Sentinel lymph node identification in breast cancer: feasibility study.

The aim of the study was to evaluate in our institute the technique of sentinel node (SN) identification and biopsy in the surgical treatment of early breast cancer. Between June 1998 and November 1999 54 patients (age range, 31-75 years) where studied. Inclusion criteria were age less than 75 years, indication for conservative surgery, absence of palpable axillary nodes, Karnofksy index >70. Lymphoscintigraphy was performed 16-18 hours prior to surgery, following injection of 0.1-0.2 mL of 99mTc-Nanocoll: the administered activity was 3-4 MBq in group A (44 pts) and 7-8 MBq in group B (10 pts). The colloids were administered by transdermal supralesional injection in 49 patients with palpable nodules and by intraparenchymal ultrasound-guided injection in five patients with non-palpable nodules. Planar projections were performed starting from the 5th until the 80th min (or 180th in the event of late migration). In 10 patients further projections were acquired 14-18 h following tracer administration. All nodes identified by gamma probe (MR 100 Pol.Hi.Tech) were histologically evaluated by immunohistochemistry and standard histology. Scintigraphic visualization of the SN was obtained in 49 patients: in 38 of these patients there was only one SN while in 11 patients there were two or three SNs. The delayed scan made in 10 patients did not show any further nodes. In all patients given US-guided perilesional injections migration was late (after at least 60 min). Our study confirms the validity of the scintigraphic procedure, its safety for patients and health care workers, and the feasibility of interdisciplinary collaboration.

Radioguided surgery of breast cancer: radiation protection survey.

The aim of this study was to estimate the radioactive risk for surgical staff performing radioguided sentinel lymph node (SN) biopsy and to calculate the contamination level in the operating room for assessment of the possible need for specific radiation protection procedures. We studied 20 patients who were selected for quadrantectomy and SN biopsy. The day before surgery a volume of 0.15 mL of 99mTc-nanocoll was injected: the activity was 3.11 +/- 0.85 MBq in group A (15 pts) and 11.6 +/- 0.6 MBq in group B (5 pts). External radiation to staff was evaluated by measuring the exposure rate in air one hour after radiopharmaceutical administration. The air KERMA rate during surgery was estimated considering the physical decay of 99mTc. Contamination of disposable materials and surgical instruments in the operating room was measured using a contamination monitor, whereas the residual activity in the SN and the injection site was measured with a gamma probe. The exposure rate at 20 cm from the injection site was 0.75 microSv/h when the most radioactive patients (group B) were treated. Contamination in the operating room proved to be negligible. Considering the number of radioguided treatments carried out by a surgeon in one year, an equivalent effective dose of 0.075 mSv was estimated; the recommended dose limit according to the relevant Italian law, DL 230/95, is 1 mSv/yr. Surgical staff therefore do not require a classification of "exposed workers" and there is no need to supply the operating room with special containers for radioactive waste.

[Bone marrow scintigraphy with 99mTc nanocolloid. A complement to bone scintigraphy with 99mTc MDP in oncologic diagnosis]. / La scintigrafia del midollo osseo con 99mTc nanocolloide. Un completamento alla scintigrafia ossea con 99mTc MDP nella diagnosi oncologica.

We compared the results of bone marrow scintigraphy (SMO) with those of conventional bone scintigraphy (SO) obtained in patients suffering of malignant neoplasms. SMO was carried out using nanometer-sized particles (nanocolloid) labelled with 99mTc, known to target the phagocitic properties of the medullar reticulo-endothelial cells. The results of the two investigations carried out in 148 patients agreed with each other. Notwithstanding the lesser definition of SMO images compared to SO and the masking effect of the high hepatosplenic activity, the two diagnostic methods were found to agree in 81.1% of all cases. SMO is easy to perform, can be compared well with SO and was demonstrated to be complementary to the latter. The SMO/SO confrontation has been found to be useful for better defining the extension of neoplastic lesions, which in turn has led to better staging of the disease. The investigation provides information about the entire distribution of the central bone marrow and its possible pathologic peripheral expansion. A remarkably reduced nanocolloid uptake cannot only be found in the osseous structure subjected to radiotherapeutic doses in excess of 30 Gy, but also in the case of longer standing high-dosage cytostatic treatments. The latter finding does not have its correlate in SO, hence it could be of considerable interest in validating the continuation of antineoplastic therapies.

