RESUMEN
PURPOSE: The aim of our study was to re-evaluate the role of whole-body bone scanning (WBBS) in detecting bone metastases in apparently operable stages of non small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: We made a retrospective analysis of 60 patients (53 males, 7 females, aged 47-87 years, mean 68+/-4) between 2004-2006. All patients had a full series of imaging staging procedures including WBBS. Their medical records were reviewed with respect to how often bone metastases were detected and whether or not the patients showed any symptoms or laboratory abnormalities indicating bone involvement. RESULTS: Skeletal metastases (confirmed afterwards by x-ray, computed tomography or biopsy) were found in 11 (18.3%) patients. All of them had normal serum alkaline phosphatase and calcium concentrations. Eleven patients had symptoms suggesting bone metastases and 49 were asymptomatic. Bone metastases were detected in 3 (27.2%) of 11 clinically symptom-positive patients and in 8 (16.3%) of 49 clinically symptom-negative patients. CONCLUSION: The present study indicates that if bones scans were done only in patients reporting skeletal symptoms an important number of patients (16.3%) would have been misstaged due to asymptomatic bone metastases. We conclude that in patients with apparently operable NSCLC preoperative staging using WBBS is useful to avoid under-staging and futile surgery.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Imagen de Cuerpo Entero , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Neoplasias Óseas/secundario , Carcinoma de Pulmón de Células no Pequeñas/secundario , Difosfonatos , Femenino , Humanos , Neoplasias Pulmonares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Compuestos de Organotecnecio , Valor Predictivo de las Pruebas , Cintigrafía , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
A total of 120 patients with squamous cell carcinoma of the cervix were prospectively monitored with simultaneous serum level estimations of SCC, CEA, and TATI in different stages and phases of their disease. Positive values were observed for SCC in 72 patients (60%), for CEA in 47 (39%), and for TATI in 12 (10%). There was no increase in the SCC serum levels in the early stages of disease (IA, IB, IIA), whereas they increased significantly with advancing stage. Serum marker levels quickly dropped to normal in patients with advanced stages (IIB or higher) or recurrent disease who responded to treatment, as well as in patients with early-stage disease following local therapy. In addition, 28 patients, who had a renewed progression after a complete remission with normal marker levels, showed an increase in SCC in 26 cases (92%) and CEA in 7 (25%). TATI did not vary in these patients. In patients whose disease did not respond to treatment, a change in serum marker levels cannot be evidenced with the available numbers. This study indicates that the routine measurement of all three markers is not justified in squamous cell carcinoma of the cervix, and that SCC estimation is a potential tool for monitoring the efficacy of treatment in advanced stages or relapse.
Asunto(s)
Antígenos de Neoplasias/sangre , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Carcinoma de Células Escamosas/diagnóstico , Serpinas , Inhibidor de Tripsina Pancreática de Kazal/sangre , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/sangre , Carcinoma de Células Escamosas/inmunología , Distribución de Chi-Cuadrado , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/inmunologíaRESUMEN
Eighty-eight patients with head and neck cancer were prospectively monitored, before and after treatment, by means of simultaneous serum SCC, CEA and TATI measurements. Thirty-two (36.6%) patients had early stages (I, II, III) and 56 (63.4%) advanced (stage IV) or recurrent disease. Pre-treatment serum SCC levels were elevated in 20.4% of patients, CEA in 27.2% and TATI in 4.5%. There was no correlation between the incidence of TATI elevation and tumour burden; this marker did not increase with progressing disease stages. CEA and SCC had low sensitivity in the early stages of head and neck cancer and reached 35.7% (20/56 patients) and 25% (14/56 patients) in stage IV or recurrent disease. Despite the low sensitivity of these tumour markers, there was a correlation between tumour marker levels and the course of the disease. This study indicates that the routine assessment of SCC, CEA and TATI serum levels is of no value. However, it can be used as a potential tool for monitoring the efficacy of individual therapy in both early and advanced stages of head and neck cancer.
Asunto(s)
Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/sangre , Neoplasias de Cabeza y Cuello/sangre , Serpinas , Adulto , Anciano , Anciano de 80 o más Años , Antígenos de Neoplasias/sangre , Antígeno Carcinoembrionario/sangre , Carcinoma de Células Escamosas/inmunología , Reacciones Falso Negativas , Neoplasias de Cabeza y Cuello/inmunología , Humanos , Persona de Mediana Edad , Pronóstico , Inhibidor de Tripsina Pancreática de Kazal/sangreRESUMEN
131I-labelled H17E2 monoclonal antibody (MAb) was administered to 16 patients with germ cell tumours of the testis (GCT). Eleven patients had non-seminomatous GCT and five seminoma. The MAb was administered into the webs between the second and third toes of both feet in 12 patients and intravenously in four patients at a dose of 1.5-2mCi. 131I-labelled 2-118 MAb (non-specific) was administered subcutaneously into the webs between the second and third toes of both feet in two patients and intravenously in one patient with non-seminomatous GCT. All three patients had only computed tomography (CT) scan. Patients were scanned immediately after until 7 days post-injection. For comparison all patients had CT scan and eight out of 16 patients had conventional lymphangiography (LG). When the radiolabelled MAb was given subcutaneously, the immunoscan (IS) was true positive in 9/12 (75%) patients and true negative in 2/12 (16.5%) and equivocal in 1/12 (8.5%). The LG gave true positive results in 6/8 (75%) patients and true negative results in 2/8 (25%) and the CT scan true positive results in 8/12 (66.6%) patients, true negative results in 2/12 (16.3%) and false negative results in 2/12 (16.3%). There was an excellent correlation of IS images with the LG results (true positivity 100%). When the radiolabelled MAb was given intravenously, both IS and CT scan gave true positive results in four cases. Our findings showed that the true positivity of IS reached 93.8%, whereas that of CT scan 87.5%. In all three patients who had the 131I-labelled 2-118 non-specific MAb, the IS was false negative, whereas the CT scan was true positive. Thus, this procedure may offer information complementary to that provided by existing conventional imaging methods.
