Role of MIBI breast scintigraphy in evaluation of palpable breast lesions.

The sensitivity and specificity of MIBI breast scintigraphy, conventional mammography and ultrasound in differentiating malignant and benign palpable breast lesions was compared in 48 women. MIBI breast scintigraphy had a sensitivity of 97% a specificity of 69%, a positive predictive value of 87.5% and a negative predictive value of 91.7%. Ultrasound and mammography had comparable results with accuracy rates of approximately 93%. We conclude that MIBI breast scintigraphy may have a complementary role in the evaluation of palpable breast lesions, but is not specific enough to replace current imaging modalities.

Superior vena cava syndrome: an oncologic complication.

OBJECTIVES: To review the clinical presentation, pathophysiology, diagnosis, treatment, and nursing care of superior vena cava syndrome (SVCS). DATA SOURCES: Journal articles, research studies, and book chapters relating to complications of lung cancer and SVCS. CONCLUSION: Lung cancer is the most common malignancy associated with SVCS. The onset of symptoms may be gradual or rapid. Treatment of SVCS is based on the etiology and histologic diagnosis. IMPLICATIONS FOR NURSING PRACTICE: Major considerations in the nursing care of patients with SVCS include recognition of high-risk patients, facilitation and coordination of diagnostic procedures, assessment of respiratory, cardiac and neurologic systems, administration of therapy, provision of emotional and psychosocial support, and patient education.

Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy, ultrasound and conventional mammography.

Axillary lymph node status is important in the staging of breast carcinoma. To evaluate the accuracy of technetium-99m sestamibi breast scintigraphy in detecting metastatic axillary lymph nodes as compared with other accepted imaging modalities, we performed 99mTc-sestamibi breast scintigraphy, conventional mammography and ultrasound in 36 patients with primary untreated breast carcinoma. With histopathology as the gold standard, 99mTc-sestamibi breast scintigraphy was found to yield true-positive results in 7 of 11 cases (64%) of axillary lymph node metastases and true-negative results in 18 of 20 cases (90%); it has an accuracy of 81%, a positive predictive value of 77.8% and a negative predictive value of 81.8%.

Case report: perinephric-splenic fistula--a complication of percutaneous perinephric abscess drainage.

A case of acute perinephric abscess due to chronic parenchymal disease and calculi is presented. During percutaneous drainage a reno-splenic vein communication developed acutely. The aetiology and treatment complications of perinephric abscesses are reviewed.

Vascularized iliac crest grafts: evaluation of viability status with marrow scintigraphy.

Forty-three vascularized iliac crest grafts in the femoral neck region in 38 patients were assessed with marrow scintigraphy. Twenty grafting procedures had been performed for treatment of fractures, 16 for nontraumatic osteonecrosis, and seven for focal bone lesions. Scintiscans were obtained preoperatively and in the early and late postoperative period. Anterior images of the hips were obtained 30 minutes after intravenous injection of 4 mCi (148 MBq) of technetium-99m tin colloid by using a gamma camera with a low-energy, general-purpose collimator. The viable graft was detected as an area of tracer uptake corresponding to the configuration of the graft on radiographs. Marrow scintigraphy at 12 weeks showed that 24 grafts were viable, 11 were nonviable, and eight were indeterminate. Early and late results concurred in 36 of 43 (84%) grafts. Nonviable grafts occurred most frequently in fractures in the elderly. In seven patients who subsequently required total hip replacement, six grafts were nonviable while one was indeterminate at 12 weeks. Results indicate that marrow scintigraphy is useful in the treatment of patients with vascularized iliac crest bone grafts.

Staging bone scintigraphy in nasopharyngeal carcinoma.

Bone scintigraphy was performed on 163 new cases of nasopharyngeal carcinoma without clinical evidence of distant metastases. Among the 10 abnormal bone scans one patient had radiographic skeletal metastases corresponding to the areas of increased tracer uptake. Two patients with abnormal bone scans subsequently developed radiographic metastases at the site of abnormal tracer uptake. The detection rate of asymptomatic skeletal metastases on presentation was thus 1.8% (3/163), and the predictive value of an abnormal scan for metastases 30% (3/10). Bone scintigraphy is not justified as a routine staging investigation for nasopharyngeal carcinoma, although it can be considered for a subset of patients considered at high risk of distant metastases.