The Comparison of Quantitative Evaluation Results of the MPS SPECT/CT and Coronary Angiography: Determining the Most Valuable Quantitative Evaluation Score

Objectives: This study aimed to determine the most important perfusion score in patient selection for coronary angiography (CA) by quantitatively evaluating myocardial perfusion scintigraphy (MPS). Methods: Patients who underwent MPS single-photon emission computerized tomography/computed tomograph imaging in our clinic between December 2017 and January 2019, without coronary artery disease (CAD) history, followed by CA were included in the study. CA was considered positive when there is a stenosis of 70% or more in at least one coronary vessel. The summed stress score, rest score, and differential score; total perfusion deficit (TPD); and the defect's extent obtained from non-attenuation-corrected (NC) and attenuation-corrected (AC) images of 80 patients were evaluated using the Mann-Whitney U test. A p value of <0.05 was considered significant. Receiver operating characteristic (ROC) analysis was performed. Results: The scores obtained from NC and AC images showed a significant difference between the two groups for all scores except for the extent and TPD scores at rest from AC images. The applied ROC curves' highest diagnostic value was determined as the TPD score at stress (TPDS) obtained from NC images (area under the curve: 0.880, 95% confidence interval, 0.807-0.952, p<0.001). The cut-off value obtained for the TPDS from the ROC curve was found to be 5.5. Conclusion: The scores obtained from NC images have more power to detect CAD than those obtained from AC images. Patients with no prior CAD history with TPDS score higher than 5 in MPS should be referred for CA with priority.

Positron emission tomography/computed tomography findings of lung invasive adenocarcinoma subgroups and comparison of their short-term survivals.

BACKGROUND: The aim of this study was to compare the maximum standardized uptake values on positron emission tomography/ computed tomography and survival of lung invasive adenocarcinoma subgroups. METHODS: Between January 2010 and January 2016, a total of 152 patients (112 males, 40 females; mean age: 64.2±8.6 years; range, 41 to 88 years) who underwent lung resection for an invasive adenocarcinoma were retrospectively analyzed. The patients were divided into subgroups as follows: acinar, lepidic, micropapillary, papillary, and solid. The maximum standardized uptake values in the imaging study and their relationship with survival were examined. RESULTS: There were 84 acinar (55%), 31 solid (20%), 23 lepidic (15%), nine papillary (5%), and five micropapillary (3%) cases. The positron emission tomography/computed tomography enhancement showed a statistically significant difference among the subgroups (p=0.004). The solid subgroup was the most involved (9.76), followed by micropapillary (8.98), acinar (8.06), papillary (5.82), and lepidic (4.23) subgroups, respectively. According to Tumor, Node, Metastasis staging, Stage I was present in 48.68% (n=74) of the cases, Stage II in 25.0% (n=38), Stage III in 25.0% (n=38), and Stage IV in 1.31% (n=2). The one-year, three-year, and five-year survival rates were significantly different among the disease stages (p=0.01). The longest survival duration was in the lepidic subgroup, although it did not reach statistical significance among the subgroups (p=0.587). CONCLUSION: The evaluation of invasive adenocarcinomas based on maximum standardized uptake values provides valuable information and may guide neoadjuvant and adjuvant therapies in the future.

Evaluation of 99mTechnetium-Vancomycin Imaging Potential in Experimental Rat Model for the Diagnosis of Infective Endocarditis.

BACKGROUND: Infective endocarditis (IE) is an infection of the heart's endocardial surface. In recent years, nuclear imaging methods have gained importance in the diagnosis of IE. The present study aims to investigate the imaging potential of 99mTc-labeled vancomycin (99mTc-Vancomycin) as a new agent that would enable the diagnosis of IE in its early stages when it is difficult to diagnose or has small vegetation in the experimental rat model. METHODS: 99mTc-Vancomycin scintigraphy was evaluated for its accumulation in IE with Staphylococcus aureus performed in an experimental rat model. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. The heart was identified as an infected organ, the liver was identified as a non-infected organ and the heart/liver uptake ratio (T / NT ratio) was compared between infective endocarditis and sterile endocarditis groups. RESULTS: Planar scintigrams (in vivo measurements) showed more uptake in the heart of rats in the infective endocarditis group compared to the uptake in the heart of rats in the sterile endocarditis group, but this difference was not statistically significant (p>0.05). From the ex vivo measurements, the 99mTc-Vancomycin heart uptake increased significantly (p = 0.016), liver uptake was significantly decreased (p = 0.045) and the T/NT ratio was significantly higher (p = 0.014) in the infective endocarditis group compared to the sterile endocarditis group. CONCLUSION: In this experimental study, 99mTc-Vancomycin scintigraphy ensured the detection of ex vivo infected tissue in a rat model of IE. In addition, the absence of significant 99mTc-Vancomycin uptake in the sterile endocarditis group indicates that this agent targeted the infected tissue instead of the sterile inflammatory tissue. Finally, this agent should also be evaluated with animal- specific imaging devices.

