Scintigraphy with 57Co-bleomycin in the detection of lung cancer. A review of 268 well-documented patients

Over a 5-year period 57Co-bleomycin scintigraphy for tumor detection was performed with a large-field-of-view gamma camera. The scintigrams of 268 patients with lung cancer, with a benign lesion, or with no abnormality in the chest, were reviewed. A sensitivity of 96% was found. In a group of 193 patients in whom a preoperative pathologic diagnosis could not be obtained sensitivity was 95%, specificity was 87%. Correlation between tumor size and tumor-to-non-tumor ratio was established for squamous cell carcinoma, adenocarcinoma, and small cell anaplastic carcinoma. Adenocarcinomas were smaller and showed lower tumor-to-non-tumor ratios than other histologic types. In squamous cell carcinoma a possible correlation between tumor-to-non-tumor ratio and histologic differentiation was investigated, but could not be established. It is concluded that 57Co-bleomycin scintigraphy is helpful in the evaluation of patients with possible lung cancer in whom a preoperative pathologic diagnosis cannot be obtained.     

Plasma spermidine concentrations as early indication of response to therapy in human myeloma.

Eighteen patients with melphalan refractory myeloma were treated with vindesine and prednisone. Plasma spermidine concentrations were measured by radioimmunoassay before and after a single vindesine injection. Seven patients showed a significant rise of plasma spermidine after vindesine and five of these showed a clinical response on further evaluation. Of the 11 patients who did not show raised spermidine concentrations, 10 did not respond to the therapy. The correlation between clinical response/rise of spermidine and between non-response/no rise of spermidine was statistically significant (p less than 0.05). Pretreatment spermidine concentrations did not distinguish those who responded to treatment nor did they differ in patients and controls.     

Some experience with 57Co-labeled bleomycin as a tumor-seeking agent.

Bleomycin labeled with 57Co was used as a tumor-localizing agent in 132 patients. In patients with pulmonary tumors the primary localization concentrated radioactivity in 52 of the 54 appropriate cases; out of the 22 clinically known metastases, 19 were visible on the scan; 40 unknown metastases especially in hilus and mediastinum were found by the method and subsequently confirmed. In 22 patients with malignant lymphomas, 18 out of 22 known pathologic lymph glands above the diaphragm were visible on the scan; below the diaphragm the results of scanning in lymph glands and spleen were disappointing, probably because of the disturbing concentration of radioactivity in the kidneys, the bladder, the liver, and sometimes the gut. In 25 patients with various other tumors, 16 out of 22 known localizations above the diaphragm were visible; 2 were uncertain and 4 negative. Below the diaphragm the results were usually negative. In 24 patients with benign lesions, uptake of 57Co-bleomycin was visible on the scintigram in 4 patients with cavitating pulmonary tuberculosis, in 2 with pulmonary infections, in 1 with Caplan lesions of rheumatoid arthritis in the lung, and in 1 with sinusitis ethmoidalis. The significance of these results is discussed.     

Abnormal Cells in the Peripheral Blood of Patients with Hodgkin''s Disease

The characteristics of large, abnormal cells in the peripheral blood of patients with Hodgkin's disease have been investigated with cytochemical stains. It was possible to distinguish clearly cells of the granulocytic series, megakaryocyte parts, cells of the mononuclear phagocytic system and immunoblasts. These cells, however, are not specific for Hodgkin's disease, for they could also be found in normal subjects, in patients with infectious mononucleosis or cytomegalovirus disease and patients with lympho- or reticulosarcoma. Cells considered to indicate dissemination of Hodgkin's disease could only be detected in the peripheral blood of patients with this condition, and not in the other diseases mentioned above. These cells do not react with the periodic acid Schiff stain, Sudan black, peroxidase, non-specific esterase and sometimes faintly with methyl green pyronin. It is therefore improbable that these cells belong to the categories of the granulocytic or monocytic cells, but a relationship to the lymphoid cells on the one hand or to the reticulum cells on the other could not be excluded on the basis of this morphological investigation.     

Bacterial infections and thrombocytopenia in chronic idiopathic thrombocytopenic purpura.

A bacterial infection was considered to be responsible for provoking or containing episodes of thrombocytopenia in 5 patients with chronic idiopathic thrombocytopenic purpura (ITP). In 3 patients the course of the disease was continuous and in 2 of them remission was attained after eradication of the infection. In the other 2 patients the course was intermittent and a number of relapses was provoked by the infection. The possible causal connection of chronic ITP and bacterial infections is briefly discussed.     

