[The use of SPECT-CT in the diagnosis of cancerous lesions of axillary lymph nodes in patients with breast cancer].

The purpose of the study was to explore the possibilities of a new hybrid technology of SPECT-CT in the diagnosis of metastatic regional lymph nodes (LN) in patients with breast cancer (BC). There were examined 57 primary patients. All patients underwent axillary lymph node dissection and /or biopsy of sentinel LN followed by histological examination of the material. Metastases in LN were verified in 20 (35%) of 57 examined patients. Sensitivity, specificity and overall accuracy of SPECT-CT in the combined use of anatomical and functional criteria for assessing the state of LN accounted for 75%, 89% and 84%, respectively. Sensitivity of SPECT-CT in the diagnosis of massive axillary LN lesion (more than two) in breast cancer patients was 95%. Thus, the new hybrid technology of SPECT-CT, combining functional and anatomical techniques for assessing of pathological changes, is highly informative in the diagnosis of metastatic lesions of regional LN in patients with breast cancer.

[Adjuvant chemotherapy for breast cancer: search for new ways of planning].

A decision regarding adjuvant chemotherapy in early (operable) breast cancer in the past was made entirely on the basis of clinical and pathological features. However with the growing awareness of tumor biology and the possibility of the genomic analysis to determine the molecular subtypes of breast cancer it is getting real to identify patients whose tumors are resistant to chemotherapy or vice versa benefit from its addition. Despite the fact that genomic analysis allows some patients avoiding chemotherapy (especially patients with localized breast cancer), such studies do not indicate the most appropriate chemotherapy regimens. Therefore treatment decisions should be based on a combination of biological features of the tumor, its stage and signs that characterize the patient such as age and tolerance to the side effects of therapy.

[The use of SPECT-CT with 99mTc-labeled phosphates in patients with suspected skeletal metastases in planar bone scintigraphy].

We assessed the diagnostic capabilities of SPECT-CT in patients with unclear and suspicious on the secondary lesion with bone scintigraphy background in planar mode (227 patients (mean age - 57 years) with various primary malignancies). All patients underwent planar scintigraphy with 99mTc-labeled phosphates in the "whole body" mode and then - bizonal single-photon-emission computed tomography combined with X-ray computed tomography (SPECT-CT). In patients with the presence of lesions in the skeleton, suspicious on metastases, there was conducted comparison with the data of SPECT-CT. During planar investigation the suspicion on metastases was detected in 41 patients (18%). The use of SPECT-CT allowed excluding metastases in 29 (71%) and confirmed in 7 (17%) of them. In 5 (12%) cases the nature of the changes remained unclear. Thus, in cancer patients with revealed by planar bone scintigraphy unclear or suspicious for metastatic foci in the skeleton, the use of SPECT-CT allowed in most cases (88%) to clarify the nature of these changes.

[Effectiveness of mammary scintigraphy for determining the results of neoadjuvant polychemotherapy in breast cancer].

Analysis of mammoscintigraphy is presented to assess the effectiveness of neoadjuvant polychemotherapy for locally advanced breast cancer. In 90% of patients there is defined conformity of scintigraphy data on the effectiveness of performed polychemotherapy to the results of histologic examination of the postoperative material. The sensitivity of scintigraphy in assessing the effectiveness of neoadjuvant polychemoterapy was 83.3%, specificity--87.9%, accuracy--86.3%, predictive value of positive and negative results-78.9% and 90.1%, respectively. Mammoscintigraphy is an effective method to control the response of locally advanced breast cancer to neoadjuvant polychemotherapy.

[Markers of effectiveness of preoperative taxane-based chemotherapy for locally advanced breast cancer].

The absolute sensitivity signs of breast cancer to the drug have not yet been developed. Data from clinical trials on the study of experimental laboratory predictive markers of chemosensitivity: TOP2alpha (topoisomerase 2-alpha), beta-tubulin (subunit of dimeric protein tubulin), and BRCA1 (breast cancer 1) are contradictory and not numerous. Analysis of the results by the end of the clinical trial will allow examining the correlation between the effectiveness of preoperative taxane-chemotherapy and the level of experimental and standard molecular markets that is important for development of algorithm of treatment tactics for patients with locally advanced breast cancer.

