A second radioisotope injection enhances intraoperative sentinel node identification in breast cancer patients without visualized nodes on preoperative lymphoscintigraphy.

PURPOSE: To evaluate the influence of a second radioisotope injection on the intraoperative success rate in patients with non-visualized axillary sentinel nodes (SN). MATERIAL AND METHODS: Altogether, 534 consecutive breast cancer patients with lymphoscintigraphy (LS) and SN biopsy and were included. An intratumoral injection of 99mTc-labeled human albumin colloid with a median dose of 93 MBq was applied. Forty-two of the 80 patients without axillary hot spots on LS received a second tracer injection with a median dose of 70 MBq. RESULTS: The visualization rate of axillary SN was 454/534 (85%). The intraoperative SN identification rate was 97% in patients with and 69% in patients without visualized SN in the axilla (P<0.00005), but the success rate was higher (88%) with a second radioisotope injection than without it (47%; P<0.0002). CONCLUSION: The failure rate in intraoperative SN identification was minimized using a second radioisotope injection in patients without axillary SN on LS.

Adjusting the radioisotope tracer dose according to the body mass index does not enhance the visualization of axillary sentinel lymph nodes.

PURPOSE: To investigate whether the visualization of axillary sentinel nodes (SN) in the lymphoscintigraphy (LS) can be enhanced by adjusting the amount of radioactivity in accordance with the patient's body mass index (BMI). MATERIAL AND METHODS: Group I consisted of 356 consecutive breast cancer patients who underwent LS and SN biopsy after a single, intratumoral radioactive tracer injection with a median dose of 92 MBq. In group II (178 consecutive patients), the dose of the tracer was adjusted according to BMI; 80, 100, or 140 MBq. RESULTS: The visualization rate of axillary SN was 86% in group I and 83% in group II (P = 0.303). In patients with BMI >30 with visualized axillary SN, the median number of SN was 1 (1-4) in group I and 3 (1-7) in group II (P = 0.002). CONCLUSION: Adjusting the tracer dose in accordance with patient BMI did not enhance the visualization rate of axillary SN in LS.

The role of Tc99m-sestamibi scintimammography in combination with the triple assessment of primary breast cancer.

AIM: The aim of this study was to evaluate if Tc99m-sestamibi scintimammography in addition to the triple assessment consisting of clinical examination, mammography, breast ultrasonography and fine needle aspiration cytology (FNA) enhances the diagnosis of breast cancer and helps in avoiding unnecessary operative biopsies. METHODS: Pre-operational scintimammography was performed within 2 weeks of operation to 46 consecutive patients with abnormal findings in clinical breast examination, mammography or ultrasonography. Three patients had abnormalities in both breasts. Histological diagnosis was obtained in all 49 cases. RESULTS: The histological diagnosis was benign in 18 (37%) cases and malignant in 31 (63%) cases. The overall sensitivity of scintimammography was 77% and the specificity was 61%. The sensitivity of scintimammography was 95% in invasive ductal carcinoma, 50% in invasive lobular carcinoma and 25% in ductal carcinoma in situ. Scintimammography showed 100% sensitivity in cases with invasive carcinoma, with highly suspicious findings for malignancy in the other examinations. The sensitivity was 63% in cases with indeterminate or contradictory findings in mammography, ultrasonography and FNA. CONCLUSIONS: Adding scintimammography to the triple assessment does not seem to be helpful in the diagnosis of breast abnormalities because of low sensitivity in malignant cases with a challenging diagnosis by mammography, ultrasonography and FNA, and because of low overall specificity.

Effects of psychological stress on plasma interleukins-1 beta and 6, C-reactive protein, tumour necrosis factor alpha, anti-diuretic hormone and serum cortisol.

The study was undertaken to determine whether psychological stress influences immunobiological functions and is an important preanalytical factor to be considered in connection with blood specimen collection. Two kinds of stress were applied, the Stroop colour conflict test and the thrill of a novice about to make the first jump with a parachute. In both test situations, the level of the stress indicators cortisol or anti-diuretic hormone rose significantly. The concentrations of the cytokines studied did not change significantly. However, in the parachute test significant positive correlations were found, e.g. between the changes of cortisol and C-reactive protein and between anti-diuretic hormone and interleukin-1 beta. This suggests that there is an interaction between the endocrine and the immune systems in the response to a psychological stress.

Preanalytical factors and standardized specimen collection: influence of psychological stress.