Factors affecting overall survival and progression-free survival in patients with metastatic castration resistant prostate cancer received 177Lu PSMA I&T therapy.

OBJECTIVE: Lutetium-177 (177Lu) prostate specific membrane antigen (PSMA) radionuclide therapy (RNT) is an effective and safe treatment option in patients with metastatic castration resistant prostate cancer (mCRPC). The first aim of this study was to determine RNT response rate. The second and main aim of this study is measure overall and progression-free survival (OS and PFS) and to determine the factors have effect on OS and PFS. MATERIAL AND METHODS: Patients with mCRPC had 177Lu PSMA RNT every 6-8 weeks. Therapy response of each cycle determined wit PSA after 6-8 weeks. Overall survival and PFS were measured, then effects of age, Gleason grade, local recurrence, extraabdominopelvic located lymph node metastasis, visceral metastasis, prostate specific antigen (PSA) changing after the first RNT, pretreatment PSA, hemoglobin (Hb), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) values on survivals were determined. RESULTS: Forty-five patients were treated with total of 164 cycles of RNT. Fifteen patients (33%) had PSA decline of ≥50%, 23 patients (51%) showed any PSA decline and 20 patients (44%) showed PSA increase of ≥25%. Median OS and PFS were 17,1 months and 7,4 months. Patients had any or ≥50% PSA response after the first cycle, lower initial ALP (<120U/L) had longer OS and PFS. Patients had normal Hb showed longer OS and patients had lower initial PSA (<51ng/mL) had longer PFS. Patients had PSA progression of ≥25% had shorter OS and PFS. CONCLUSION: Prostate specific antigen response after the first cycle, lower initial ALP is related to longer OS and PFS. Normal pretreatment Hb is a predictor of longer OS and lower initial PSA is related to longer PFS. Prostate specific antigen progression after the first cycle causes shorter OS and PFS.

Management of the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer: A single-center study.

The neoadjuvant chemotherapy (NAC) is the gold standard initial treatment of the locally advanced breast cancer (LABC). However, the reliability of methods that used to assess response the NAC is still controversial. In this study, patients with LABC who underwent NAC were evaluated retrospectively. The assessment of response to NAC and the effect of axillary approach were investigated on LABC course.The study comprised 94 patients who received NAC with an LABC diagnosis between 2008 and 2020. In our center, magnetic resonance imaging, ultrasonography, and F-flouro deoxyglucose positron emission tomography/computed tomography, and, for some patients, fine-needle aspiration biopsy of suspicious axillary lymph nodes have been performed to assess the effects of NAC. Patients with positive hormone receptor status received adjuvant hormonotherapy, and those with human epidermal growth factor receptor 2 gene expression were treated with trastuzumab. Adjuvant radiotherapy was applied to all patients undergoing breast conserving surgery. Radiotherapy was applied to the peripheral lymphatic areas in the clinical N1 to N3 cases regardless of the response to NAC.The clinical response to the NAC was found that partial in 59% and complete in 19% of the patients. However, 21.2% of the patients were unresponsive. The mean of lymph nodes that excised with the procedure of sentinel lymph node biopsy (SLNB) was 2.4 (range 1-7). In 22 of the 56 patients who underwent SLNB, axillary dissection (AD) was added to the procedure upon detection of metastasis in frozen section examinations. There was no difference between the SLNB and AD groups regarding overall survival (OS; P = .472) or disease-free survival (DFS) rates (P = .439). However, there were differences in the OS (P < .05) and DFS (P = .05) rates on the basis of the LABC histopathological subtypes.The study found that a relationship between molecular subtypes and LABC survival. However, the post-NAC axillary approach had no effect on OS or DFS. Therefore, multiple imaging and interventional methods are needed for the evaluation of NAC response. In addition, morbidity can be avoided after AD by the use of SLNB in cN0 patients.

The use of molecular volumetric parameters for the evaluation of Lu-177 PSMA I&T therapy response and survival.

