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Youngfibroadenomas show strong enhancement during estrogen Phase of female cycle 1) Papillary type of DCIS,with abundant vascularization of the papillary fingers 2) Invasive medullary cancer with strong enhancement. Substances released from dense lymphohistiocytic infiltrates increase vascular permeability 3) Comedo-type DCIS with release of necrosis factors and extraductal neoangiogenesis prostaglandins , periductal neoangiogenesis Fig. 34. Enhancing factors making it possible to demonstrate...

Preliminary Results in Nstaging of Medullary Thyroid Cancer

For curative treatment of medullary thyroid cancer, accurate determination of the extent of disease and early identification of any metastases is of critical importance. There is no single sensitive imaging modality available for localizing metastases. Therefore, several imaging modalities, e.g. sonography, CT, MRI, and scintigraphy using pentavalent mtechnetium-dimercaptosuccinic acid (DMSA), thallium-201, mIn-pentetreotide, radiolabeled anti-CEA antibodies or 123I-metaiodobenzyl-guanidine...

Histo and Cytopathological Diagnosis

It is beyond doubt that the sentinel node approach sometimes restricts the conventional histopatho-logical diagnosis, which has to be made on the basis of primary tumors. The highest degree of limitation exists in the diagnosis of malignant melanomas. As a rule, in practice this tumor is often removed in toto with an adequate safety margin before the sentinel node search is started (see also Chapter 25). In breast cancer the diagnostic results obtained by radiodiagnosis (mammography, MRI) can...

T3

Influence of spatial resolution in separate detection of neighboring lymph nodes Fig. 4. Distorting signal caused by a leak in shielding conceals the sentinel lymph node (SLN) in the measurement cone Fig. 4. Distorting signal caused by a leak in shielding conceals the sentinel lymph node (SLN) in the measurement cone Fig. 5. Commercially available gamma probe systems 2 ScintiProbe, pol.hi.tech, Italy 3 Europrobe, Eurorad, France 4 Tecprobe, Stratec, Germany 5 Crystal Probe 2000,...

Pattern of Distant Hematogenous Metastases from Lung Cancer

The pattern summarized for distant metastasis is highly characteristic for lung cancer, and especially for the small-cell (anaplastic, oat-cell) type but high-grade adenocarcinomas and anaplastic squamous cell cancers also develop metastases in the organs listed (see Fig. 5). After confirmation of the diagnosis of lung cancer by biopsy or cytology and before local SLN labeling, N-staging, and surgical treatment (lobectomy, pneumectomy) the organs listed and the skeleton must be carefully...

Direct and Secondary Hematogenous Metastasis of Breast Cancer

Besides the characteristic locoregional spread via the lymphatics, breast cancer can metastasize very quickly via the bloodstream. Initial, direct hematogenous spread via cancer cell invasion of the veins is a well known fact to take place, and its importance has been discussed from many angles. The first organ involved in these circumstances is the lung. In addition to this, however, the venous bloodstream can also be reached secondarily via cancer infiltration of the axillary sentinel node,...

Differential Diagnosis of Very Sharply Delineated Breast Cancers

All imaging systems (mammography, MRI, ultrasound) can show up round, sharply delineated nodes within the breast parenchyma. These round nodes often correspond to specific subtypes of breast cancer but for diagnosis of a fibroadenoma large foci of sclerosing adenosis (with and without microcalcifications) must be delineated. The histological criteria of these cancer subtypes and the MRI findings of fibroadenomas are listed in Table 13. Fig. 55. Bifocal breast cancer in the upper lateral...

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5mm Nodule Mammogram

AIn an overview of the literature, Witt et al. (2002) stated that the frequency of axillary involvement in the pT1a stage given in the literature varies from zero to 28 Figs. 8, 9. Breast cancer types with excellent prognosis, in which the SLN search helps to avoid extended axillary revision (levels I and II) Fig. 8. Tubular cancer in most cases grade I, very low mitotic activity, nearly regularly homogeneous hormone receptor equipment. In nearly all cases there is no axillary lymph node...

Method to Improve Security in Sentinel Node Investigation and Timing in Interdisciplinary Cooperation

In the strategies to detect SLNs in different primaries, such as breast cancer, melanoma, lung and gastrointestinal carcinomas and also neuroendocrine tumors and urogenital cancers, exact timing of the various diagnostic and therapeutic procedures has an important role. As a general rule, it is extremely helpful to have an exact histopatho-logical and or cytopathological diagnosis before sentinel lymphadenectomy is performed. In certain tumor entities, such as melanoma, primary biopsies before...

Criteria for Clinical and Histopathological Sentinel Node Evaluation Breast Cancer

In contrast to the clearly defined conditions in which sentinel node search and detection are helpful to avoid axillary revision in levels I and II and exceptions in which parasternal location of the sentinel node(s), for instance in cases with multicentric, partly centromedially localized cancers is helpful with regard to far-reaching decision making, there are clearly defined entities in which the search for sentinel nodes is contraindicated. These constellations are summarized in Table 4,...

