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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Breast carcinoma ; Magnetic resonance mammography ; Breast preservation ; Impact on ; Schlüsselwörter: Mammacarcinom ; Magnetresonanzmammographie ; brusterhaltende Operation ; Einfluß auf das operative Vorgehen.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Einleitung: In einer prospektiven Studie wurden der diagnostische Stellenwert sowie der Einfluß der Magnetresonanzmammographie (MRM) auf das operative Vorgehen bei Patientinnen (n = 125) geprüft, bei denen aufgrund der klinischen, sonographischen oder mammographischen Untersuchung der Verdacht auf ein Mammacarcinom bestand. Diese Patientinnen wurden zusätzlich einer bilateralen MRM zugeführt. Besonderes Interesse bestand hinsichtlich der Erkennung multifocaler, multizentrischer und kontralateraler Läsionen. Methode: Nach kompletter operativer Entfernung aller diagnostizierten Läsionen erfolgte die Ermittlung von Sensitivität und Spezifität der diagnostischen Methoden sowie einer Korrelation zwischen den apparativen und den histologischen Befunden. Ergebnisse: Bei 112 Patientinnen lagen vollständige Daten für die Auswertung vor: Allein mit Hilfe der konventionellen Verfahren wurden 91 Malignome entdeckt; dabei betrug die Sensitivität/Spezifität für die klinische Untersuchung 73 % bzw. 67 %, für die Mammasonographie 58 % bzw. 86 % und für die Röntgenmammographie 89 % bzw. 20 %. In diesem vorselektionierten Patientinnenkollektiv (Prävalenz 81,25 %) wurden durch die MRM die bereits durch konventionelle Verfahren entdeckten Läsionen mit einer Sensitivität von 96,7 % und einer Spezifität von 19 % bestätigt. Darüber hinaus wurden durch die MRM 46 weitere suspekte Läsionen diagnostiziert. Es fanden sich histologisch 28 maligne (25 ipsilaterale multifocale oder multizentrische Läsionen, 3 kontralaterale Carcinome) und 18 benigne Tumoren. Die Rate falsch-positiver MRM-Befunde lag bei 18 %. Aufgrund der MRM-Befunde wurde in 14,3 % der Fälle anstatt des ursprünglich geplanten brusterhaltenden Verfahrens eine Mastektomie durchgeführt. Schlußfolgerung: Anhand unserer Untersuchungsergebnisse ist die MRM das Verfahren der Wahl in der Differentialdiagnose diskrepanter Befunde von Mammographie und Sonographie und stellt die sensitivste Methode zum Ausschluß einer Multifocalität oder Multizentrizität dar. In unserem Patientinnenkollektiv beeinflußten die Befunde der MRM die Planung des operativen Vorgehens erheblich. Für den sinnvollen Einsatz der Methode sind ein hoher technischer Standard sowie eine hohe Qualifikation des Untersuchers und eine enge interdisziplinäre Kooperation zwischen Radiologen, Pathologen und Chirurgen Voraussetzung.
    Notes: Summary. Introduction: In a prospective study the diagnostic validity of magnetic resonance mammography (MRM) as well as its impact on the choice of the operative procedure in the treatment of breast cancer was examined. In 125 patients who were suspected of having breast cancer by clinical examination, ultrasound, and X-ray mammography, additional bilateral MRM was performed. Of special interest was the diagnostic potential of MRM with regard to multifocal, multicentric and contralateral lesions. Methods: After a complete resection all lesions diagnosed by the various conventional methods were examined pathohistologically. In 112 patients, complete data were available to calculate the sensitivity and the specificity of each method as well as to correlate its results with the pathohistological findings. Results: In 91 cases, a breast carcinoma was diagnosed by conventional methods, with a sensitivity/specificity of 73 %/67 % for clinical examination, of 58 %/86 % for ultrasound, and of 89 %/20 % for X-ray mammography. In this preselected series of patients with a prevalence of 81.25 % the diagnosis established by the various methods was confirmed by MRM with sensitivity of 96.7 % and specificity of 19 %. Forty-six additional suspicious lesions were found only by MRM, of which 28 were malignant (25 multifocal or multicentric and 3 contralateral carcinomas), and 18 benign. The rate of false-positive MRM results was 18 %. Due to the MRM findings, the therapeutic procedure was changed from breast preservation to mastectomy in 14.3 %. Conclusion: Not only for the differential diagnosis of discrepant findings between X-ray mammography and ultrasound, but especially for the diagnosis of multifocal or multicentric lesions, MRM seems to be the method of choice. Consequently, MRM plays an important role in planning the operative procedure in breast cancer patients, especially in the context of breast preservation. To ensure optimal use of this new diagnostic tool high technical standards, proper expertise on the part of the examining radiologist, and effective cooperation among the involved disciplines (radiology, pathology, surgery) must be guaranteed.
