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OBJECTIVES: Inguinal lymphadenectomy used in the treatment of vulvar cancer often results in complications, such as lymphoedema or abnormal wound healing. Aim of this study was assessment of the diagnostic effectiveness of the sentinel lymph node biopsy (SLNB) procedure in patients treated due to vulvar cancer. MATERIAL AND METHODS: Eighty-four patients diagnosed with squamous cell vulvar carcinoma (FIGO I-IV) underwent preoperative lymphoscintigraphy with technetium 99 to map sentinel lymph node. During surgery sentinel lymph nodes were identified and resected, followed by complete bilateral groin lymphadenectomy. RESULTS: Sentinel lymph nodes were mapped with lymphoscintigraphy and biopsied in 84.3% and 90.1% of patients, respectively. False negative predictive value (FNPV) was 9.1% and false negative rate (FNR) was recorded in 16.7% of cases. Patients in advanced stages (FIGO III and IV) had significantly lower rate of lymphatic mapping compared to those in stage I and II (OR = 0.148, p = 0.022). Detection of sentinel lymph node in lymphoscintigraphy for tumor grade 2 and 3 was nearly eight times lower than for grade 1 cancers, however without statistical significance (OR = 0.126, p = 0.058). CONCLUSIONS: The use of SLNB should be limited to vulvar cancer patients in early clinical stages.

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INTRODUCTION: Inadvertent removal of, or damage to the parathyroid glands in the course of operations on the anterior neck compartment are responsible for over 80% of cases of chronic hypoparathyroidism (HypoPT). This study searched for factors related to the development of permanent HypoPT after total thyroidectomy and central neck lymphadenectomy in patients with thyroid carcinoma. MATERIAL AND METHODS: In total, 89 of 103 screened patients met the study's criteria and were put under prospective one-year observation. Demographic and surgical factors as well as the biochemical parameters of mineral homeostasis, controlled both preoperatively and postoperatively, were subject to statistical analysis. In line with contemporary guidelines, postoperative hypocalcaemia, rather than an abnormally low serum parathormone (PTH) concentration, was considered a diagnostic criterion of HypoPT. RESULTS: On postoperative day one (POD1), serum concentration of PTH decreased below the normal range (< 12 pg/mL) in 29 patients and was undetectable in 19 patients (< 6 pg/mL). At one year postoperatively, 12 patients with undetectable POD1 PTH required treatment for hypocalcaemia and were diagnosed with permanent hypoPT. All the other patients regained normocalcaemia. Relative risk of permanent HypoPT associated with undetectable POD1 PTH was 88.75. A significant difference in median POD1 serum calcium concentration between the patients with undetectable POD1 PTH and those with detectable POD1 PTH was found (p < 0.001). The difference between the POD1 serum calcium in patients with permanent or transient HypoPT in the subgroup with undetectable POD1 PTH did not reach the level of statistical significance (median, 1.82 mmol/L vs. 1.96 mmol/L). At one month postoperatively, in patients who later developed permanent HypoPT, serum calcium was lower than it was in all other patients (p = 0.167). At one year postoperatively, serum concentration of PTH was in the normal range in 10 of 12 patients with permanent HypoPT; however, it was significantly lower than it had been before the operation and distinctly lower than it was in patients who regained normocalcaemia. The number of parathyroid glands either dissected or autotransplanted did not affect the development of permanent HypoPT. CONCLUSIONS: Undetectable POD1 PTH is an important risk factor of permanent HypoPT. The main cause of permanent HypoPT was irreversible damage to the left in situ parathyroid glands.

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BACKGROUND: Localization and histopathological examination of sentinel lymph node is a standard of melanoma treatment. The first stage of identification of the SLN is the preoperative lymphoscintigraphy. The aim of this study was to assess and compare diagnostic value of planar lymphoscintigraphy and SPECT/CT in sentinel lymph node biopsy procedure performed in patients with cutaneous trunk melanoma. MATERIAL AND METHODS: Between 2015 and 2016, patients with trunk melanoma (N = 255, F/M 95/160), aged from 17 to 88 after an excisional biopsy, with primary tumor ≥ pT1b (AJCC 2009, median Breslow thickness 2.0 ± 3.13) were included in the study. In all the patients PL was followed by SPECT/CT 1-3 hours after injection of 99mTc- colloid particles, and SLNB was performed the next day. RESULTS: SPECT-CT revealed 78 (18.6%) SLN more than PL, and in 40 patients showed additional lymph drainage regions leading to surgical adjustments. In 18 patients (7.1%) SPECT-CT revealed SLN not visible in the PL (false-negative PL) and in 22 patients (8.6%), foci of uptake interpreted in PL as hot SLNs were found to be non-nodal sites of uptake when assessed on SPECT/CT (false positive PL). SPECT-CT vs. PL mismatch was observed in 31 patients (12.2%) and was the most common in patients with primary lesions located in the anterior inferior medial region (75%). CONCLUSIONS: Results of the presented study indicates the high diagnostic value of SPECT-CT in assessment of SLNs and proved that SPECT-CT increases the sensitivity and accuracy of SLN identification as compared to PL even in very experienced hands.

