Akciğer sarkoidozunda Tc99m-DTPA aerosol ve Ga-67 sintigrafisinin değeri

göstermiştir. AKMP ile erken dönemde radyolojik olarak görüntülenemeyen alveolo-kapiller membran hasarını saptamak mümkün olmuştur. AKMP, solunum fonksiyonları hakkında bize bilgi sağlamıştır. SFT'lerden ZVK, ZEV1 bozuldukça AKMP artmaktadır. AKMP ile DLco arasında zayıf bir korelasyon saptanırken, BAL sıvısındaki lenfosit yüzdesiyle bir ilişki bulunamamıştır. Sonuç olarak, akciğer sarkoidozlu hastaların tanısında, takibinde, tedavi endikâsyonunda ve tedavinin yanıtını takip etmede sintigrafik yöntemlerden Ga-67 sintigrafisi ve aerosolize Tc99m-DTPA'nın kullanıldığı AKMP ölçümü değerli ve sensitif bir test olarak bulunmuştur. 49AKMP ölçümü için oksijen basınçlı nebulizatörde aerosolize edilmiş 20mCi Tc99m-DTPA, supin pozisyonda, tidal volümde, 3 dakika inhale ettirilmiştir. Hasta supin pozisyonda iken 64x64 matrikste, 1 dakikalık 20 posterior toraks imajı elde edilmiştir. Bu görüntülerde çizilen ROl'lerden elde edilen sayımlardan zaman aktivite eğrileri bilgisayar yardımıyla çizdirilmiştir. Bu negatif eğimli regresyon eğrilerinin ilk onbir dakikasından Tc99m- DTPA'nın dakikakadaki yüzde azalış miktarı (% dak~1) bilgisayar yardımıyla hesaplanmıştır. Bu değer alveolo-kapiller mebran permeabilitesinin bir göstergesi olarak kabul edilmiştir. Değerlerin ortalamaları kullanılmıştır. 5mCi Ga-67'nin İV enjeksiyonundan 48 saat sonra orta enerjili kolimatörle, Ga-67'nin foto pikleri üzerine açılan %20 lik pencereler ile 500.000 sayımlık anterior ve posterior toraks imajları 256x256 matriks kullanılarak elde edilmiştir. İmajlar vizüel olarak değerlendirilmiştir.Akciğer parankimi, hiler ve mediastinel lenfadenopatilerdeki aktivite uptake lokalizasyonuna göre sintigrafik bir sınıflama yapılmıştır. Buna göre Evre 0: normal uptake, Evre 1: hiler ve mediastinal uptake, Evre 2: hiler ve mediastinal uptake'inin yanısıra akciğer parankim uptake'i, Evre 3: yanlızca akciğer uptake'i olarak kabul edildi. Ayrıca torakal aktivite uptake'inin şiddetine göre semikantitatif bir yöntem uygulandı; 0: anormal aktivite tutuluşu yok, 1 +: çok az aktivite tutuluşu var, 2+: belirgin aktivite tuluşu var ancak karaciğer aktivitesinden az, 3+: Karaciğer aktivitesine eşdeğer bir aktivite tutuluşu var, 4+: karaciğer aktivitesinden fazla aktivite tutuluşu var. Çalışmamızda, akciğer sarkoidozlu hastaların %86'sında değişik lokalizasyon ve yoğunlukta anormal torakal Ga-67 uptake'i izlenmiştir. Ga-67 uptake'in yoğunluğu ve lokalizasyonu ile hastalığın aktivitesini değerlendirmek mümkün olmuştur. İrreversibl bir patoloji olan fibrotik değişiklikleri tedavi edilebilir leyonlar olan granulom oluşumu yada alveolitten Ga-67 uptake'i ile ayırd edilebilmiştir. Toraks dışı Ga-67 uptake'i ile sarkoidoz tanısının doğrulanmasına, biyopsi için uygun yer seçimine ve önemli bir komplikasyon olan üveitin değerlendirilmesine faydalı olmuştur. AKMP, sarkoidozlu hastalarda özellikle radyolojik ve sintigrafik olarak gösterilebilen akciğer parankim tutuluşu başladıktan sonra anlamlı artış 48göstermiştir. AKMP ile erken dönemde radyolojik olarak görüntülenemeyen alveolo-kapiller membran hasarını saptamak mümkün olmuştur. AKMP, solunum fonksiyonları hakkında bize bilgi sağlamıştır. SFT'lerden ZVK, ZEV1 bozuldukça AKMP artmaktadır. AKMP ile DLco arasında zayıf bir korelasyon saptanırken, BAL sıvısındaki lenfosit yüzdesiyle bir ilişki bulunamamıştır. Sonuç olarak, akciğer sarkoidozlu hastaların tanısında, takibinde, tedavi endikâsyonunda ve tedavinin yanıtını takip etmede sintigrafik yöntemlerden Ga-67 sintigrafisi ve aerosolize Tc99m-DTPA'nın kullanıldığı AKMP ölçümü değerli ve sensitif bir test olarak bulunmuştur. 4