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  • 2
    ISSN: 1619-7089
    Keywords: Regional chemotherapy ; Probe system ; Leakage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to establish a probe system for intraoperative quantitative leakage measurement during selective limb perfusion for adjuvant high-dose chemotherapy in patients with malignant melanomas. We used a portable gamma probe with digital display and investigated the physical properties in a phantom study simulating blood pool activity at different angles of the probe to the surface and different distances. In 20 patients the limb circulation was surgically separated from the systemic blood circulation, and the limb was then selectively perfused (cytostatics added) for 60 min. Initially, 15 MBq technetium-99m labelled autologous red blood cells was injected into the limb circulation, and an equal amount was kept as a standard. Every 10 min, blood samples were drawn from the body circulation and count rates were simultaneously measured by the probe system at the lower end of the sternal body. At the end of perfusion, the circulation of the limb was reconnected, the standard injected into the systemic circulation, and a blood sample drawn after 10 min. All blood samples were counted for calculation of leakage in terms of percent of the injected dose, and the results compared with the intraoperative count rates of the probe system. In the range of leakage observed in this study (0%–86%), the count rate of the probe system (corrected for blood volume, i.e. for body surface) correlated with the results of conventional measurement (r=0.92) according to the equation: %leakage=counts per sx[1.2×body surface (m2)−1.19]. In conclusion, the use of the described probe system is a feasible approach for leakage quantification which continuously yields data during selective limb perfusion.
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  • 3
    ISSN: 1432-1335
    Keywords: NSCLC ; Vindesine ; Etoposide ; Dexverapamil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine whether the chemotherapy resistance of non-small cell lung cancer could be modified by oral dexverapamil, the D-isomer of verapamil, 54 patients were entered into a randomised phase II study of oral dexverapamil plus chemotherapy (vindesine/etoposide) (arm B) versus chemotherapy (arm A) alone in January 1994. Chemotherapy consisted of intravenous vindesine 3 mg/m2 bolus on days one and five and etoposide 140 mg/m2 on days two and four. Dexverapamil was given for six days, 1500 mg a day divided into six doses of 250 mg every four hours starting 24 h prior to chemotherapy. According to the individual tolerability, the single dose could be increased up to a maximum of 400 mg. Cycles were repeated 3 weekly up to four courses. At this stage of the analysis, 34 patients (18 in arm A and 16 in arm B) are evaluable for toxicity and response. Cardiovascular side effects were more marked in the patient group with dexverapamil. On average, the dose of dexverapamil was 1800 mg a day. There were 5 partial remissions (31.3%) and 9 no changes (56.3%) in the group with dexverapamil as opposed to 2 partial remissions (11.1%) and 6 no changes (33.3%) in the group without dexverapamil. As far as the preliminary results show, the addition of dexverapamil to vindesine/etoposide chemotherapy in this study seems to be associated with improved outcome.
