Radio-guided surgery with the use of [99mTc-EDDA/HYNIC]octreotate in intra-operative detection of neuroendocrine tumours of the gastrointestinal tract.

PURPOSE: Radio-guided surgery (RGS) is an intra-operative localising technique which enables identification of tissue "marked" by a specific radiotracer injected before surgery. It is mainly used for sentinel node mapping and for detection of parathyroid adenomas and other tumours, including neuroendocrine tumours of the gastrointestinal tract (GEP-NET). The aim of this study was to determine whether intra-operative radio-detection with the use of [(99m)Tc-EDDA/HYNIC]octreotate, a new somatostatin analogue, is able to reveal an unknown primary and secondary sites, thereby improving surgical treatment and the final outcome of GEP-NET. METHODS: The study group included nine patients with suspected GEP-NET (four carcinoids, five pancreatic NET) localised with somatostatin receptor scintigraphy (with [(99m)Tc-EDDA/HYNIC]octreotate), who had negative results on other pre-operative imaging tests. At surgery, suspected tumours were measured in situ and ex vivo and precise exploration of the abdominal cavity was performed with the intra-operative scintillation detector (Navigator). RESULTS: Intra-operative gamma counting localised three carcinoids. In one patient SRS was false positive (owing to inflammatory infiltration). Compared with SRS, RGS revealed additional lymph node metastases in one case. RGS resulted in successful localisation of all pancreatic NET (the smallest lesion was 8 mm in diameter). CONCLUSION: [(99m)Tc-EDDA/HYNIC]octreotate SRS followed by RGS is a promising technique to improve the rate of detection and efficacy of treatment of GEP-NET, especially in the presence of occult endocrine tumours. The imaging properties of [(99m)Tc-EDDA/HYNIC]octreotate and the 1-day imaging protocol offer opportunities for more widespread application of this tracer followed by RGS in oncology.

Intraoperative ultrasonography in detecting and assessment of colorectal liver metastases.

OBJECTIVE: to assess the clinical value of intraoperative ultrasonography (IOUS) in detecting and assessment of liver metastatic tumours in colorectal cancer patients. METHODS: a study is a retrospective analysis of 388 patients operated on for colorectal carcinoma between 1997 and 2004. In all the patients intraoperative ultrasound was performed. The authors analyzed of sensitivity, specificity, PPV, NPV and accuracy of pre- and intraoperative ultrasonography in detecting and staging of colorectal metastatic lesions. RESULTS: Intraoperative ultrasonography showed the highest sensitivity, specificity and accuracy in both, tumor detection (99.1, 98.5 and 98.9%, respectively) and assessment (95.4, 99.5 and 99.1%, respectively). Overall sensitivity of IOUS was significantly better in detection and staging compared with preoperative ultrasonography 91.1 and 72.2%, respectively). CONCLUSIONS: IOUS should be used as routine diagnostic modality in colorectal cancer patients with hepatic metastases or suspected metastases. Transabdominal ultrasonography cannot be used as the only diagnostic tool in the evaluation of liver lesions, but may be helpful in preoperative screening.

99mTc-EDDA/HYNIC-octreotate scintigraphy, an efficient method for the detection and staging of carcinoid tumours: results of 3 years' experience.

PURPOSE: At all stages of the disease, serious difficulties are encountered in the imaging diagnosis of carcinoids. Somatostatin receptor scintigraphy (SRS) holds great promise for detecting primary tumours and metastases. 99mTc-EDDA/HYNIC-octreotate should significantly improve the diagnosis of carcinoids in comparison with 111In-Octreoscan owing to the better affinity for SSR2 and the higher count rate. The aim of this study was to assess the diagnostic efficiency of 99mTc-EDDA/HYNIC-octreotate scintigraphy in the detection and staging of carcinoid tumours. METHODS: The study population comprised 75 patients (age 48.5+/-15.5 years): 46 with histological confirmation of carcinoid and 29 with suspected disease. 99mTc-EDDA/HYNIC-octreotate (740 MBq) SRS and CT were performed in all patients. Fifteen patients were examined with 111In-Octreoscan. RESULTS: High-quality 99mTc-EDDA/HYNIC-octreotate images were obtained in all cases, with maximum tumour tracer accumulation 4 h p.i. The mean target/non-target ratios for whole body (WB) and SPECT scans were, respectively, as follows: primary lesions: 4.5 and 10.2; metastases: liver, 3.1 and 12.3; abdominal focal lesions, 2.7 and 5.8; lung, 2.7 and 8.3; mediastinum, 3.4 and 7.6; bones, 6.8 and 19.0. 99mTc-EDDA/HYNIC-octreotate WB scans revealed more metastases than 111In-Octreoscan, with better individual separation. 99mTc-EDDA/HYNIC-octreotate SRS revealed new metastatic lesions in seven patients with confirmed carcinoid, and in four with dissemination the primary focus was found. Five patients qualified for radioguided surgery and 11 were referred to 90Y-DOTA-TATE therapy. The sensitivity of SRS in comparison with CT was higher for primary lesions and liver and abdominal lymph node metastases. In the subgroup of patients with suspected neuroendocrine tumours, two duodenal carcinoids, one thymic carcinoid and one ileal carcinoid were found. CONCLUSION: 99mTc-EDDA/HYNIC-octreotate, with high imaging quality, is an excellent alternative to 111In-Octreoscan for staging of carcinoids, and it seems to be the method of choice for detection of the primary focus in patients with metastases from an unknown primary tumour.