Asunto(s)
Anticuerpos Monoclonales , Metástasis Linfática/diagnóstico por imagen , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias Testiculares/diagnóstico por imagen , Humanos , Radioisótopos de Yodo , Linfografía , Masculino , Tomografía Computarizada de EmisiónRESUMEN
The purpose of this study was to evaluate jogging in place as an electrocardiographic exercise test. Jogging in place continuously recorded via an ordinary single-channel electrocardiograph was compared with the Bruce treadmill protocol with a three-channel monitor and recorder in 141 cases with a wide spectrum of chest complaints. Agreement for the presence or absence of electrocardiographic ischemia (ST-segment displacement greater than or equal to 1 mm at 80 ms from the J point, or U-wave inversion) for the two tests was observed in 91 percent of the cases (95 percent confidence intervals: 86 percent to 95.5 percent). One hundred of the previous cases with paired electrocardiographic exercise tests were compared with the presence of reversible defects on exercise myocardial thallium-201 scintigraphy. The electrocardiographic ischemia had a similar correct classification rate in both methods (83 percent with jogging in place and 85 percent with Bruce treadmill protocol; not significant) against the finding of scintigraphic ischemia. This was also true for 52 cases having selective coronary arteriography. The correct classification rate was 54 percent (28/52) with jogging in place and 48 percent (25/52) with Bruce treadmill protocol (not significant). Given the safety and the easy applicability, even in older persons, this simplified test can be recommended as a valid alternative to the established multistage exercise tests.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Electrocardiografía , Prueba de Esfuerzo/métodos , Trote , Adulto , Anciano , Angiografía Coronaria , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Radioisótopos de TalioRESUMEN
131I-labelled HMFG2 or HMFG1 F(ab')2 monoclonal antibody (MAb) was administered intraperitoneally to 15 patients with epithelial ovarian cancer who had completed chemotherapy and were in complete or good partial remission. Each patient received 2-3 mCi. Patients were scanned immediately after and until 7 days post-injection. In 3/15 patients the immunoscan failed because extensive adhesions from the previous surgery prevented MAb diffusion. Of the remaining 12 patients, 9 underwent second-look laparotomy (SL). Immunoscan was true positive in 8/9 (89%) patients and equivocal in 1/9 (11%), whereas the abdominal CT scan gave true positive results in 6/9 (67%) patients. In 8 out of 9 patients there was a good correlation between distribution of all sites of abnormal uptake and the surgical findings at SL. Of the 3 patients not undergoing SL, the immunoscan was positive in all, whereas clinical examination and abdominal CT scan were negative. All 3 patients relapsed after 3, 4 and 5 months. Thus the total true positivity of immunoscan reached 92%, CT scan remaining at 50%. Immunoscan with intraperitoneal administration of 131I-labelled MAbs can thus accurately detect the presence of residual disease in ovarian cancer patients and appears more sensitive than abdominal CT scan.
Asunto(s)
Anticuerpos Monoclonales , Radioisótopos de Yodo , Neoplasias Ováricas/diagnóstico por imagen , Radiografía Abdominal , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Fragmentos Fab de Inmunoglobulinas/inmunología , Persona de Mediana Edad , CintigrafíaRESUMEN
Radiolabelled specific monoclonal antibodies (MAbs) HMFG2 and HMFG1 F(ab')2 and non-specific 11.4.1 and 4C4 F(ab')2 were injected into the webs between the 2nd and 3rd fingers of both hands in 31 patients with clinical diagnosis of breast cancer. We studied 10 patients with clinically obvious axillary lymph-node disease (group A) and 10 patients with clinically negative axilla (group B) using HMFG2, 5 patients with clinically negative axilla (group C) using HMFG1 F(ab')2 and 6 patients with clinically positive axilla (group D) using non-specific 11.4.1 and 4C4 F(ab')2 MAbs. In group A, 7 patients had true positive scans. There were also 3 false negative scans, due to problems related to proper iodination at the beginning of this study. In group B there were 4 true positive scans, 4 true negative, I false positive and I false negative. In group C there were 4 true negative scans. In one patient the radiolabelled antibody was arrested in the middle of the arm, because of lymphatic obstruction. In group D, there were 3 false negative scans with 11.4.1 antibody and 3 false negative scans with 4C4 F(ab')2 MAb. The results of immunoscintigraphy were in accordance with the histopathology and immunoperoxidase staining findings. These results indicate that this non-invasive approach can accurately detect metastatic involvement in the axillary lymph nodes and can be used for the diagnosis and staging of breast cancer.