In order to devise and evaluate standardized specimen collection procedures, we studied the influence of psychological stress on the results of commonly analysed blood components: creatine kinase, lactate dehydrogenase, total protein and albumin in serum and blood picture. In addition, serum cortisol was assayed. Two kinds of stress were used: the Stroop test, a colour conflict task, and the thrill caused by the first jump of new parachutists. More changes were observed after the parachutist test than after the Stroop test. There was a difference in the responses of males and females. Females were more sensitive, especially to the parachutist test. Most of the changes observed were interpreted as being caused by haemoconcentration, possibly related to muscular tension. Cortisol, commonly used to indicate the level of stress, did not react much and is therefore not a good index of psychological stress.

Experimental basis of standardized specimen collection: the effect of short moderate exercise on serum K, Na, ASAT, ALAT, CK and LD.

Strenuous exercise is known to produce marked changes in many serum components. Present recommendations concerning drawing of blood for laboratory tests, therefore, allow little exercise before specimen collection. However, the effects of moderate exercise are unknown. Moderate exercise administered by bicycle ergometer (120-160 W for 15 min) to healthy persons and ambulant patients (average 107 W) induced a rapid and statistically significant effect on serum potassium, sodium, ASAT, CK and LD concentrations. However, the observed changes were largely abolished by having the patient to sit for 15 min before venipuncture. It appears to be possible to allow moderate exercise before venipuncture as long as the specimen collection procedure itself is sufficiently standardized, i.e. by specifying sitting for 15 min and no use of tourniquet.

Experimental basis of standardized specimen collection: the effect of the site of venipuncture on the blood picture, the white blood cell differential count, and the serum albumin concentration.

The effect of the specimen collection site on blood picture and WBC differential count was investigated in 13 and 25 volunteers, respectively. Lower values were found for the mature neutrophils and higher monocyte values in ear and finger blood compared to venous blood. There were no statistically significant differences in the WBC differential count values found in the ear and finger specimens. A higher S-Alb concentration was found in ear and finger specimens compared to venous blood. The average WBC concentration was higher in the ear and finger specimens than in the venous blood (7.66 x 10(9)/l, 7.11 x 10(9)/l and 6.88 x 10(9)/l, respectively). Also the platelet concentration exhibited a statistically significant difference, the mean concentrations being 273 x 10(9)/l, 260 x 10(9)/l and 231 x 10(9)/l in the vein, finger and ear specimens, respectively. The differences found are partly explained by peripheral ultrafiltration of intravascular fluid, leading to haemoconcentration, and partly by the different properties of different white blood cells. In conclusion, the specimens for blood picture and WBC differential count should always be obtained from the same site, especially in follow-up cases.

Experimental basis of standardized specimen collection: effect of posture on blood picture.

22 subjectively healthy females were supine, sat in an armchair and stood while specimens of peripheral venous blood were collected after at least 15 min in each position without using a tourniquet. The albumin, haemoglobin, erythrocyte concentration and the haematocrit increased significantly when the subjects assumed a more erect position, probably as a result of increased hydrostatic pressure. The leucocyte count did not rise, and there was a statistically significant drop in the lymphocyte concentration when changing from supine to sitting. However, the leucocyte concentration rose significantly from supine to sitting or standing. When interpreting laboratory data, the difference in the behaviour of different cell species should be kept in mind. However, on the whole this study supports the stipulation contained in international recommendations that the posture of the subject should be standardized before collection of peripheral blood for haematological tests.

Experimental basis of standardized specimen collection: the effect of moderate ethanol consumption on some serum components (K, Na, ASAT, ALAT, CK, LD, total protein).

Venous blood was collected on two mornings from seven healthy volunteers using the standard Scandinavian procedure (fasting, sitting and no tourniquet) and serum Na, K, ASAT, ALAT, CK, LD and total protein were assayed. Then ethanol (0.75 g/kg body weight) was given on three consecutive evenings and the subsequent observed values 1, 3, 15, 38, 62 and 110 h post-ethanol were compared with the morning values. The mean component/total protein ratios dropped 14% for ASAT and 19% for ALAT 62 and 15 h post-ethanol, respectively. CK rose 17% at 3 h and dropped 17% at 62 h. However, the absolute values of ASAT, ALAT and CK did not change significantly. The only significant post-ethanol changes occurred in Na +2.14 mmol/l at 1 h (p less than 0.01), K -0.24 mmol/l at 3 h (p less than 0.05) and +0.26 mmol/l at 15 h (p less than 0.05), and LD +31 IU/l at 15 h (p less than 0.05) and +25 IU/l at 110 h (p less than 0.01). In one series, the total protein concentration dropped 4.57 g/l at 110 h post ethanol (p less than 0.001) but this drop was not reproducible in two additional series. It is concluded that moderate (social) ethanol consumption does not produce clinically significant effects on the components analysed. Also it may be misleading to express results as component/total protein ratios.