The value of modern ultrasonographic techniques and computed tomography in detecting and staging of pancreatic carcinoma.

OBJECTIVE: to assess the clinical value of ultrasonographic methods and computed tomography in diagnosing and staging pancreatic carcinoma. METHODS: prospective clinical trial of 140 patients (64 women and 77 men; mean age 59,6) operated on for pancreatic carcinoma between 2000 and 2004. In each case helical CT, routine-, color- and power Doppler and 3-D USG were performed to detect and stage cancer. Analyses of accuracy, sensitivity, specificity, PPV and NPV of ultrasonographic methods and CT were made. RESULTS: 3-D USG showed the best accuracy of local staging (T): 95.6%. CT was the most accurate in lymph node assessment: 91.3%. The accuracy of CT, 3-D USG and power-Doppler at detecting vascular infiltration was 93.1%. CONCLUSIONS: diagnostic accuracy of modern ultrasound techniques is comparable to helical CT in detecting and staging pancreatic carcinoma. USG is recommended due to the relatively low cost, non-invasiveness and availability of the procedure.

Incidence of thyroid cancer in the selected areas of iodine deficiency in Poland.

The aim of the study was to evaluate the incidence rate (IR), trend and histotype of the differentiated thyroid cancer in the selected areas with varying iodine deficiency. The study was carried out in three areas: Krakow, (Carpathian endemic goiter area with 1.99 million mixed rural and urban population), Gliwice (Upper Silesia--moderate iodine deficiency area mostly industrial with 4.89 million inhabitants) and Olsztyn (slight iodine deficiency area, mainly rural with 0.77 million inhabitants). Between 1990 and 2001, in the study area 2691 newly diagnosed cases of malignant neoplasms of the thyroid gland were registered. In over 80% of patients it was differentiated thyroid cancer: mainly in women over 40 years, with F/M ratio 5.8. The highest percentage of papillary cancer 72.9% was observed in Olsztyn and lowest--50.0%--in Krakow and Nowy Sacz districts. In this period of time incidence rate of differentiated thyroid cancer in women increased in Kraków, Gliwice, and Olsztyn from 1.51 to 9.34 in 1998 1.27 to 5.74 in 1999 and from 2.52 to 11.35 in 2001 respectively. In the youngest (0-20 years) age group no significant increase of IR was observed. Between 1998 and 2001 the dynamics of increase of the thyroid cancer incidence markedly diminished. In conclusion it was hypothesised that an increase in IR of differentiated thyroid cancer in the study area was caused mainly by the suspension of iodine prophylaxis in 1980 and was diminished by the introduction of an obligatory model of iodine prophylaxis in 1996/1997. It was modified in terms of histotype and dynamics of increase by exposure to ionizing radiation. A very specific group at risk on the population level were women aged 20-40 years in the reproductive age exposed to iodine deficiency after suspension of iodine prophylaxis in 1980 and to radiation after the Chernobyl accident in 1986.

[Ulcerative colitis concomitant with pyoderma gangrenosum and erythema nodosum--presentation of two cases]. / Wrzodziejace zapalenie jelit towarzyszace piodermii zgorzelinowej i rumieniowi guzowatemu--pokaz dwóch przypadków.

Authors present case of a 28-year old woman with skin symptoms of pyoderma gangrenosum and ulcerative colitis seriously advanced. The patient benefited from wide resection of the colon and steroid therapy. The other patient was 23-year old woman with ulcerative colitis concomitant with skin changes of erythema nodosum. In this case steroid therapy gave also a very good effect. We tried to find pathogenetic connection between these diseases based on the reports from the medical literature.

[Radical surgical treatment of differentiated thyroid cancer--necessity or over-enthusiasm?]. / Radykalizacja leczenia operacyjnego zróznicowanego raka tarczycy--koniecznosc czy nadgorliwosc?

