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INTRODUCTION: Breast cancer is one of the leading causes of cancer-related deaths in women; it is the most frequently diagnosed cancer in women in the United States with a lifetime risk of dying of about 3.4%. Regional lymph node involvement is quite early in breast carcinoma and axillary lymph node metastasis is an important predictor of recurrence and survival, particularly in invasive ductal histology of breast carcinoma. Localization of sentinel lymph node/nodes followed by frozen section and histopathological evaluation helps to prevent unnecessary axillary nodal dissection and, hence, reduces associated post-surgical morbidity. Sentinel nodes are the first ones to receive lymph-borne metastatic cells and, hence, lymphoscintigraphy followed by biopsy is quite reliable to detect nodal metastasis, particularly at an early stage (I, II) of breast cancer. METHODS: Here we will share our experience of introducing procedure, personnel training, and workflow of sentinel lymph node lymphoscintigraphy in breast cancer patients at our cancer institute to help other centers establish programs for this study. RESULTS: Initially, 10 procedures were performed, all of which were successful in the localization of sentinel nodes and played a substantial part in the surgical planning of breast cancer. Planar lymphoscintigraphy and single-photon emission computerized tomography (SPECT)-CT images of our first patient revealed radiotracer avidity in the lymph node in the ipsilateral axilla, which was later on diagnosed as metastatic resulting in axillary nodal clearance. CONCLUSIONS: In multidisciplinary/closely-placed surgical, pathological, and hybrid imaging facility settings, lymphoscintigraphy provides a quick, accurate, and better way of nodal localization leading to correct surgical decision-making. In addition to planar imaging, SPECT-CT acquisition significantly improves the specificity of the lymphoscintigraphy procedure, which is beneficial for patients to avoid false-positive results, thus saving breast cancer patients from potential adverse effects of surgery.
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ABSTRACT Objective: To determine immature platelet fraction (IPF) in patients with thrombocytopenia and correlation with their bone marrow findings and to determine its predictive value in differentiating peripheral (hyper destructive) thrombocytopenia from central (hypo-productive) thrombocytopenia. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: King Edward Medical University (KEMU) and Doctors Hospital Lahore, from December 2018 to February 2019. METHODOLOGY: Patients of both genders and all age groups with thrombocytopenia presenting for bone marrow biopsy were included in the study. Clinical data, complete blood count (CBC) sample in EDTA, bone marrow aspirate and trephine biopsy were obtained. Slides were prepared and reviewed. CBC sample was analysed for counts and IPF in Doctors Hospital Laboratory within 4 hours of collection. RESULTS: According to bone marrow findings, patients were grouped under two categories; Group 1 with central (hypo-productive group) thrombocytopenia and Group 2 with peripheral (hyper-destructive group). Group1 (n=44) showed median interquartile range (IQR) IPF 8.2 (4.6-16.7), which was significantly lower (p <0.001) than that of Group 2 (n=14) in which Median IQR IPF was 25.5 (15.2-39.3). A significant moderate degree negative (inverse) correlation was observed between platelet counts and IPF in thrombocytopenic patients in both groups by Pearson correlation. It was statistically significant at p <0 .001 level. IPF in hyper-destructive group has 100% predictive value compared to 31% in hypo-productive group. CONCLUSION: IPF is a useful parameter and can reliably identify patients having thrombocytopenia due to peripheral destruction. In other cases, IPF should be used in conjunction with other investigations like bone marrow biopsy etc. Key Words: Immature platelet fraction, Complete blood count, Central thrombocytopenia, Peripheral thrombocytopenia, Bone marrow failure, Peripheral destruction.