Problematic Aspects of Sentinel Lymph Node Biopsy and Its Relation to Previous Excisional Biopsy in Breast Cancer

WOS: 000272363600003PubMed ID: 20139816Purpose: The aim of the study is to review problematic aspects of sentinel lymph node biopsy (SLNB) and to evaluate the influence of a previous excisional biopsy on these problems. Materials and Methods: A total of 345 patients were evaluated retrospectively, 156 of them had a previous biopsy. Tc-99m tin colloid was injected the day before surgery at 4 quadrants around the areola intradermally. Problems complicating SLNB are reviewed in 3 topics: visualization or gamma probe detection problems, dilated lymphatic channels, and misleading activity accumulation. Results: SLN detection rate and mean sentinel lymph node numbers were as follows in patients with and without biopsy, respectively: 95.5% versus 99.4% and 1.71 +/- 0.97 versus 1.70 +/- 0.92. Problems complicating the procedure occurred in 20 patients (5.8%). Among these 20 patients, 15 had a prior excisional biopsy, and incisions were located in the upper, outer and periareolar zones. Visualization or gamma probe detection problems occurred in 8 patients. Except for one with faint uptake in a sentinel node, all had a prior biopsy. Lymphatic channel dilatation complicated the procedure in 7 patients. Of these 7 patients, 4 had a previous biopsy. Misleading activity accumulations compromised SLNB in 5 patients, 4 of whom had a prior biopsy. Conclusion: Although SLNB is still applicable with a high success rate in cases with excisional biopsy, a review of problematic aspects of SLNB demonstrated a relation with the presence of a previous biopsy and its localization. The demonstration of nonvisualization preoperatively and the precise localization of atypically located activity accumulation may be helpful in the prevention of potential complications

Recurrence Rate of Tumor and the Value of Diagnostic I-131 Whole Body Scintigraphy and Recombinant TSH in Low-Risk Well Differentiated Thyroid Cancer Patients Who Have Had I-131 Radioablation

WOS: 000314145000028Objective: The aim of this study was to find out the recurrence rate and to evaluate effectiveness of diagnostic I-131 whole body scintigraphy (WBS) and recombinant human (rh) TSH in low-risk well differentiated thyroid cancer (WDTC) patients who have had I-131 radioablation and have undetectable stimulated serum thyroglobulin (T-g) levels. Material and Methods: Study groups consisted of 149 patients (Group 1) using endogenous TSH stimulation and 50 patients (Group 2) using rhTSH. Mean follow-up period was 12 years for Group 1. Postablative 6th, 18th month, 5th, 10th and 15th year endogenous TSH stimulated diagnostic WBS and serum Tg levels in G1; and 6th month endogenous TSH stimulated and 18th month rhTSH stimulated diagnostic WBS and serum Tg levels in G2 patients were evaluated. Results: The TSH stimulated Tg values were = 30 mu IU/mL in all patients. There was no significant difference between 6th month endogenous TSH and 18th month rhTSH stimulated Tg levels and diagnostic WBS in G2 patients and the 6th, 18th month, 5, 10th and 15th year endogenous TSH stimulated diagnostic WBS and Tg levels in G1 Patients. Conclusion: In low-risk WDTC patients who have undergone total thyroidectomy and I-131 radioablation, the recurrence rate of tumor was extremely low. rhTSH was used successfully without hypothyroid state at I-131 WBS and serum Tg measurement. If 6th month WBS was negative and serum Tg level was undetectable, the 18th month, 5th, 10th and 15th years WBSs were also negative in all patients and yielded no additional information that could influence the following therapeutic strategy and therefore may be avoided. In the follow-up of this group of patients, rhTSH stimulated Tg measurement may be considered as an alternative approach