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  • 4
    ISSN: 1432-1335
    Keywords: Key words RT/PCR ; PTHrP ; Metastasis ; Blood ; Bone marrow ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tumor cell dissemination in the bone marrow is an independent prognostic marker for relapse and survival for patients with primary breast cancer. Parathyroid-hormone-related protein (PTHrP) is expressed in most primary tumors and bone metastases of patients with breast cancer. PTHrP acts as an autocrine growth factor for breast cancer cells in vitro and there is evidence that it is especially important for osseous metastasis. For a sensitive detection of PTHrP-positive disseminated tumor cells a reverse transcriptase/polymerase chain reaction (RT/PCR) assay for PTHrP transcripts in the peripheral blood (PB) and in the bone marrow (BM) has been established. In mixing studies, the sensitivity of the reverse transcriptase/polymerase chain reaction (RT/PCR) for PTHrP was one tumor cell in 1 × 106 mononuclear cells. At this level of sensitivity, transcripts of PTHrP were detected in none of 30 PB samples and in 3 of 25 BM samples of healthy volunteers; there were also no transcripts of PTHrP in the PB and BM of 6 patients with benign breast lesions. The PB samples of 31 patients and the BM samples of 34 patients with predominantly early-stage breast cancer were tested for PTHrP expression along with immunocytology against cytokeratin 18 (CK18) as a standard immunological detection technique. PTHrP expression was shown in 9 of 31 patients in the PB and in 9 of 34 patients in the BM. In 30 patients, PB and BM samples were available simultaneously. There were cases of combined positive findings in the PB and the BM (4/30) and of isolated positivity in the PB (5/30) or in the BM (4/30). Compared to immunocytology, RT/PCR assay of PTHrP assay was significantly more sensitive in the peripheral blood (8/30 by RT/PCR compared to 1/30 by immunocytology). In the bone marrow there were cases of positivity for both markers (2/34), cases of isolated positivity by immunocytology for CK18 (3/34) and cases of isolated positivity for PTHrP transcripts (7/34). In conclusion the RT/PCR assay for PTHrP transcripts is a feasible and very sensitive technique for the detection of tumor cell dissemination in the PB, even in patients with early-stage breast cancer. The specificity of detection of PTHrP transcripts in the bone marrow is limited, possibly because of autochthonous expression of PTHrP in osteoblastic cells. The clinical follow-up of the subgroups of patients at risk, as defined by this assay, will show its prognostic significance for patients with breast cancer.
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  • 5
    ISSN: 1432-1335
    Keywords: RT/PCR ; PTHrP ; Metastasis ; Blood ; Bone marrow ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tumor cell dissemination in the bone marrow is an independent prognostic marker for relapse and survival for patients with primary breast cancer. Parathyroid-hormone-related protein (PTHrP) is expressed in most primary tumors and bone metastases of patients with breast cancer. PTHrP acts as an autocrine growth factor for breast cancer cells in vitro and there is evidence that it is especially important for osseous metastasis. For a sensitive detection of PTHrP-positive disseminated tumor cells a reverse transcriptase/polymerase chain reaction (RT/PCR) assay for PTHrP transcripts in the peripheral blood (PB) and in the bone marrow (BM) has been established. In mixing studies, the sensitivity of the reverse transcriptase/polymerase chain reaction (RT/PCR) for PTHrP was one tumor cell in 1×106 mononuclear cells. At this level of sensitivity, transcripts of PTHrP were detected in none of 30 PB samples and in 3 of 25 BM samples of healthy volunteers: there were also no transcripts of PTHrP in the PB and BM of 6 patients with benign breast lesions. The PB samples of 31 patients and the BM samples of 34 patients with predominantly early-stage breast cancer were tested for PTHrP expression along with immunocytology against cytokeratin 18 (CK18) as a standard immunological detection technique. PTHrP expression was shown in 9 of 31 patients in the PB and in 9 of 34 patients in the BM. In 30 patients, PB and BM samples were available simultaneously. There were cases of combined positive findings in the PB and the BM (4/30) and of isolated positivity in the PB (5/30) or in the BM (4/30). Compared to immunocytology, RT/PCR assay of PTHrP assay was significantly more sensitive in the peripheral blood (8/30 by RT/PCR compared to 1/30 by immunocytology). In the bone marrow there were cases of positivity for both markers (2/34), cases of isolated positivity by immunocytology for CK18 (3/34) and cases of isolated positivity for PTHrP transcripts (7/34). In conclusion the RT/PCR assay for PTHrP transcripts is a feasible and very sensitive technique for the detection of tumor cell dissemination in the PB, even in patients with early-stage breast cancer. The specificity of detection of PTHrP transcripts in the bone marrow is limited, possibly because of autochthonous expression of PTHrP in osteoblastic cells. The clinical follow-up of the subgroups of patients at risk, as defined by this assay, will show its prognostic significance for patients with breast cancer.
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