[Methodological issues of sentinel lymph nodes biopsy in patients with breast cancer].

Radionuclide imaging of sentinel lymph nodes (SLN) was performed in 122 breast cancer patients, which before the biopsy of lymph nodes it was performed intratumoral injection of colloidal radiopharmaceuticals (RFP): in 89 patients--nanocolloidal (NC) and in 33--colloidal with particle size from 200 to 1000 nm. After the introduction of NC the SLN image was obtained in 83 of 89 women. (93.3%). After the introduction of large colloids (200-1000 nm or more) SLN visualization in this group was achieved in 27 of 33 patients, i.e., in 81.8% of cases (p < 0.05). Along with the axillary SLN, in 55.8% of cases SLN image was obtained in parasternal area and/or lymph nodes of the second and higher orders in axillary as well as under-and supraclavicular regions. On the contrary while using larger colloids, RFP accumulated only in SLN of axillary region in 85.1%. These differences in the topography of the absorption of various diameters radiocolloids were reliable (p = 0.01). Using the NC RFN compared with colloidal RFP of larger diameter can reliably improve SLN visualization till 98.9% however leads to a concomitant accumulation of RFP in lymph nodes of the second order in 55.8% of patients.

[Combined use of 99mTc-MIBI scintigraphy and ultrasonography (US) in the diagnosis of axillary lymphatic metastasis in patients with breast cancer].

We aimed to evaluate different imaging strategies for diagnosis of axillary LNMs in patients with primary breast cancer (BC). 168 consecutive patients with primary BC were included in the study. Functional imaging by scintigraphy (AxSc) with 99mTc-MIBI was performed in static and tomography modes 15 min after i/v injection. Focal areas of tracer accumulation in axial region were considered as sings of LNMs. Ultrasound (US) examination of axillary region was performed on 7.5 kH scanner. Nodes with diameter more than 1 cm were considered abnormal. All patients were operated with axial LN dissection and subsequent histological evaluation. Scintigraphic signs of LNMs revealed in 65 patients: 48--true positive, 17--false positive. Among 103 women with normal AxSc results 27 had LNMs and 76--uninvolved nodes. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of AxSc were as follows: 64%, 82% and 74%. Sonography diagnosed LNMs in 74 women: 56 were metastatic on histology while other 18--uninvolved. On the contrary, 19 of 94 US normal sized nodes were metastatic on histology. US had following values when used for diagnosis of axillary LNMs: Sen--75%, Sp--81%, Ac--78%. When LNMs were diagnosed as the combination of concordantly abnormal US and AxSc examinations Sp reached 95%, Sen dropped down to 56% and Ac--to 77%. Another model was based on the assumption that LNMs must be diagnosed in all patients with abnormal US or AxSc examinations. According to this strategy Sen reached 83%, Sp--68% and Ac--74%. Thus, we found comparative accuracy of US and AxSc in diagnosis of axillary LNMs in patients with primary BC. Combination of both modalities can significantly improve sensitivity (83%) or specificity (95%) of final conclusion which is determined by established diagnostic strategy and criteria's that are used for BC diagnosis.

[Diagnostic accuracy of mammography and mammoscintigraphy in multifocal breast cancer].

The aim of the study was to compare accuracy of conventional mammography and mammoscintigraphy with the 99mTc-Technetril in the detection of multicentric (MC) breast cancer. A total of 135 women (mean age 52 years) with unilateral simple breast lesions at clinical examination underwent preoperative mammography and mammoscintigraphy. Data of diagnostic procedure were compared with histopathologic analysis in all cases. The present of MC breast cancer was proven in 11 of 135 cases (8%). Mammography detected only one of 11 multicentric cases, while mammoscintigraphy-9 of 11 cases. Mammography showed a 9.1% and 93.5% sensitivity and specificity rates for the detection of multicentric breast cancer, respectively. The overall sensitivity and specificity rates for the detection of the form were 81.8% and 91.1% for mammoscintigraphy, respectively. Confirmation of the distinction between two methods has been attained by Bayesian probability calculation. Mammoscintigraphy proved a more highly sensitive diagnostic method than mammography in the detection and preoperative assessment of MC breast cancer and may contribute to changing surgical management in some cases.