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Technetium (99mTc)-radiolabeled colloids are popular tracers used to map lymphatic vessels and regional lymph nodes (LNs). The regional LN status is a significant determinant of cancer stage and patient prognosis, and strongly influences treatment. Regional LN dissection has become a part of surgical treatment. However, not all patients with LN involvement benefit from extensive lymphadenectomy in terms of prolonged survival. Moreover, overtreatment of patients with localized disease carries the unnecessary risk of complications. It is believed that sentinel LN biopsy (SLNB) allows to assess the involvement of the most representative LN of the lymphatic basin and to decide on radical LN dissection.99mTc is an easily available radionuclide emitting gamma rays. The value of 99mTc for diagnostic procedures is associated with its relatively short half-life that makes it safe both for patients and medical personnel. A colloid presenting specific physical and biological properties, including optimal particle size, is a carrier for the radionuclide. When administered at the tumor site, a radiocolloid is absorbed by the lymphatics, and the first LN that it gets trapped in is referred to as the sentinel LN (SLN). The radiopharmaceutical must reach the SLN relatively quickly, but its storage within the SLN, and the radionuclide's half-life must be long enough to enable intraoperative imaging and evaluation. SLNB is currently the gold standard in breast cancer and malignant melanoma diagnosis, and is under extensive investigation in gynecological cancers. Here, we provide a historical perspective of the SLN concept and the clinical relevance of SLNB in gynecologic oncology. Moreover, we review the technical aspects of the application of 99mTc-based radiopharmaceuticals in lymphoscintigraphy and intraoperative lymphatic mapping.

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Nephron sparing surgery (NSS) is a technique more frequently utilized in the case of surgical treatment of kidney tumor. The aim of the study is to assess renal function in patients treated with NSS for renal tumors. Twenty patients, after NSS performed for renal tumor, were included in the study. In each patient dynamic renal scintigraphy was performed before surgical treatment (test No. 1) and after a mean interval of 12 months after surgical procedure (test No. 2). In each test renographic curves were evaluated. Creatinine levels and GFR rates were also assessed. Mean GFR was 84 ml/min/1.73 m(2) before surgery, and 79 ml/min/1.73 m(2) after surgical procedure. Mean change of GFR value after the surgical procedure was -5.1 (p >0.058). On renography significant deterioration of renal function was observed in the operated kidneys of 4 patients (20%) after NSS, insignificant deterioration - in four patients (20%) and improvement of renal function of operated kidney was found in one patient. In 12 patients (60%) no change was observed. The relative percentage GFR-share of operated kidney decreased by the average value of 3.8% (p >0.005). Multifactorial analysis did not identify significant effect of potential risk factors on the function of the kidney subjected to NSS. Preliminary results of this study confirm that deterioration of renal function after NSS is a rare event.

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OBJECTIVES: (1) Evaluation of the influence of hemostatic disorders on renal function in patients with FIGO stage IIB-IIIB cervical cancer treated with radiochemotherapy. (2) Identifying methods of improving renal function in this patients group. METHODS: Treatment design assumes the administration of a total radiation dose of 46-65 Gy and, additionally, cisplatin 40 mg/m2 every 7 days in patients with normal plasma creatinine level. Renal function was assessed with the aid of dynamic scintigraphy with glomerular filtration rate (GFR) evaluation. Analysis of serum hemostatic system covered D-dimers, PAP, PAI-1, tPA, FDP, F1+2 and TAT. The same hemostatic parameters were also evaluated in urine. The patients were divided into two groups: the study group - i.e. patients with affected GFR and the control group - with normal GFR. Half of study group patients, throughout the entire treatment, receive nadroparine 2850 units aXa/0.3 ml every 24 h during and 6 weeks after the treatment. RESULTS: There are significant decreases of GFR in control (median -9.7%) and study group without nadroparine (median -9.9%) and increase in the GFR (median 22.3%) in study group with nadroparine (p=0.0001). Plasma and urine hemostatic parameter analysis showed activation of fibrinolysis in patients treated with nadroparine and fibrinolysis inhibition in remaining groups. CONCLUSIONS: (1) Inhibition of fibrinolysis may cause subclinical renal insufficiency in patients with advanced cervical cancer. (2) Insufficiency increases after the end of radiochemotherapy in patients, as well with normal GFR as, with primary decreased GFR. (3) Application of nadroparine causes fibrinolysis activation, and increase in the GFR.

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Bone scan remains the most frequently requested investigation in any nuclear medicine department. The main reason for this is the exquisite sensivity of the bone scan for lesion detection, combined with clear visualisation of the whole skeleton. The isotope bone scan is now generally accepted as initial investigation of choice in the search for bone metastases from most tumours. 13583 bone scans for metastases were performed in our institution in 1998-2002 years. The frequency of bone metastases was highest in breast, prostate and lung cancer (53,9%, 58,6% and 29,5% respectively). Future progress depends on further advances in specificity of radiotracers and improvements of image acquisition and processing.