Therapy Regimens for Soft Tissue Tumors

Adjuvant chemotherapy for the treatment of sarcoma remains controversial. For advanced disease doxorubicin and ifosfamide are the most active agents. Tables 46-48 show some frequently used regimens. Table 46. Doxorubicin as single-agent chemotherapy for sarcomas Doxorubicin 70 mg m2 i.v. Day 1 Table 47. Mesna, Adriamycin, ifosfamide and dacarbazine (MAID) regimen (Elias 1989) for sarcomas a Table 47. Mesna, Adriamycin, ifosfamide and dacarbazine (MAID) regimen (Elias 1989) for sarcomas a

Tracers Most Frequently Used for Detection of SLN

The simplest technique that can be used to visualize draining lymph vessels and the SLN is the operative search for these tissue structures after injection of the dye patent blue or other blue dyes. Moreover, radioactive tracers such as mtechnetium sulfur nanocolloid can be used, either separately or in combination with injection of such blue dye solution. In a patient in whom breast cancer has been detected, this material is injected intradermally over the cancer or peritu- lized apoptotic or...

Andor Cytopathology Before Sentinel Lymph Node Labeling

Reasons for Histology Cytology-based Diagnosis of Breast Cancer Most publications based on investigations aimed at sentinel lymph node (SLN) detection state that a clear-cut histology- or cytology-based diagnosis of breast cancer is required before SLN labeling (99mTc and or patent blue injection) starts. Only when a palpable circumscribed solid tumor mass has been found on imaging and already certified as cancer can SLN labeling be started without preceding biopsy. In such cases, the often...

Management in Cancers with Tendency to Multifocality or Multicentricity

The rates of multifocal and multicentric breast cancers are at least partly type related. Lobular cancers are multifocal or multicentric in 10-15 Fig. 45. Diffuse nonpalpable cancer after labeling by peritumoral injection (blue dye and or mTc-nanocolloid) an axillary lymph node is labeled as the sentinel node. Primary localized by imaging (mammography, MRI, ultrasound) peritumoral (subdermal) ultrasound-guided injection of mTc-nano-colloid blue dye Fig. 46. Two possible localizations of cancer,...

New Strategies and Devices for Combined Radiological and Histological Cancer Diagnosis Exclusion or Confirmation

The simplest system that is only minimally invasive is ultrasound-guided or mammographically controlled fine-needle aspiration cytology (FNAC), which is very successful in highly experienced hands. In the past few years, however, international companies such as Fischer-Techniques, Siemens and others have developed new, electronically guided machines for taking core or vacuum biopsies from tiny suspicious foci these are steered mammographically or by magnetic resonance tomography (MRT). 1. Under...

Breast Cancer

After a general learning period of nearly a decade, there is already an important knowledge base about the fundamental primary techniques for managing sentinel lymph node (SLN) detection in the best way. The international literature makes it clear that early experience was gained in the treatment of breast cancer and malignant melanoma, whereas experience of SLN diagnosis of other primaries is still limited. Three routes of contrast solution injection (subdermal, peritumoral, intratumoral) have...

Pitfalls Attributable to Mimicry of Sentinel Nodes in Wrong Positions

Sentinel Lymph Nodes

Normal lymph drainage can be blocked by scars. The drainage to the mammaria interna lymph nodes can be potentiated when scars in the lateral parts of the glandular body of the breast block the flow to the axillary nodes. The lymphatic drainage via the retromammillary lymph circle may then be strongly increased, and with it drainage of cancer cells to the nodes of the mammaria interna chain. Fig. 48. The different basins or node groups into which centrally localized cancers can drain Fig. 48....

Alternatives to Tamoxifen

Buzdar et al. stressed the effectiveness of anastro-zole (1 mg respectively 10 mg day) as long ago as 1996. They state that the effects are similar to those of megestrol acetate, which was in trial at the same time. Anastrozole was even effective in postmenopausal women with advanced breast cancer that had progressed during tamoxifen therapy. In 2003, Buzdar reported on new findings, comparing anastrozole (1 mg once daily) alone and in combination with tamoxifen (20 mg once daily). In summary,...

References

Albertini JJ, Lyman GH, Cox C Yeatman T, Balducci L, Ku N, Shivers S, Berman C, Wells K, Rapaport D, Shons A, Horton J, Greenberg H, Nicosia S, Clark R, Cantor A, Reintgen DS (1996) Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 276 1818-1822 Cox CE, Bass SS, Ku NN, Berman C, Shons AR, Yeatman TJ, Reintgen DS (1998) Sentinel lymphadenectomy a safe answer to less axillary surgery Recent Results Cancer Res 152 170-9 De Cicco C, Cremonesi M, Luini A, Bartolomei...