[Nuclear medicine in radiotherapy planning for patients with malignant neoplasms of different locations].

The performance of nuclear medicine methods in radiation therapy tactics determination was analyzed in patients receiving therapy for Hodgkin lymphoma (HL, n=556), breast cancer (BC, n=230), treatment-naive patients with non-small cell lung cancer (NSCLC, n=86). In HL patients the nuclear medicine methods were used to determine the irradiation fields for spleen irradiation (67%) and abdominal lymph nodes (27%). The bone marrow scan data had significant influence on radiation therapy tactics in 10-27% of cases. The visualization of primary tumor lymphatic drainage lead to changing the irradiation field topography in 75% cases of external BC and 85% of internal BC localization. Tumorotropic isotope mammal scan data lead to the changes in planned irradiation volume in 16% of BC patietns. In NSLC patients the results of "positive" scintigraphy with lipophilic 99mTc-marked cations lead to the change in irradiation tactics in 16% of cases. Therefore, the results of diagnostic investigations suggest the important role of nuclear medicine diagnostic methods in patients with various tumors of different localizations.

[Methodologic aspects of radionuclide diagnosis of breast cancer with 99mTc-MIBI].

The aim was to study the diagnostic possibilities of breast scintigraphy with help of domestic RFP tehnetril labeled 99mTc. Breast scintigraphy was performed in 132 women at age between 32 and 68 years. Visualization of both breasts in planned mode was performed in the lateral and anterior projections in 10-15 minutes after intravenous injection of 740-860 MBq of 99mTc-tehnetril. After this, a study was conducted in the mode emission computed tomography. Morphological verification of changes in the breast was performed in all cases. Sensitivity, specificity and overall accuracy of planar breast scintigraphy was 96% (105/112), 94% (245/252) and 95% respectively. Upon planar study of 132 breasts suspicious on cancer presence breast scintigraphy showed not high specificity 68% (7/21), sensitivity reached 94% (105/112), overall accuracy--90%. SPECT did not show visible benefits: sensitivity-92% (100/112), specificity--75% (5/21), and overall accuracy--89%. Usage of a semi-quantitative accrual rate of RFP in tumor allowed distinguishing four groups of patients with different, to breast scintigraphy data, likelihood of breast cancer (from 2-10% to 96%). As a result current methods of breast scintigraphy provide high sensitivity (88-96%) and accuracy in breast cancer detecting of any size as far as the use of additional diagnostic criteria, semi-quantitative ratio RFP accumulation in tumor in particular, can significantly increase (up 94%), specificity of diagnostic conclusions.

[Lymphoscintigraphy of separate lymph nodes for radiotherapy planning in breast cancer].

Determination of lymph flow from breast cancer can be used as effective tool for individualization of radiation portals for regional radiotherapy. We evaluated this technique in 86 patients with lymph nodes (LN) scintigraphy which was performed 20-240 min after intratumoural injection of 50-100 MBq of 99mTc-nanocolloids. After visualisation of lymph flow patterns standard radiation portals were modified in 75% of patients with external and 85%--with internal localisation of primary tumours, In addition we recognised that extent and wideness of radiation portals for internal mammary lymph LN must be arranged in accordance with individual lymph flow pattern. In particularly irradiation of LN on both sides of the sternum was performed only in 3 of 27 (11%) evaluated cases.

[Early diagnosis of breast cancer with scintimammography and ultrasound ].