PURPOSE: The primary aim of this study was to evaluate the volumetric therapy response via Ga-68 PSMA I&T PET/CT in patients treated with Lu-177 PSMA I&T therapy. The secondary purpose was to determine the impact of volumetric parameter responses to overall survival. METHODS: PSMA tumor volumes (PSMA-TV) and tumor lesion PSMA expressions (TL-PSMA) were calculated with a semi-automatic program on Ga-68 PSMA I&T PET/CT images that were obtained before and after Lu-177 PSMA I&T therapies with 19 patients. The median overall survival was compared with PSMA-TV, TL-PSMA, SUVmax, PSA, and alteration in PERCIST criteria. RESULTS: PSMA-TV values were decreased in 12 patients (63%), and TL-PSMA values were decreased in 15 patients (79%) following the therapy. The SUVmax and the PSA values were also decreased in 14 (74%) and 10 (53%) patients, respectively. The complete remission (CR) was observed in two patients (10%). The partial response (PR) and progressive disease were observed in 6 (32%) and 11 (58%) patients, respectively, according to PRECIST criteria. The survival rates were statistically significant in patients with a decrease in PSMA-TV and TL-PSMA values than patients without any decrease (p 0.001, p < 0.001, respectively). However, the survival rates did not differ in responders (PR or CR) and non-responders according to the PERCIST criteria (p 0.232). The survival rates did not also differ in responders and non-responders according to the SUVmax and PSA values (p 0.140, p 0.206, respectively). CONCLUSIONS: Molecular and volumetric parameters are beneficial in the assessment of Lu-177 PSMA I&T therapy response. Although the number of patients is small, TL-PSMA response, which includes both the tumor volume and PSMA expression in tumor, may be considered as the most valuable parameter for the evaluation of the therapy response and the prediction of survival rate.

Ochronosis Involvement and Extensity With 18F-FDG PET/CT.

Ochronosis (alkaptonuria) is an autosomal recessive inherited metabolic disease that causes pigmentation by accumulation of homogenous acid in the connective tissue. The most important causes of morbidity are ochronotic arthropathy and cardiovascular involvement seen in fourth and sixth decades, respectively. In this case report, we report the prevalence of F-FDG PET/BT findings in a 48-year-old man with ochronosis who underwent F-FDG PET/BT imaging for the evaluation of mediastinal lymphadenopathy.

Comparison of Bone Uptake in Bone Scan and Ga-68 PSMA PET/CT Images in Patients with Prostate Cancer.

OBJECTIVE: The aim of this study was to compare images from Tc-99m MDP bone scan (BS) and Ga-68 PSMA PET/CT of patients with prostate cancer in terms of bone metastases. METHODS: Overall, 34 patients exhibited a mean age of 66 ± 9.5 (50-88) years, mean PSA of 51 ± 159ng/ml (0-912), and mean Gleason score of 8 (6-9). BS and Ga-68 PSMA PET/CT were applied to 34 patients within 30 days, and the results were evaluated, retrospectively. In both tests, radiopharmaceutical uptake in bones were compared. RESULTS: In 7 patients (20.5%), uptake was not significant on BS and Ga-68 PSMA PET / CT images, which is related to metastasis. In 14 (41%) patients, bone metastases were observed in both examinations. However, more metastatic lesions were observed in the Ga-68 PSMA PET/CT of 3 patients and in the bone scintigraphy of 2 patients. PSMA expression was not observed on Ga-68 PSMA PET / CT in 13 (38%) patients with increased activity in bone scintigraphy. Two (6%) of these patients were thought to be metastatic, 2 (6%) were suspicious for metastasis, and 9 (26%) had no metastasis. When a lesion-based evaluation was performed, a total of 480 activities were evaluated: increased activity uptake was found in 305 BS, and 427 PSMA expression activity was detected. Furthermore, 435 of these activities were evaluated as metastatic. CONCLUSION: Ga-68 PSMA PET/CT provides an additional contribution to the BS evaluation of activity areas because of the presence of PSMA expression and anatomical lesions. In 6% of the patients, activity on BS and metastatic appearance in CT images were observed and the presence of lesions in the absence of PSMA was determined. This suggests that bone metastases without PSMA expression may also be present.

The use of pre-test and post-test probability values as criteria before selecting patients to undergo coronary angiography in patients who have ischemic findings on myocardial perfusion scintigraphy.