The extent of surgical treatment of well differentiated thyroid cancer has been controversial and widely discussed for years. Although the recommendations defining the strategy of thyroid surgery were approved in 1995, a lot of questions remained. The aim of this retrospective study was to analyse long-term results of surgical treatment of thyroid cancer according to the type of applied surgical procedure. The study group consisted of 206 patients surgically treated for well differentiated thyroid cancer with the minimal follow-up period of 5 years. The median age patients was 49.1 years. 159 patients (77.2%) have still remained in the follow-up programme, 23 died because of thyroid cancer (11.1%) and the remaining 24 have either refused to participate in the programme or died of other causes. Median follow-up period was 10.7 years. Total thyroidectomy was performed in 90 patients (43.7%) and less extensive procedures in 106 (51.4%). The remaining patients were qualified for palliative reduction of the tumour mass and they were not included in this study. The comparison of the patients with I and II stage of the disease according to the type of surgical procedure did not show differences in 10-year survival. In stage III the difference was very close to statistical significance. The same results were observed with regard to disease recurrence. Long-time survival in low risk patients was not related to the extent of surgical procedure. The risk of recurrence and death was higher in the patients with advanced disease in stage III who underwent less radical procedures like total resection of involved lobe with isthmus and subtotal resection of contralateral lobe.

[Poorly differentiated carcinoma of the thyroid--immunohistochemical evaluation of p53 and p27 protein expression]. / Niskozróznicowany rak tarczycy--immunohistochemiczna ocena ekspresji bialka p53 i p27.

Thyroid carcinomas represent a broad spectrum of tumours with different biologic behaviours. The gap between the indolent course of well-differentiated papillary and follicular carcinomas and the very aggressive behaviour of anaplastic carcinomas is filled by variants of thyroid carcinoma with intermediate prognosis, designated in the literature as poorly differentiated (with insular, trabecular and solid patterns) and tall/columnar cell variant of papillary carcinoma. The study has been carried out in 103 patients who had thyroid cancer with various grade of differentiation. The diagnostic significance of p53 and p27 expression in tumor cells has been investigated by immunohistochemical analysis. Well differentiated carcinomas have exhibited the lowest p53 staining frequency, the expression has been higher in poorly differentiated carcinomas and 100% of anaplastic carcinomas have been positive p27 immunohistochemistry has been positive in 80% of investigated carcinomas (in 15% strong positive reaction). In the group of poorly differentiated tumours positive reaction has been observed in 75% cases (in 15% strong positive reaction). Our data suggest that expression of p53 and p27 seems to have limited routine diagnostic significance, but p53 positivity is a good marker of tumour progression.

[Expression of protein p53: the marker of low neoplastic cell differentiation in thyroid carcinoma]. / Ekspresja bialka p53: marker niskiego zróznicowania komórek nowotworowych w raku tarczycy.

UNLABELLED: The aim of the study was to evaluate the frequency of positive staining of p53 protein in the course of thyroid carcinoma and to establish the prognostic value of such expression. MATERIAL AND METHOD: Immunohistochemical staining of frozen sections was performed in 159 patients with thyroid carcinoma (139 females and 29 males). The average age was 50.4 years. All patients have been followed-up for at least 5 years and the average time of observation was 10.7 years. There were 46% patients with papillary carcinoma, 39% with follicular carcinoma and 15% with poorly differentiated thyroid carcinoma in the study group. Additionally, staining was performed in 6 cases of anaplastic carcinoma. The expression of p53 protein was assessed by two-degree scale: a medium (10% of cells with positive staining) and strong (50% of positive staining). RESULTS: In the group of 135 patients with well differentiated thyroid carcinoma the expression of p53 protein has been found in 55 cases (40.1%) but significantly more often in medium (69.1%) than in strong degree (30.9%). Significantly more often in expression has occurred among patients with poorly differentiated carcinoma (66%) and anaplastic carcinoma (100% of patients with strong expression in all cases). Comparing the frequency of p53 protein expression on every stage of disease, no significant difference has been found. The presence of p53 protein has not correlated with reduced changes in survival. In multivariate analyses the expression of p53 protein have not shown prognostic value. CONCLUSION: The expression of p53 protein has concerned the poorly differentiated carcinomas of thyroid and has not correlated with the stage of disease. No influence of expression on clinical course of the well differentiated thyroid carcinoma has been found. Worse prognoses have correlated with poor differentiated thyroid cancer cases and with strong expression of p53 protein.

[Thyroid carcinoma--contemporary diagnostic principles and treatment]. / Rak tarczycy--wspólczesne zasady diagnostyki i leczenia.

Thyroid cancer, which is a rare neoplasm, is still controversial issue. References approved in Poland in 1995 caused unification of the extension of thyroid surgery to total resection of thyroid gland in case of cancer. For many surgeons such a radical treatment is still doubtful. On the other hand thyroid cancer is an object of many studies because of its heterogenous clinical course and prognosis depending of histological type. This article focuses on modern principles of diagnosis, treatment and follow-up according to obligatory references in Poland. The authors show current epidemiological data, prognosis according to histological type of cancer and explain pathogenesis of the disease. Preoperative diagnostic model has been described including role of ultrasound examination, biopsy, cytology and histology examination. Special interest was taken to follow-up patients after total thyroidectomy emphasising the role of thyreglobin in early detection of cancer recurrence. It is also important to observed patients for the rest of their life because cancer recurrences have been reported even 40 years after surgery. Preoperative diagnosis and treatment is a typical example of multi-disciplinary procedure which should be held in specialistic centres with proper equipment and experience.