Evaluation of early versus delayed lymphoscintigraphic imaging in detecting internal mammary sentinel lymph nodes in breast cancer: a multicenter study to establish an optimal lymphatic mapping protocol.

OBJECTIVE: Metastases in the internal mammary lymph nodes have an important prognostic value in breast cancer. Lymphatic mapping and sentinel node biopsy of internal mammary nodes improves staging and permits specific therapeutic strategies, thereby possibly improving final outcome. Therefore, optimal lymphoscintigraphic results are needed. Visualization of internal mammary lymph drainage, however, is influenced by several factors. We evaluated the effect of different time intervals between radioactive tracer injection and lymphoscintigraphy on visualization of internal mammary sentinel lymph nodes. METHODS: From February 1997 to August 2001 a total of 682 eligible breast cancer patients underwent sentinel lymph node mapping. The technique involved the injection of 370 MBq (10 mCi) (99m)Tc-nanocolloid peritumorally. In 470 patients (group A) the time interval between injection of the radiocolloid and lymphoscintigraphy was 16 h, compared to 2.5 h in 212 patients (group B). RESULTS: Patient characteristics showed no statistically significant difference between both groups for age and location of the tumour. Axillary hotspots were visualized in 97% in group A and 96% in group B. Lymphoscintigraphy showed internal mammary hotspots in 21% in group A, compared to 27% in group B. The mean number of internal mammary hotspots per patient was 1.9 in group A and 1.8 in group B. CONCLUSIONS: We found no significant differences between early and delayed lymphoscintigraphic imaging in visualizing internal mammary sentinel lymph nodes.

[A man with thyroid abnormalities: ectopic parathyroid adenoma and multifocal thyroid carcinoma]. / Een man met schildklierafwijkingen: ectopisch bijschildklieradenoom en multifocaal schildkliercarcinoom.

BACKGROUND: Thyroid abnormalities are found in 70% of patients with primary hyperparathyroidism. The simultaneous occurrence of a parathyroid adenoma and non-medullary thyroid carcinoma is rare. CASE DESCRIPTION: A parathyroid adenoma was suspected in a 39-year-old man with hypertension and a previous history of nephrolithiasis on the basis of laboratory results and scintigraphic investigations of the thyroid gland. Histopathological investigation of perioperatively obtained frozen sections of 2 nodules, however, revealed lymph node metastases of a papillary thyroid carcinoma; thyroid carcinoma was confirmed by studying a biopsy of the thyroid gland. Immunohistochemical staining of this biopsy for parathyroid hormone was negative; a parathyroid adenoma could not be confirmed. Total thyroidectomy and exploration of the parathyroid glands followed. Parathyroid hormone and calcium values declined following extirpation of the thyroid gland. Histopathological investigation of the thyroid gland revealed an intrathyroidally situated parathyroid adenoma and a multifocal papillary thyroid carcinoma. CONCLUSION: The case history emphasises the importance of thorough evaluation of the thyroid gland in patients with primary hyperparathyroidism to reveal or exclude simultaneous presentation of parathyroid adenoma and thyroid carcinoma.