The Effect of Freezing on the Immunoprofile of Breast Carcinoma Cells

WOS: 000348654600010PubMed ID: 25667788Background: Intraoperative frozen section procedure may be required in some operations performed for breast masses. Aims: We investigated the effect of frozen section procedure on the immunoprofile of breast carcinoma cells. Study Design: Cross-sectional study. Methods: A total of 53 breast carcinoma cases evaluated with intraoperative frozen sections were included in this study. Immunohistochemically, oestrogen (ER), progesterone (PR) and HER2 primary antibodies were evaluated in both frozen and non-frozen sections of each tumour sample. Results: No difference was found between the frozen and non-frozen sections in 33 cases in terms of staining rate and intensity of ER, PR and HER2. A decrease was found in the ER, PR and HER2 staining rate (in 10 cases, 9 cases and 6 cases, respectively). Likewise, a decrease was detected in ER, PR and HER2 staining intensity in 6 patients for each. Although there was no staining in frozen sections, immunopositivity was observed in 3 non-frozen sections for ER, in 2 for PR and in 5 for HER2. Statistically, a significant difference was found between the frozen and non-frozen sections in terms of staining rate and intensity for each of the three markers. Conclusion: In this study, the frozen section procedure in breast carcinoma had a negative effect on the immunoprofile. However, considering the importance of hormone receptor status in the treatment, these results should be supported with larger series

The value of F-18-FDG PET/CT imaging in breast cancer staging

WOS: 000426444900010PubMed ID: 28763628The National Comprehensive Cancer Network (NCCN) guidelines recommend assessment with positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (F-18-FDG PET/CT) in staging of breast cancer, starting from the stage IIIA. Previously, PET/CT contributed to the accurate staging from the stage IIB. Our aim is to evaluate the contribution of F-18-FDG PET/CT in staging of breast cancer patients. A total of 234 patients were retrospectively evaluated. PET/CT was performed preoperatively in 114/234 and postoperatively in 120/234 patients. Initial staging was performed based on histopathological results in 125/234 and clinical results in 109/234 patients, according to the American Joint Committee on Cancer (AJCC) classification. All patients had a normal abdominal ultrasound and chest x-ray. Following PET/CT imaging, modification in the staging was performed in patients with the metastatic findings. In 42/234 (17.9%) patients hypermetabolic extra-axillary regional lymph nodes and in 65/234 patients (27.7%) distant metastatic involvement were detected with PET/CT. Modification in the staging was applied in 82/234 (35%) patients. Patient management was changed in 69/234 (29.4%) cases. The percentage of patients with upstaging, according to each stage, was as follows: IIA: 18.6%, IIB: 30%, IIIA: 46.3%, IIIB: 68.8%, and IIIC: 20.8%. In 43/43 patients, Tc-99m-methylene diphosphonate (MDP) bone scan did not show additional bone metastasis. In 5/32 patients, metastatic involvement was detected with sentinel lymph node biopsy (SLNB), but preoperative PET/CT scan did not reveal hypermetabolic lymph nodes. Although our study was limited by the referral bias and lack of homogeneity in the referral group, PET/CT still significantly contributed to the accurate staging and management of our breast cancer patients, starting from the stage IIA

Osteosarcomas of jaw: Experience of a single centre

WOS: 000347297600003PubMed ID: 24780088Although osteosarcoma is the most common primary malignant tumour of bone, osteosarcomas of jaw are rare. In osteosarcomas of jaw, evaluating the clinicopathological factors affecting the prognosis is not easy because of different approaches to diagnosis, treatment, and follow-up. This study reviewed 14 cases of JOS that were diagnosed between 1990-2010, in terms of age, gender, site, clinical history, histopathologic type and histopathologic grade, treatment, and prognosis. Median age was 35 years, while male: female ratio was 1.8:1. Eight tumours were located in the mandible. Osteoblastic differentiation was the predominant feature in seven cases followed by chondroid osteosarcoma (four cases), fibroblastic osteosarcoma, low-grade (parosteal) osteosarcoma associated with fibrous dysplasia, and postradiation osteosarcoma (one cases each). During follow-up, recurrence was seen in four patients at least once and they all died. In conclusion, early diagnosis and complete resection seems to be effective in prognosis. Therefore, clinicians and pathologists should be aware of its characteristics and main differential diagnosis to avoid late recognition