A Pilot Study for the Feasibility of F-18 FLT-PET in Locally Advanced Breast Cancer: Comparison with F-18 FDG-PET / 핵의학분자영상

PURPOSE: The aim of this study was to investigate the feasibility of 3'-[F-18]fluoro-3'-deoxythymidine positron emission tomography(FLT-PET) for the detection of locally advanced breast cancer and to compare the degree of FLT and 2'-deoxy-2'-[F-18]fluoro-d-glucose(FDG) uptake in primary tumor, lymph nodes and other normal organs. MATERIAL AND METHODS: The study subjects consisted of 22 female patients (mean age; 42+/-6 years) with biopsy-confirmed infiltrating ductal carcinoma between Aug 2005 and Nov 2006. We perfomed conventional imaging workup, FDG-PET and FLT PET/CT. Average tumor size measured by MRI was 7.2+/-3.4 cm. With visual analysis, Tumor and Lymph node uptakes of FLT and FDG were determined by calculation of standardized uptake value (SUV) and tumor to background (TB) ratio. We compared FLT tumor uptake with FDG tumor uptake. We also investigated the correlation between FLT tumor uptake and FDG tumor uptake and the concordant rate with lymph node uptakes of FLT and FDG. FLT and FDG uptakes of bone marrow and liver were measured to compare the biodistribution of each other. RESULTS: All tumor lesions were visually detected in both FLT-PET and FDG-PET. There was no significant correlation between maximal tumor size by MRI and SUVmax of FLT-PET or FDG-PET (p>0.05). SUVmax and SUV75 (average SUV within volume of interest using 75% isocontour) of FLT-PET were significantly lower than those of FDG-PET in primary tumor (SUVmax; 6.3+/-5.2 vs 8.3+/-4.9, p=0.02 / SUV75; 5.3+/-4.3 vs 6.9+/-4.2, p=0.02). There is significant moderate correlation between uptake of FLT and FDG in primary tumor (SUVmax; rho=0.450, p=0.04 / SUV75; rho=0.472, p=0.03). But, TB ratio of FLT-PET was higher than that of FDG-PET(11.7+/-7.7 vs 6.3+/-3.8, p=0.001). The concordant rate between FLT and FDG uptake of lymph node was reasonably good (33/34). The FLT SUVs of liver and bone marrow were 4.2+/-1.2 and 8.3+/-4.9. The FDG SUVs of liver and bone marrow were 1.8+/-0.4 and 1.6+/-0.4. CONCLUSION: The uptakes of FLT were lower than those of FDG, but all patients of this study revealed good FLT uptakes of tumor and lymph node. Because FLT-PET revealed high TB ratio and concordant rate with lymph node uptakes of FDG-PET, FLT-PET could be a useful diagnostic tool in locally advanced breast cancer. But, physiological uptake and individual variation of FLT in bone marrow and liver will limit the diagnosis of bone and liver metastases.

Comparison of Early Postoperative Axillary Morbidity Following the Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB) is a relatively accurate diagnostic method for determining the presence of axillary lymph node metastasis (ALND). SLNB reduces the need for axillary lymph node dissection, thereby decreasing the postoperative axillary morbidity. The present study compared the postoperative axillary morbidity rates during early postoperative days for patients undergoing either SLNB or conventional ALND. METHODS: We conducted a prospective case-control study of breast cancer patients. The degree of axillary morbidity was compared between 28 SLNB patients (Group I) and 38 ALND patients (Group II). RESULTS: The SLNB group showed decreased arm swelling and restriction of their shoulder motion in comparison with the conventional axillary dissection group (p<0.05). SLNB and additional lymph node sampling did not result in any additional morbidity. CONCLUSION: SLNB or lymph node sampling was associated with less axillary morbidity like arm edema, limitation of motion than was conventional ALND. The rate of postoperative axillary morbidity did not differ following lymph node sampling and SLNB. SLNB may be an effective method for diagnosing of axillary lymph node metastasis with decreasing the postoperative axillary morbidity

Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope. METHODS: Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n< or =5) or no further treatment was done. RESULTS: The mean number of resected SLNs was 2.67+/-0.98 (1-7) and the mean number of total LN was 8.5+/-5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant. CONCLUSION: SLNB using (99m)Tc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.

Milk aspiration as a Result of Hypotonic-hyporesponsive Episodes after DTaP and Polio Co-immunization / 대한법의학회지

We analyzed autopsy findings of 5 neonates and infants who suddenly died after DTaP and Polio Coimmunization. Microscopically, there were multifocal small amounts of pinkish amorphous materials within the alveolar spaces with marked proliferation of alveolar macrophages. Immunohistochemical stain using anti-human alpha-lactalbumin shows intense staining to these foreign materials. We concluded that milk aspiration and asphyxia may play an important role in course of death after DTaP and Polio Co-immunization and assumed that hypotonic-hyporesponsive episodes as an adverse events of immunization could be a preceding cause of milk aspiration. Education of parents about the risk of milk aspiration after immunization should be included in guideline.