RESUMO
PURPOSE: To compare patients with visualized sentinel lymph nodes (SLNs) and patients with nonvisualized SLNs, with a focus on variables affecting SLN visualization at preoperative lymphoscintigraphy and on nodal drainage basins as related to tumor location. MATERIALS AND METHODS: One hundred thirty-six patients who had breast cancer underwent preoperative lymphoscintigraphy before SLN biopsy. Patients with visualized and nonvisualized SLNs were compared for age; tumor site, size, and histologic findings; injection guidance method; diagnostic biopsy type; interval between biopsy and lymphoscintigraphy; intraoperative identification method; and surgical identification rate. Visualized SLN drainage basins were noted. RESULTS: Ninety-nine patients had visualized and 37 had nonvisualized SLNs, without statistically significant differences in tumor site, size, and histologic findings; injection guidance method; diagnostic biopsy type; and interval between biopsy and lymphoscintigraphy. Ninety-nine (73%) of the 136 SLNs were visualized at lymphoscintigraphy; 30 (81%) of the 37 nonvisualized SLNS were identified at surgery. Of the seven SLNs not identified at surgery, five were mapped with radiocolloid only. Patients with nonvisualized SLNs were older than those with visualized SLNs. Eleven (46%) of 24 tumors with internal mammary drainage were in the outer part of the breast. CONCLUSION: Patients with and those without visualization differed in age, SLN identification at surgery, and surgical identification method. Nonvisualized status does not preclude axillary metastasis. In older patients with nonvisualized SLNs, blue dye may aid in SLN detection, as compared with isotope-only localization.
Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/secundário , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Cintilografia , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
We assessed the reproducibility of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) and protease sequencing using cryopreserved plasma aliquots obtained from 46 heavily treated HIV-1-infected individuals in two laboratories using dideoxynucleotide sequencing. The rates of complete sequence concordance between the two laboratories were 99.1% for the protease sequence and 99.0% for the RT sequence. Approximately 90% of the discordances were partial, defined as one laboratory detecting a mixture and the second laboratory detecting only one of the mixture's components. Only 0.1% of the nucleotides were completely discordant between the two laboratories, and these were significantly more likely to occur in plasma samples with lower plasma HIV-1 RNA levels. Nucleotide mixtures were detected at approximately 1% of the nucleotide positions, and in every case in which one laboratory detected a mixture, the second laboratory either detected the same mixture or detected one of the mixture's components. The high rate of concordance in detecting mixtures and the fact that most discordances between the two laboratories were partial suggest that most discordances were caused by variation in sampling of the HIV-1 quasispecies by PCR rather than by technical errors in the sequencing process itself.
Assuntos
Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/enzimologia , Laboratórios/normas , Mutação , Análise de Sequência de DNA , Sequência de Aminoácidos , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Sequência de Bases , Resistência Microbiana a Medicamentos/genética , Quimioterapia Combinada , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Protease de HIV/sangue , Protease de HIV/química , Transcriptase Reversa do HIV/sangue , Transcriptase Reversa do HIV/química , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , RNA Viral/sangue , Reprodutibilidade dos Testes , Inibidores da Transcriptase Reversa/farmacologia , Inibidores da Transcriptase Reversa/uso terapêuticoRESUMO
PURPOSE: To compare observer performance in the detection of abnormalities on 1,760 x 2,140 matrix (2K) and 3,520 x 4,280 matrix (4K) digital storage phosphor chest radiographs. MATERIALS AND METHODS: One hundred sixty patients who underwent dedicated computed tomography (CT) of the thorax were prospectively recruited into the study. Posteroanterior and lateral computed radiographs of the chest were acquired in each patient and printed in 2K and 4K formats. Six radiologists independently analyzed the hard-copy images and scored the presence of parenchymal (opacities =2 cm, opacities >2 cm, and subtle interstitial), mediastinal, and pleural abnormalities on a five-point confidence scale. With CT as the reference standard, observer performance tests were carried out by using receiver operating characteristic (ROC) analysis. RESULTS: Analysis of averaged observer performance showed 2K and 4K images were equally effective in detection of all three groups of abnormalities. In the detection of the three subtypes of parenchymal abnormalities, there were no significant differences in averaged performance between the 2K and 4K formats (area below ROC curve [A(z)] values: opacities =2 cm, 0.62 +/- 0.056 [standard error] and 0.59 +/- 0.045; opacities >2 cm, 0.86 +/-.025 and 0.85 +/- 0.030; subtle interstitial abnormalities, 0.73 +/- 0.041 and 0.72 +/- 0.041). Averaged performance in detection of mediastinal and pleural abnormalities was equivalent (A(z) values: mediastinal, 0.70 +/- 0.046 and 0.73 +/- 0.033; pleural, 0.85 +/- 0.032 and 0.86 +/- 0.033). CONCLUSION: Observer performance in detection of parenchymal, mediastinal, and pleural abnormalities was not significantly different on 2K and 4K storage phosphor chest radiographs.
Assuntos
Intensificação de Imagem Radiográfica , Radiografia Torácica , Tomografia Computadorizada por Raios X , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Doenças do Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doenças Pleurais/diagnóstico por imagem , Curva ROC , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricosAssuntos
Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/genética , Armazenamento e Recuperação da Informação , Mutação , Software , Sequência de Aminoácidos , Protease de HIV/química , Transcriptase Reversa do HIV/química , HIV-1/enzimologia , Humanos , Dados de Sequência Molecular , Fases de Leitura , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Alinhamento de SequênciaRESUMO
The HIV RT and Protease Sequence Database is an online relational database that catalogs evolutionary and drug-related human immunodeficiency virus (HIV) reverse transcriptase (RT) and protease sequence variation (http://hivdb.stanford.edu). The database contains a compilation of nearly all published HIV RT and protease sequences including International Collaboration database submissions (e.g., GenBank) and sequences published in journal articles. Sequences are linked to data about the source of the sequence sample and the antiretroviral drug treatment history of the individual from whom the isolate was obtained. The database is curated and sequences are annotated with data from >230 literature references. Users can retrieve additional data and view alignments of sequence sets meeting specific criteria (e.g., treatment history, subtype, presence of a particular mutation). A gene-specific sequence analysis program, new user-defined queries and nearly 2000 additional sequences were added in 1999.