[Evaluation of the effects of thymopentin on the incidence of leucopenia in patients treated with chemotherapy for breast carcinoma]. / Valutazione degli effetti di Timopentina sull'incidenza di leucopenia in pazienti trattate con chemioterapia per carcinoma mammario.

Random additional treatment with Thymopentine was administered to a group of 46 mastectomised women in order to assess its possible anti-leucopenic efficacy in relation to cytotoxicity caused by anti-blastic drugs. Results reveal a certain degree of efficacy in reducing the incidence of leucopenia when treatment was administered continuously from the start to the end of chemotherapy. This aspect plays an extremely important role in avoiding the protraction of the normal interval between one cycle of anti-blastic chemotherapy and the next.

[Scintigraphy of the bone marrow for the evaluation of injuries caused by antiblastic agents]. / Scintigrafia del midollo osseo per la valutazione del danno da farmaci antiblastici.

For various reasons the well-known myelopoietic damage caused by cancer chemotherapy is not easy to quantify by means of usual diagnostic procedures. The bone marrow scan with a Tc 99m-nanocolloid rapidly cleared by the phagocytic action of the RES, which has a topographic extension similar to red marrow, has been used for many years to evaluate the inflammatory and neoplastic diseases, both localized and diffuse. Such examination was thus performed in patients undergoing cytostatic therapy, either to follow-up metastatic lesions or to evaluate a tissue damage due to different drugs. The BMS is easily performed and has no side-effects. It consists of a dynamic and a static part. Moreover, it helped pointing out important diagnostic data, such as the reduction of the sacroiliac uptake index below the normal values (3.7) in 33 out of 57 cases, and an abnormal distribution of nanocolloid in the skeleton (Munz's classification, 1983) in 37 out of 69 cases, higher in more myelotoxic cytostatics, which could be detected even after a few months.

[Course of the serum determination of 4 tumor markers in viral hepatitis]. / Andamento del dosaggio sierico di quattro markers tumorali in corso di epatite virale.

The radioimmunological method was used to measure the serum levels of 4 tumour markers--CEA, TPA, Ca 19-9 and Ferritin--in 20 hepatitis patients. Blood levels of bilirubin and transaminase were assayed at the same time. Patients with high levels of bilirubin and transaminase also revealed pathological levels of all 4 markers, especially TPA and ferritin which fell towards normal levels once the acute attack was over.

[Scintigraphy of bone marrow for the evaluation of injuries caused by antiblastic radiotherapy]. / La scintigrafia del midollo osseo per la valutazione del danno da radioterapia antiblastica.

A nanocolloid marked with 99mTc was used to perform 100 bone marrow scintiscans in 72 patients given radiotherapy for tumours. The compound is taken up by the cells of the phagomonocytic system whose distribution in the bones is similar to that of the erythropoietic marrow. With doses over 30 Gy a more or less marked reduction in captation by the marrow involved in radiation was always noted. The damage remains even for years after radiation, though recovery is possible especially in young patients given moderate doses of up to 40-45 Gy. Bone marrow scintigraphy using a nanocolloid is noninvasive and inexpensive, involves only tiny radiation doses and appears to be useful in the study of cancer patients subjected to radiation treatment either alone or in combination with chemotherapy.

[Advantages and limitations of combined assays of 4 serum markers in various types of malignant neoplasms]. / Vantaggi e limiti del dosaggio combinato di quattro markers sierici in diversi tipi di neoplasie maligne.

CEA, TPA, GICA and Ferritin were assayed in 700 cancer patients (230 assays in 181 breast cancers, 75 in 57 lung cancers, 114 in 70 cervico-facial neoplasms, 131 in 95 uterovaginal tumours, 444 in 225 colorectal tumours, 106 in 72 gastric cancers). Groups were divided into stages and the results of all possible associations were assessed. Only the most significant are reported. Among combinations of 2 markers the combined assay of CEA and TPA offers the best response as diagnostic potential (expressed as percentage positivity) in all neoplasm groups as well as a good correlation with the evolution of the disease.

[Scintigraphy in the study of varicocele]. / L'indagine scintigrafica nello studio del varicocele.

Varicocele which is relatively common after puberty may cause even severe alterations to fertility. Sequential Isotopic Scrotal Angiography (SISA) was used for the diagnosis of this condition in both the recognition and confirmation phase. This dynamic and static survey based on the use of 99mTc-pyrophosphate proved able to discriminate between the various degrees of varicocele. No statement can as yet be made on the specificity and sensitivity of the examination since so few cases have so far been checked with other techniques (Doppler-Telethermography-Phlebography) and an insufficient number of postsurgical controls came to our observation.