OBJECTIVE: Myocardial perfusion scintigraphy (MPS) is a diagnostic test which is frequently used in the diagnosis of coronary heart disease (CHD). MPS is generally interpreted as ischemia present or absent; however, it has a power in predicting the disease, similar to other diagnostic tests. In this study, we aimed to assist in directing the high-risk patients to undergo coronary angiography (CA) primarily by evaluating patients without prior CHD history with pre-test and post-test probabilities. METHODS: The study was designed as a retrospective study. Between January 2008 and July 2011, 139 patients with positive MPS results and followed by CA recently (<6 months) were evaluated from patient files. Patients' pre-test probabilities based on the Diamond and Forrester method and the likelihood ratios that were obtained from the literature were used to calculate the patients' post exercise and post-MPS probabilities. Patients were evaluated in risk groups as low, intermediate, and high, and an ROC curve analysis was performed for the post-MPS probabilities. RESULTS: Coronary artery stenosis (CAS) was determined in 59 patients (42.4%). A significant difference was determined between the risk groups according to CAS, both for the pre-test and post-test probabilities (p<0.001, p=0.024). The ROC analysis provided a cut-off value of 80.4% for post- MPS probability in predicting CAS with 67.9% sensitivity and 77.8% specificity. CONCLUSION: When the post-MPS probability is ≥80% in patients who have reversible perfusion defects on MPS, we suggest interpreting the MPS as "high probability positive" to improve the selection of true-positive patients to undergo CA, and these patients should be primarily recommended CA.

Undifferentiated Laryngeal Carcinoma with Pagetoid Spread.

Pagetoid spread, is used to define intraepithelial spread of cancer cells, when a massive carcinoma is identified beneath the basal membrane. There are only few reports of pagetoid spread at the head and neck region. Herein a 74 year old male patient with bilateral transglottic laryngeal high grade malignant epithelial tumor with pagetoid spread is presented. The tumor was located at the submucosa and there was spread of the CK7 and CK19 positive tumor cells into the non neoplastic mucosa, which was CK5/6 positive, sparing the basement membrane, creating a typical pagetoid pattern. Radiographic and positron emission tomography scan examination of the patient was unremarkable at presentation other than the laryngeal and neck lesions; but extensive systemic metastasis developed at 6 months following operation. To the best of our knowledge no epithelial malignancy with pagetoid spread was described at the larynx. Pagetoid spread may be a hallmark of very aggressive behavior in laryngeal carcinoma.

The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence.

OBJECTIVE: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision. METHODS: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT. RESULTS: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients' management in 20 (15%) cases. CONCLUSIONS: 18F-FDG PET/CT can provide useful information in discriminating true recurrence in patients with suspected gastric cancer recurrence and may have significant impact on clinical decisions/patient management in a considerable percentage of patients.

Evaluation of (131)I-pentamidine for scintigraphy of experimentally Leishmania tropica-infected hamsters.

We aimed to assess the ability of (131)I-Pentamidine scintigraphy to detect the lesions of Leishmania tropica infection. An experimental model of cutaneous leishmaniasis was developed. The presence of cutaneous leishmaniasis was confirmed. Pentamidine was radioiodinated with (131)I. The radiolabeled pentamidine was validated by the requisite quality control tests to check its radiolabeling efficiency, in vitro stability. (131)I-Pentamidine (activity: 18.5 MBq/100 µl) was injected intracardiacally into infected hamsters. Static whole body images of the hamsters were acquired under the gamma camera at 5 and 30 min, 2, 6 and 24 h following the administration. On the scintigrams, anatomically adjusted regions of interest (ROIs) were drawn over the right feet (target) and left feet (not-target) and various organs. Accumulation of (131)I-Pentamidine at sites of infection is expressed as the target to non-target (T/NT) ratio. The results T/NT ratio decreased with time. In concluding the (131)I-Pentamidine has poor sensitivity in detection of L. tropica infection.

The effect of radioiodine on the intima media thickness of the carotid artery.

