Single-photon-emission computed tomography (SPECT) with technetium-99m sestamibi in the diagnosis of small breast cancer and axillary lymph node involvement.

BACKGROUND: In a prospective study we evaluated the accuracy, sensitivity, and specificity of single-photon-emission computed tomography (SPECT) technetium-99m (99Tcm) sestamibi scintimammography to differentiate between benign and malignant small solid lesions of the breast, and to diagnose axillary node involvement in patients with small breast tumors. METHODS: We prospectively evaluated 172 women with a solid lesion of the breast less than 3 cm in diameter and no evidence of axillary lymph node involvement on physical examination, ultrasound, and mammography. Thereafter, all patients underwent excision of the lesion, and, if pathology was positive for cancer, quadrantectomy and axillary lymph node dissection independently by the results of scintimammography. RESULTS: There were 92 patients with a benign lesion and 80 patients with cancer. SPECT scintimammography correctly identified all 80 patients with cancer; there were six false-positive cases and no false-negative cases for a test efficacy of 96.5%, sensitivity of 100%, and specificity of 93.5%. Forty-five of the 80 patients with cancer had axillary lymph node involvement and scintimammography correctly identified 39 of the 45 patients. There was one false-positive case and six false-negative cases for a test efficacy of 90%, sensitivity of 86.4%, and specificity of 97.5%. CONCLUSION: SPECT scintimammography should be considered selectively in the preoperative evaluation of patients with small solid lesions of the breast. It allows correct identification of patients with cancer and identification of a significant number of patients with axillary lymph node involvement.

Challenging abdominal incisional hernia repaired with platelet-rich plasma and bone marrow-derived mesenchymal stromal cells. A case report.

INTRODUCTION: The necessity to develop new treatment options for challenging procedures in hernia surgery is becoming even more evident and tissue engineering and biological technologies offer even newer strategies to improve fascial healing. The present case reports a patient-tailored surgical technique performed to repair a grade IV abdominal incisional hernia, with a combined use of platelet-rich plasma and bone marrow-derived mesenchymal stromal cells, implanted on a biological mesh. PRESENTATION OF THE CASE: A 71 year-old female patient complained of an abdominal incisional hernia, complicated by enterocutaneous fistula, four-months following laparostomy. Contrast enhanced computed tomography showed an incisional hernia defect of 15.5×20cm, with a subcutaneous abscess and an intestinal loop adherent to the anterior abdominal wall, with a concomitant enterocutaneous fistula. Surgery involved abdominal wall standardized technique closure, with in addition platelet-rich plasma and bone marrow-derived mesenchymal stromal cells implanted on a biological mesh. Two years follow up showed no recurrences of incisional hernia. DISCUSSION: Coating surgical meshes with patient's own cells may improve biocompatibility, by reducing inflammation and adhesion formation. Moreover, platelet-rich plasma is a good source of growth factors for wound healing, as well as a good medium for bone marrow multinucleate cells introduction into fascial repair. CONCLUSION: This approach is likely to improve abdominal wall repair in high grade (IV) incisional hernia, with the real possibility of improving prosthetic compatibility and reducing future recurrences. The authors agree with the necessity of further studies and trials to assure the safety profile and superiority of this procedure.