[Computerized processing of static scintigraphic gamma camera images. Experimental results and clinical applications]. / Elaborazione computerizzata delle immagini scintigrafiche statiche da gammacamera. Risultati sperimentali ed applicazioni cliniche.

Two different phantoms were used to carry out several scintigraphic experiments with a gamma camera linked to a computer. Each image was subjected to several types of electronic processing. The contrast was assessed in certain pre-established areas in order to obtain an indication of the efficacity of the various techniques. The experimental results were transferred to scintigraphic application methodology with the formulation of treatment schedules consisting of a variable sequence of successive processings designed to improve the quality of the information required for more accurate diagnosis.

[Lymphoscintigraphy. Comparison of 2 microcolloids labeled with Tc99m]. / Linfoscintigrafia. Confronto di due microcolloidi marcati con 99mTc.

The physical and chemical properties of two colloids labelled with 99mTc used for lymphoscintigraphic investigations for some time are reviewed. The advantages of human albumin nanocolloids over sulphated microcolloids are described and discussed. These mainly consist of more rapid, larger-sale endolymphatic transport.

The usefulness of sequential isotopic angiography of the scrotum for study of the varicocele.

132 patients were examined by Sequential Isotopic Scrotal Angiography (SISA) to determine whether or not they had primary varicoceles. The results with SISA were more reliable than those of clinical examination and scrotal telethermography. It is a rapid, simple and essentially harmless procedure that also provides pictures that can clearly present the situation to the patient. The principal indications for the examination are to confirm the presence of small varicoceles and to look for clinically non-detectable (subclinical) varicoceles.

[Lung cancers synchronous and metachronous with primary malignant neoplasms in other sites]. / Carcinomi del polmone sincroni e metacroni a neoplasie maligne primitive in altre sedi.

A series of 19 cases are reported in which, with the exception of one case, two primary malignant tumours developed at different times, one of which in the lung. Some details of this occurrence are discussed in relation to similar findings in the international literature. The average interval between the two tumours was found to be 7.5 years. In eight cases, all male, the lung tumour arose in subjects who had already been subjected to radical treatment for a laryngeal tumour. A lung carcinoma appeared in four women who had been subjected to radiation therapy following mastectomy. This sequence of events was considered a coincidence and not radioinduced in view of the fact that a total of 1061 similarly treated patients were observed over the same period. Finally it is suggested that certain histobiochemical factors induced by the lung tumour may somehow become pathogenically transformed to simulate a new primary malignant tumour.

[Malignant tumors preceding or following breast cancer]. / Tumori maligni precedenti o susseguenti al carcinoma della mammella.

Using the records of the Cancer Clinic of Biella Hospital that date back more than 25 years, a retrospective survey was conducted into 65 patients suffering from two primary malignant neoplasms one of which affected the breast. Graphs and tables illustrate; the frequency, location, histological type, staging, the age of the patient and the date of the onset of the first neoplasia, any previous family history of cancer, the interval between the two neoplasias and the type of treatment given during this interval. Particular attention is paid to cases in which both neoplasias were breast tumours, and brief remarks on certain aspects of such cases are presented.

[Evaluation of vesico-ureteral reflux in children with computerized isotopic cystography in association with urodynamic tests]. / Valutazione del reflusso vescico ureterale in età pediatrica con cistografia isotopica computerizzata in associazione ad esame urodinamico.

Method and results are presented for the cystoscintigraphic detection with 99mTc-DTPA, associated with urodynamic examination for the evaluation of the vesicoureteral reflux, involving a relatively simple execution. The use of this method is advised in Pediatrics because of its low gonadal dose, thorough examination and least aggressiveness.

[Index of splenohepatic uptake of 99mTc-MMA in the diagnosis of diffuse hepatopathy]. / Indice di captazione spleno-epatica del 99mTc-MMA nella diagnosi di epatopatia diffusa.

A sequential scintigraphic technique for the evaluation of liver and spleen granulopexic function is described. The spleno-hepatic uptake index revealed by computerised scintiscanning proved a reliable indicator of moderate and especially severe diffuse hepatopathy. The test is quickly and easily performed and is also practical since it uses the same radioactive bolus injected for static scintigraphy.