Stefania Latteri

Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients

Background Preoperative lymphoscintigraphy is without doubt a valid method for the detection of the sentinel lymph node (SLN). There has been considerable debate regarding the optimal site for the introduction of the tracer; various sites include peritumoral (PT), periareolar (PA), subdermal, and intradermal injection. Purpose To evaluate retrospectively the lymphoscintigraphic identification rate of peritumoral (PT) injection versus subdermal periareolar (PA) injection in the detection of SLNs in breast cancer. Material and Methods Between October 2002 and December 2011, a cohort of 906 consecutive patients with biopsy proven breast cancer underwent 914 SLN biopsy procedures. A total of 339 procedures (Group A) were performed using a PT deep injection of radiotracer while 575 procedures (Group B) adopted a subdermal PA injection of radiotracer towards the upper outer quadrant, regardless of the site of the carcinoma. All the patients underwent synchronous excision of the breast cancer and SLN biopsy. Results SLNs were identified in the lymphoscintigram in 308/339 cases (90.85%) of Group A (PT injection) and in 537/575 cases (93.39%) of Group B (PA injection). Furthermore, in 2/339 patients (0.58%) of Group A, internal mammary lymph nodes were found at lymphoscintigraphy, whereas no internal mammary sentinel nodes were found in the Group B patients. The intraoperative identification rate of axillary SLNs was 99.41% (337 of 339) in the Group A patients and 99.65% (573 of 575) in the Group B patients. There was no significant difference in the two groups between the incidence of the number of SLNs detected and the incidence of identification of positive SLNs. Conclusion PT versus PA injection of radiotracer showed comparable success rates for axillary SLN identification, and can be considered a rapid and reliable method.

Barium study associated with water siphon test in gastroesophageal reflux disease and its complications

PurposeThe aim of this study was to evaluate the role of digital cineradiography associated with the water siphon test (WST) in the diagnosis of gastroesophageal reflux and to compare the results with oesophageal motility study, pH monitoring and endoscopy associated with biopsy and histology.Materials and methodsOne hundred and sixty consecutive patients underwent digital cineradiography with WST, motility study, pH monitoring and endoscopy with biopsy. The presence of gastroesophageal reflux, oesophagitis, Barrett’s oesophagus and intestinal metaplasia was evaluated.ResultsWST vs. pH monitoring showed sensitivity of 71%, specificity of 31%, positive predictive value (PPV) of 53% and negative predictive value (NPV) of 50%; when middle-proximal refluxes only were considered, sensitivity decreased to 45% and specificity increased to 55%. Furthermore, the association between reflux and oesophagitis demonstrated by the chi-square (χ2) test proved to be statistically significant both for WST and pH monitoring, whereas the association between reflux and Barrett’s oesophagus was not significant for either WST or for pH monitoring. With regard to intestinal metaplasia, WST (middle-proximal refluxes) showed higher sensitivity (64% vs. 58%) and specificity (63% vs. 51%) than pH monitoring, whereas the statistical association between reflux and metaplasia proved to be significant for WST but not for pH monitoring.ConclusionsWST is a simple, inexpensive and reliable test that might be useful in the diagnosis of gastroesophageal reflux disease (GERD). A positive WST might be an additional indication for endoscopy with biopsy.RiassuntoObiettivoValutare il ruolo della videofluorografia con water siphon test (WST) nella diagnosi di reflusso gastroesofageo (GERD) comparandone i risultati con manometria, pH-metria ed endoscopia con biopsia e istologia.Materiali e metodiCentosessanta pazienti consecutivi sono stati sottoposti a videofluorografia digitale, manometria, pH-metria ed endoscopia con biopsia. È stata valutata la presenza di GERD, esofagite, esofago di Barrett e metaplasia intestinale.RisultatiIl WST vs. pH-metria ha presentato sensibilità del 71%, specificità del 31%, valore predittivo positivo (PPV) del 53% e valore predittivo negativo (NPV) del 50%; la sua specificità aumenta (55%) considerando solamente i reflussi medioprossimali, ma diminuisce la sensibilità (45%). Inoltre l’associazione reflusso-esofagite (test del chi-quadro) è risultata statisticamente significativa sia per il WST che per la pH-metria, mentre l’associazione reflusso-Barret non è risultata statisticamente significativa né per WST né per pH-metria. Rispetto alla metaplasia intestinale, il WST (reflussi medioprossimali) ha sensibilità (64% vs. 58%) e specificità (63% vs. 51%) maggiori rispetto alla pH-metria; l’associazione statistica tra reflusso e metaplasia è risultata significativa per il WST ma non per la pH-metria.ConclusioniIl WST è un test semplice e poco costoso, facilmente realizzabile, che può essere utile nella diagnosi di GERD; la sua positività può essere un indicatore per selezionare i pazienti da avviare all’endoscopia con biopsia.