AIM: The radiation can induce vessel injury. The result of this injury can be severe and life-threatening. There are a few studies demonstrating an increase in intima-media thickness (IMT) of the common carotid artery (CCA) after radiotherapy, especially in head and neck cancers. We evaluated the effect of I-131 to the IMT of the CCA in the patients who were treated for hyperthyroidism. METHODS: 38 patients (25M, 13W) referred to our department for radioiodine treatment with the diagnosis of nodular goitre (25 patients) and diffuse hyperplasia (Graves disease (GD), 13 patients) were included to the prospective study. An USG was performed for all the patients before therapy, 3, 6 and 12 months after radioiodine therapy in order to measure IMT of CCA and the femoral artery (FA). The IMT was measured at the level of proximal part of bulbus anteriorly on the left and right side. The IMT of FA was measured just before the bifurcation. RESULTS: There was a statistically significant increase in IMT of both CCA and FA bilaterally in nodular hyperthyroid patients. However, in the patients with Graves disease, there was only statistically significant increase in the left IMT of CCA at 0-3rd, 0-6th month measurements and in the right IMT of FA at 0-3rd month measurements. CONCLUSION: Though the limitation of the study is the interobserver and intraobserver variability, it was seen that I-131 therapy might affect the IMT of CCA in the patients with NG. I-131 effect on the IMT of CCA in patients with nodular goitre was higher than the IMT of CCA in patients with GD. I-131 effect on the IMT of CCA might be due to administered dose and adjacency. The interesting point of our study was the increased thickness of IMT in FA. We think that the increase in IMT is due to the systemic effect of radioactivity circulating in the blood vessel. I-131 effect on the IMT of FA in patients with nodular goitre was higher than the IMT of FA in the patients with GD due to I-131 uptake of thyroid gland. Because I-131 uptake was lower in patients with nodular goitre, I-131 in systemic circulation was higher. CONFLICT OF INTEREST: None declared.

Preparation of (131)I-Pyrimethamine and evaluation for scintigraphy of experimentally Toxoplasma gondii-infected rats.

We aimed to assess the ability of (131)I-Pyrimethamine scintigraphy to detect the lesions of Toxoplasma gondii infection. An experimental model of toxoplasmosis was developed. The presence of toxoplasmosis was confirmed 60 days after implantation. Pyrimethamine was radioiodinated with I-131. The radioligand was validated by the requisite quality control tests to check its radiolabeling efficiency, in vitro stability and radiochemical purity etc. (131)I-Pyrimethamine (specific activity: 7.08 MBq/µmol) was injected intravenously into the tail vein of the control and infected rats. Static whole body images of the rats were acquired under the gamma camera at 5 min, 45 min, 2 h, 6 h, and 24 h following the intravenous administration of the radioactivity (3.7 MBq/rat). Then the scintigraphic data were analyzed both visually and semiquantitatively. Regions of interest (ROIs) were drawn over the organs (thyroid, stomach, liver, bladder, and soft tissues) to calculate the ratios of the radiotracer in infected vs. control rats. The mean ratio of radiotracer in infected/control rats in the liver and diaphragm was over 1 at 45 min which persisted till 24 h. In conclusion, (131)I-Pyrimethamine may be useful agent for diagnosis toxoplasmosis especially involving liver and diaphragm, needs further preclinical validation before being extended for use in clinical applications.

Interobserver and intraobserver agreement in parathyroid scintigraphy: How can parathyroid scintigraphy be made more reliable?

OBJECTIVE: To determine the intraobserver and interobserver agreement levels in the evaluation of technetium Tc 99m sestamibi parathyroid scintigraphic images. METHODS: Ninety-eight patients with hyperparathyroidism were included in the study, and their parathyroid images were evaluated by 4 experienced nuclear medicine observers. The 98 cases were evaluated twice by each observer within an interval of 2 weeks. The evaluations were performed directly on workstations with use of digital images. A questionnaire was completed by each observer. The presence of a lesion, the number and the localizations of the lesions, and whether the lesion was clear or doubtful were all evaluated. Cohen kappa statistics and total agreement percentages were calculated by using SPSS version 11.0 software. RESULTS: The 4 observers performed 8 different evaluations and identified a minimum of 38 and a maximum of 43 cases with a parathyroid lesion (or lesions). Both the intraobserver and the interobserver agreements were "very good" for the presence of a parathyroid lesion. The intra-observer agreement was also "very good" and the interobserver agreement was "good" (for only 1 pair of observers) or "very good" for the evaluation of the number of parathyroid lesions. The intraobserver agreement was "very good" or "good" and the interobserver agreement was "good" for the lesion localization and for the presence of a doubtful lesion. CONCLUSION: Parathyroid scintigraphy seems to be an observer independent method in the detection of a parathyroid lesion, in the determination of the number of lesions, and in the localizations of the lesions. The measured high agreement between observers increases the reliability of parathyroid scintigraphy.

