLTII data. The sentinel node is analysed using more and more sophisticated techniques (RT-PCR) in order to detect isolated tumoral cells, although their clinical significance is not known yet. Metastases occurrence is a dramatic phenomenon because chemotherapy, radiotherapy or biologic therapy have insignificant results. The only therapeutic modality which may increase survival in this situation is surgery for some carefully selected patients.

Glutathione S-transferase activity in human breast tumors.

The level of total glutathione S-transferase (GST) activity was examined in forty-three breast carcinomas (forty tumors from previously untreated patients and three tumors from patients previously treated by chemotherapy), and thirteen benign breast tumors. Cytosolic GST activity was determined according to a spectrophotometric method. Using Student's t-test, significant differences were found between GST levels in these two groups of tumors (p < 0.01). The higher values were found in malignant tumors. The range of values in both malignant and benign tumors was very wide. The relationship between GST activity and hormone receptor status was examined in thirty-three cases for estrogen receptor (ER) status, and thirty-one cases for progesterone receptor (PR) status. The level of hormonal receptors was determined according to the dextran-charcoal technique. No significant difference between the mean levels of GST activity in ER+ and ER-tumors was found (p > 0.4), but the difference corresponding to PR+ and PR-tumors approximated the 1% level of significance. The relationship between total GST activity and clinical or pathological parameters was also studied. Significant difference was found between the mean levels of GST activity corresponding to the groups of patients with non-involved nodes, and those having one or more involved nodes, respectively (p < 0.05). No correlation was found with respect to age (p > 0.2), tumor size (p > 0.2), or tumor grade (p > 0.4). Increased levels of GST activity were found in PR-tumors and in tumors with involved axillary nodes. Both groups of tumors are known to have a poorer prognosis. It was concluded that the significance of GST activity as an additional marker of prognosis must be taken into consideration.