Immunological Responsiveness in Idiopathic and Drug-induced Panmyelopathy: Discrepancy between Sensitization with DNCB and Haemocyanin

S ummary . Immunological responsiveness to two primary antigens, haemocyanin and dinitrochlorobenzene, was tested in seven patients with idiopathic or drug-induced panmyelopathy. Humoral immunity was quite normal, but cell-mediated immunity was partially deficient. Six patients showed in vitro lymphocyte reactivity to haemocyanin and positive intracutaneous tests with haemocyanin after immunization. The one patient in whom sensitization to haemocyanin did not develop had received prednisone during immunization because of overt bleeding tendency. In contrast to the successful immunization with haemocyanin, sensitization with DNCB did not succeed in any of the seven patients. PHA reactivity of the lymphocytes was not significantly lowered.     

Clinical implications of sentinel nodes outside the axilla and internal mammary chain in patients with breast cancer

PURPOSE: The aim of this study was to determine the incidence, location, surgical identification rate, tumor status, and clinical implications of sentinel nodes outside the axilla and internal mammary chain. PATIENTS AND METHODS: In 785 breast cancer patients, pre-operative lymphoscintigraphy was performed after intratumoral injection of 116 MBq 99mTc-labeled nanocolloid (0.2 ml; 3.1 mCi). Sentinel nodes were pursued using a gamma-ray detection probe and vital blue dye. RESULTS: Lymphoscintigraphy visualized sentinel nodes outside the axilla and internal mammary chain in 91 of the 785 patients (12%). Sentinel nodes (106) were identified in 80 patients. These nodes were found in the following locations: 50 in the breast, 31 in the infraclavicular fossa, 19 between the pectoral muscles, and 6 within the supraclavicular bed. Eighteen nodes contained a metastasis (17%) and were removed from 16 patients. The treatment strategy was adjusted in 12 of them with the addition of adjuvant local or systemic therapy. Two additional patients with an unusually situated tumor-negative sentinel node were spared an axillary node dissection that would otherwise have been performed. CONCLUSION: Unusually situated sentinel nodes were visualized in 12% of the patients. The treatment was adjusted in 18% of patients in whom these nodes were identified.     

57Co-bleomycin and 67Ga-citrate in detecting and staging lung cancer.

In the investigation of suspected lung cancer bleomycin labelled with cobalt-57 and gallium-67 labelled with citrate are currently used to detect the primary tumour and to establish the presence of metastases in the lung hilum and mediastinum. A comparative study of these radio-pharmaceuticals was performed in 63 patients with proved lung cancer. 57Co-bleomycin showed the primary tumour in 58 patients (92%) and 67 Ga-citrate in 34 (54%) (p less than 0.01). The average tumour-to-lung ratio was 3.4 with 57Co-bleomycin and 1.5 with 67Ga-citrate. Proved metastases in the hilum or the mediastinum were visualised with 57Co-bleomycin scintigraphy in 16 out of 18 patients (89%) and with 67 Ga-citrate scintigraphy in only eight (45%) (p less than 0.01). These results indicate that 57Co-bleomycin scintigraphy is more suitable for detecting and staging lung cancer than is 67Ga-citrate. 57Co-bleomycin is valuable in the detection of peripheral lesions, in which a pathological diagnosis is difficult to achieve, since a positive scintigram indicates malignancy. When 57Co-bleomycin scintigraphy suggests hilar or mediastinal metastases mediastinoscopy should be carried out; but when no metastases are apparent it is reasonable to proceed directly to thoracotomy without mediastinoscopy.     

Contemporary management of penile squamous cell carcinoma

Squamous cell carcinoma (SCC) is the most common tumor of the penis. The natural history and its proclivity to spread via regional lymphatics has been well defined. Laser ablation of the primary tumor has a prominent role in patients with a superficial tumor as a penis-conserving approach. Patients with deeper infiltrating tumors, should undergo (partial) penile amputation. For patients presenting with proven metastatic nodes complete (ilio-) inguinal lymphadenectomy should be performed. During the last two decades, the management of penile carcinoma patients with impalpable regional lymph nodes has improved due to better knowledge of risks for metastases, the introduction of modified lymphadenectomy, and sentinel node biopsy. Future perspectives in penile cancer comprises continuing research to reduce mutilation without jeopardizing clinical outcome.