[Is preoperative bone scintigraphy in early stage of breast cancer T1N0 indicated and meaningful?]. / Je predoperacní scintigrafie skeletu v casném stadiu karcinomu prsu T1N0 indikovaná a smysluplná?

In the Czech Republic bone scintigraphy has still been performed routinely as a part of preoperative staging examinations of early breast carcinomas, which had been in 42% diagnosed in the national breast cancer screening program. The incidence of synchronnous distant metastases was analysed for a subgroup of T1N0 breast carcinomas using the database of the Czech National Cancer Registry. Out of 21,675 women with T1N0 breast carcinomas diagnosed in the decade of 2001-2010 the potential occurence of various distant metastases (M1) was estimated in 147 cases (0,68%). Since only approximately 40% of all distant metastases were skeletal (M1 OSS), the pro-bability of bone metastases in T1N0 breast cancer does not exceed 0,3-0,4%. Distant metastases were present in 0,5% in a subgroup of well and moderately differentiated carcinomas and up to 1,2% in poorly differentiated and anaplastic tumors, however, only a minor part (0,2% and 0,5%, respectively) involved bones. We conclude that preoperative bone scintigraphy is overused and undue in more than 99% of Czech women with early breast cancer T1N0. Skeletal scintigraphy as a staging procedure for small breast carcinoma T1N0 may perhaps be recommended only postoperatively and very selectively with regards to individual risk factors and symptomatology.

[Porphyria cutanea tarda after antineoplastic drugs]. / Porphyria cutanea tarda po protinádorových lécích.

Chronic hepatic porphyria is in some cases a paraneoplasia, in others part of the neoplastic disease. Sometimes it is, on the other hand manifested during antineoplastic treatment. Its development may be associated with this therapy. The presented case-history describes a female patient with breast cancer treated with antineoplastic agents, who developed a sporadic form of late cutaneous porphyria with a classical clinical and laboratory picture. The authors contemplate on the possible porphyrinogenic effect of antineoplastic agents, in particular cyclophosphamide and tamoxifen, which in the latter preparation was not described so far.