Gold nanoparticle probes: design and in vitro applications in cancer cell culture.

A new architecture has been designed by the conjugation of [(18)F]2-fluoro-2-deoxy-D-glucose ((18)F-FDG), gold nanoparticles (AuNPs), and anti-metadherin (Anti-MTDH) antibody which is specific to the metadherin (MTDH) over-expressed on the surface of breast cancer cells. Mannose triflate molecule is used as a precursor for synthesis of (18)F-FDG by nucleophilic fluorination. For the conjugation of (18)F-FDG and AuNPs, cysteamine was first bound to mannose triflate (Man-CA) before synthesizing of (18)F-FDG which has cysteamine sides ((18)FDG-CA). Then, (18)FDG-CA was reacted with HAuCl(4) to obtain AuNPs and with NaBH(4) for reduction of AuNPs. At the end of this procedure, AuNPs were conjugated to (18)F-FDG via disulphide bonds ((18)FDG-AuNP). For the conjugation of Anti-MTDH, 1,1'-carbonyl diimidazol (CDI) was bound to the (18)FDG-AuNP, and Anti-MTDH was conjugated via CDI ((18)FDG-AuNP-Anti-MTDH). This procedure was also performed by using Na(19)F to obtain non-radioactive conjugates ((19)FDG-AuNP-Anti-MTDH). Scanning electron microscopy (SEM) images demonstrated that synthesized particles were in nano sizes. (18)FDG-AuNP-Anti-MTDH conjugate was characterized and used as a model probe containing both radioactive and optical labels together as well as the biological target. The (18)FDG-AuNP-Anti-MTDH conjugate was applied to MCF7 breast cancer cell line and apoptotic cell ratio was found to be increasing from 2% to 20% following the treatment. Hence, these results have promised an important application potential of this conjugate in cancer research.

Factors predicting non-sentinel lymph node involvement in sentinel node positive breast carcinoma.

OBJECTIVE: In routine practice, axillary lymph node dissection is performed in early invasive breast cancer patients with positive sentinel node biopsy. However, sentinel node is the only involved axillary node in 40-70% of patients, and determining factors that predict axillary non-sentinel node involvement will therefore prevent unnecessary axillary lymph node dissection and decrease morbidity. MATERIAL AND METHOD: In this study, 119 invasive breast cancer patients with sentinel node metastasis who underwent axillary lymph node dissection between 1998-2009 at our institution were studied. Primary tumor characteristics and features of the metastatic tumors in sentinel nodes, such as microanatomic location, size of metastasis, and the ratio of metastatic tumor area to the total sentinel node area were evaluated. Student's t-test and multivariate logistic regression were used for statistical analysis. RESULTS: The mean age of the patients was 50.7 years (28-80). Forty-three patients (36%) had invasive ductal and 25 patients (21%) had invasive lobular carcinoma. Most of the patients had either pT1 (44%) or pT2 (54%) tumors. Fifty-four patients (45%) had no further positive nodes in the axilla. The metastatic deposits in the sentinel node were subcapsular in 16 patients (13%). The percent area of sentinel node occupied by tumor (p < 0.001), number of sentinel nodes (p=0.041), and microanatomic location of metastatic tumor (p=0.002) were significantly associated with non-sentinel node metastasis in univariate analysis. The percent area of sentinel node occupied by tumor (p < 0.001) and number of sentinel nodes (p=0.033) remained significantly associated with non-sentinel node involvement in multivariate analysis. CONCLUSION: In patients with invasive breast cancer and positive sentinel node, area percent of sentinel node occupied by tumor, and the number of sentinel nodes removed are independently predictive of non-sentinel node involvement.

[The ability of 67Ga scintigraphy to detect Trichinella spiralis]. / Trichinella spiralis'in Tanisinda Gallium-67 Sintigrafisinin Yeri.

To assess the value of (67) Ga scintigraphy in the lesions of Trichinella spiralis, an animal model was developed. Three infected and five healthy animals were enrolled in this study. After the injection of 7.4 MBq (200 micro Ci) (67) Ga citrate intravenously, static images from whole body were obtained at 24(th), 48 (th) and 72 (nd) hours Visual and semiquantitative analyses were performed. In semiquantitative analysis, activity counts were calculated over the whole body, diaphragm, neck muscles and extremities muscles of all animals. Between the infected animals and control group, mean bodies activity ratios were compared as visually and statistically. (67) Ga scintigraphy can't successfully demonstrate the lesions of Trichinella spiralis.