A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer.

BACKGROUND: Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. METHODS: Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately. RESULTS: At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1 ± 1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9 ± 1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection. CONCLUSION: The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.

Surgical treatment of lower extremity lymphedema with subcutaneous implantation of silicone tubing.

A 65-year-male patient was admitted to our clinic with swollen, painful, and wound discharge of lower extremity. There was widespread edema, skin infection, and lymphangitis secondary Stage 3 lymphedema below the knee. In addition to conventional treatment methods, lymphatic artificial pathway creation was used with subcutaneous implantation of silicone tubing. In conclusion, subcutaneous implantation of silicone tubing is a new technique that can be applied in advanced stage lymphedema patients, which increases the effectiveness of compression therapy.

Factors affecting the mortality rate of patients with cancer hospitalized with COVID-19: a single center's experience.

The main objective is to define the mortality of patients with cancer admitted to our hospital, their clinical and demographic characteristics, investigate the risk of COVID-19 for patients with cancer, and determine factors that affect the mortality rates of patients with cancer dying of COVID-19. A total of 2401 patients were admitted to our hospital with the diagnosis of COVID-19 from March 11th, 2020, to May 31st, 2020. Ninety-two out of a total of 112 cancer patients were included in this study based on the planned inclusion/exclusion criteria. The clinical, demographic, and laboratory features and treatments provided were studied, and their effect on mortality rates was analyzed. In our study the median age of the patients was 67 years, and 55.4% were male. More than half (56.5%) of our patients had metastasis. The mortality rate was 6.2% in the overall population with COVID-19, whereas it was 23.9% in patients with cancer. The mortality rate in patients with metastasis was statistically significantly higher compared with those without metastasis (34.0% vs. 10.3% P = 0.008). The mortality rate in patients still smoking was statistically significantly higher than in non-smokers (37.5% vs. 12.5% P = 0.033). The mortality rates of patients with high average C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer levels were statistically significantly higher than in those without, and the mortality rates of patients with lower average albumin and hemoglobin levels were statistically significantly higher than those without (P < 0.001, P = 0.006, P = 0.041, P < 0.001, P < 0.001, and P = 0.028, respectively). Having metastases concurrent with COVID-19 was a statistically significant factor predictive of prognosis. Also, high CRP, ferritin, LDH, and D-dimer, and low albumin and hemoglobin were related to increased mortality rates. The predictive and prognostic role of possible factors related to prognosis is still unknown and further large, multicenter prospective studies are needed to confirm these results.

99mTc ethylene dicysteine scintigraphy for diagnosing cortical defects in acute pyelonephritis: a comparative study with 99mTc dimercaptosuccinic acid.

AIM: To evaluate the clinical usefulness of early cortical phase images in the diagnosis of acute pyelonephritis and to compare the measurements of differential renal function obtained by both 99mTc ethylene dicysteine (99mTc-EC) and 99mTc dimercaptosuccinic acid (99mTc-DMSA). METHODS: Forty-three children who had undergone both 99mTc-EC and 99mTc-DMSA studies within 5 days of acute infection were studied. Cortical images of 99mTc-EC were obtained by the sum of the renogram frames achieved between the first 60-120 s of the renogram study. DMSA and EC images were visually interpreted using four points of semiquantitative ratings: 0, normal; 1, mild hypoactivity; 2, moderate hypoactivity with partial loss of margins; 3, marked hypoactivity with loss of cortical margins. Values for the differential renal function were obtained for both studies. RESULTS: DMSA detected a total of 109 lesions in 36 patients and EC detected 90 lesions with a sensitivity of 82.5%. 99mTc-EC successfully detected moderate-to-severe cortical lesions but was less effective with mild lesions (sensitivity 60%). Bland-Altman analysis demonstrated good agreement among the results for differential renal function (95% CI -0.26 to 0.96). CONCLUSION: 99mTc-EC early phase images detected most of the cortical lesions. Its sensitivity depends on the severity of the lesions. EC provided reliable information in the estimation of differential renal function.

Evaluation of sentinel nodes in the assessment of cervical metastases from head and neck squamous cell carcinomas.

AIMS AND BACKGROUND: To delineate the lymphatic drainage in head and neck squamous cell carcinoma (SCC) patients by lymphoscintigraphy and to investigate whether the results of histopathological evaluation of sentinel nodes have any diagnostic relevance with regard to the metastatic involvement of all cervical lymph nodes. METHODS: Forty-one patients clinically pre-diagnosed as having primary head and neck SCC underwent Tc-99m nanocolloid lymphoscintigraphy and were evaluated according to the Memorial Sloan Kettering cervical lymph nodes level system. Treatment of 24 of these patients included neck dissection in addition to surgery for the primary tumor. RESULTS: Among the 24 operated patients nine were found to be pathologically N+. In two (22%) of these nine patients there were histopathological metastases in non-sentinel lymph nodes. In one patient with a metastatic lymph node, no sentinel nodes were identified. Altogether, lymphoscintigraphic sentinel node detection failed in three (33%) cases. CONCLUSION: The procedure of lymphoscintigraphic imaging of sentinel lymph nodes and its use in the determination of squamous cell carcinoma metastases is theoretically promising. However, in order to assess the true value of sentinel lymph node imaging and make treatment plans based on this technique, it's necessary to increase the number of cases included in the studies, and obtain results that are specific for the primary tumor and involved lymph nodes.