The purpose of this study was to evaluate the role of scintimammography (SMG) and ultrasound (US) in early diagnosis of breast cancer. SMG was administered to 32 women with breast lesions of less than 1 cm in diameter. In addition, all patients underwent high frequency US imaging with digital wide field of view. The following US features were set as diagnostic: heterogeneous echo pattern, irregular morphology, hyperecho, poorly defined edges, posterior acoustic attenuation. SMG was performed in planar and tomography modes 15 min. after i/v injection of 740-860 MBq 99mTc-sestamibi. Images with focal and scattered patchy uptake were discarded. Data on all lesions were verified by biopsy and/or surgery. Thirty-six women revealed lesions of less than 1 cm: 12 out of 14 cases of breast cancer had them, while malignancy was not detected in 16 of 21 women with benign breast lesions. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of SMG in this group was as follows: 86%, 76% and 80%, respectively. US examinations in this group diagnosed benign lesions in 27 out of 35 women: 21--negative, 6--false negative. In the remaining 8 cases, US findings on breast cancer were positive: Sen was low (57%), Sp--high (100%) and Ac--moderate (82%). Taking into account that SMG represents functional status of breast lesions while US--anatomical one, we tested diagnostic value of their combination too (US+SMG). Cancer diagnosis was passed when either SMG or US revealed abnormalities. This diagnostic strategy featured outstanding Sen (100%), moderate Sp (76%) and Ac of 82%. It may be concluded that the combination procedure seems highly promising as far as early diagnosis of small (< 1 cm) breast cancers are concerned.

[The risk of local recurrence after breast-conserving surgery for breast cancer].

Recently, the rates of early stage breast cancers involving breast-conserving therapy have increased due to use of mammography screening. Morever, a patient's desire to keep the breast is now considered to be a factor which determines the surgery tactics. However, there has been so far no consensus on optimal extent of surgery capable of preventing local recurrence. In order to precisely estimate such risk it is essential to take into account factors such as tumor size, surgical margin status and age. Besides, correlations between certain subtypes of breast cancer and various associated risks of local recurrence are to be established. Another important factor is to devise the necessary subsequent radiotherapy.

[Radionuclide visualization of lymphatic flow from primary breast cancer].

Our study was concerned with evaluation of patterns of lymph flow from primary breast cancer. Radionuclide scintigraphy (RS) of lymph nodes was performed in 92 patients. Scinitigraphic images were obtained 30-60 and 240-360 min after intratumoral injection of 75-150 MBq (0,5-1 vl) of 99mTc nanocolloids. The pool sites of the radiodrug collection were as follows: axillary (Ax), sub-supraclavicular (SSCL) and internal mammary (IM). Imaging proved effective in 86 cases. No drug transport was recorded in 5 cases; 4 of them revealed macroscopic metaststases to the lymph nodes. External involvement of the axillary lymph nodes was visualized in 51 patients out of 52 while in 26 it occurred on the axillary site only. In another 25 patients, images of lymph nodes were obtained on 2 or 3 sites: drainage Ax+SSCL (12;23.1%), Ax+IM (6;11.6%) and Ax+SSCL+IM (7;13.4%). In patients with tumors in internal quadrants (34), the lymph flow patterns were as follows: Ax (12;35.3%), IM (2;5.8%), Ax+SSCL (8;23.5%), Ax+IM+SSCL (5;14.7%). Hence, the efficacy of lymph node visualization after intratumoral injection of nanocolloids was 98%. Visualization on Ax sites was further confirmed by lymph flow to SSCL and IM (29.1%) and (35.9%), respectively. The likelihood of lymph flow to IM is significantly higher in patients with internal localization of breast cancer (37.1%) but it is not negligible (22.9%) in cases of external quadrants.

[Phase II clinical trial of neoadjuvant hormone therapy in comparison with chemotherapy of patients with breast cancer].

Data are presented on a randomized study (stage II) which was undertaken to assess the efficacy of neoadjuvant chemotherapy (doxorubicin+paclitaxel) vis-a-vis endocrine therapy with aromatase inhibitors (anastrazole or exemestane) in postmenopausal women with ER-positive and/or PgR-positive tumors. Preoperative neoadjuvant chemotherapy was well tolerated and showed similar rates of overall response as compared with the latter regimen.