[Sentinel lymph nodes in breast carcinoma: why, how, when]. / Lo studio del linfonodo sentinella nel carcinoma mammario: perché, come, quando.

Thanks to a retrospective analysis of the first 250 cases of sentinel lymph nodes in breast cancer assessed by the authors over the period from October 1998 to December 2000 in the light of a careful review of the literature, it has been possible to establish the importance of careful patient selection, strict compliance with the execution technique and, above all, the need for an adequate learning curve, before the procedure is used in particular protocols and/or in routine clinical practice in the near future. In particular, the training should first of all ensure that all personnel involved, i.e. surgeons, nuclear medicine specialists, and histopathologists, should attend specific courses at qualified Institutions followed by the actual management of a certain number of consecutive cases. In order to perfect the methodology and organisation, a preliminary study in a group of patients at different stages of evolution of the disease is recommended (50 cases in the study population reported). The next phase should include a group of highly selected patients, numbering at least 50-100. The training may be considered complete when in at least 20 cases, an identification rate of at least 90% is achieved with an incidence of false negatives of not more than 5%. In the authors' experience, these results were reached after 100 selected patients, and were later consistently confirmed after a further 50 cases.

Usefulness of pyridinium crosslinks and CA 15-3 as markers in metastatic bone breast carcinoma.

Numerous tumor markers such as CEA, MCA, CA 15-3 have been assayed in breast cancer patients to detect relapse at a preclinical stage and most of all to monitor the treatment of the advanced disease. Since they are not site-specific, pyridinium crosslink dosage has recently been reported as a specific bone resorption marker in several non neoplastic diseases. The aim of this study was to evaluate the urinary pyridinium crosslink levels in breast cancer with or without osseous involvement, and to correlate it with serial doses of CA 15-3. 285 breast cancer patients (226 free of disease and 59 with bone metastases) were measured for both pyridinoline and CA 15-3. In the metastatic patients the mean values of the two markers were significantly higher than in non evident disease patients (P = < 0.01 and p = < 0.001 respectively). Abnormal values over the normal were found in 22% for pyridinoline and 11% for CA 15-3 in patients free of disease while the normal values observed in patients with bone metastases were 22% for pyridinoline and 39% for CA 15-3. Tandem dosage of CA 15-3, was highly sensitive but site-aspecific, and pyridinoline, which is bone specific, may be useful chiefly in the monitoring of breast cancer treatment, since many physiological conditions such as age, menopausal status and variation over 24 hours, and cost effectiveness will influence the use of pyridinoline during follow-up.

[Current trends in the treatment of Graves' disease]. / Attuali orientamenti nel trattamento del morbo di Basedow.

Between 1973 and 1992 153 patients with Graves' disease were observed at the Surgery and Oncology Institute-Cagliari University. 103 underwent subtotal (70) or total (33) thyroidectomy, while 50(after 1985) were submitted to radioactive-iodine therapy. Surgical indications were failure of antithyroid drug therapy, signs of compression and large size goitre. Until 1988, all patients were submitted to subtotal thyroidectomy with thyroid remnant of about 8 g. From 1988 the choice of total thyroidectomy came out from: similar complications (paralysis of recurrent nerve and hypoparathyroidism), lack of relapse and suppression of risk of occult carcinoma. After subtotal thyroidectomy definitive hypoparathyroidism in 1 patient (1.8%), transitory hypoparathyroidism in 5 (9.4%), clinical hypothyroidism in 17 (31.5%), recidive hyperthyroidism in 3 patients (5.5%) were observed. After total thyroidectomy 1 patient presented definitive paralysis of recurrent nerve (3%), 1 definitive hypoparathyroidism (3%), 8 transitory hypoparathyroidism (24%): small (44 patients) or large goitre (3 patients) or relapse (3 patients) were indications to radioactive-iodine therapy. At median follow-up of 16 months no relapses of hyperthyroidism were observed, while clinical signs of hypothyroidism were present in 33% of patients. Authors stress that, after a first attempt with antithyroid drugs therapy, radioiodine treatment is elective in Graves' disease. Surgery still remains the treatment of choice during pregnancy, in patients with large goitres, signs of compression or in presence of scintigraphic "cold" area.