vol 17 no 4 DECEMBER 2009 221AIM 2009; 17(4): 221-225SUMMaRY. Introduction: The aim of this study was to, based on the data collected, determine the right time for the application of bone scintigraphy in patients with breast cancer. Discovery of bone metastasis in their initial stages of development, before the occurrences of clinical signs, can completely alter treatment and improve prognosis of patients with breast cancer. Materials and methods: A retrospec-tive study was conducted on three hundred consecutive patients with breast cancer in the period of 2005-2008. Patients without prelimi-nary biochemistry analyses, radiological data and bone scintigraphy, were not included in the study, however, exceptions were made for Computer Aided Tomography and Magnetic Resonance Imaging examinations, because some patients didn’t make them. Bone scin-tigraphy was always performed after clinical examination of all patients, three hours after intravenous administration of 555-740 MBq activity of 99mTc MDP. Results: Two hundred ninety nine (99.67%) were female with breast cancer and only one case (0.33%) was male with breast cancer. Investigation group (IG) included 126 patients (42.0%) with breast can-cer, before surgical treatment (positive clinical signs and laboratory findings for cancer) and in our control group (CG) were included 174 patients (58%) with breast cancer after surgical treatment. Unilateral mastectomy with removal of lymph nodes in the axillae was done in 97 patients (55.74%) whereas in 77 patients (44.26%) only mastectomy. Suspected lesions for bone metastases were found in 30 patients (23.8%) included in the investigation group and 65 patients (37.36%) included in the control group. Suspected bone lesions were found mainly in axial skeletal (vertebrae 57%, ribs 24%, pelvis 12%) and long other extremities (7%). Probability of bone metastases in patients ranged with stage three (III) and four (IV) of disease, was significantly higher (46.6% and 69.6%), in comparison with stage I and II (3.84% and 6.5% respectively), however bone metastases were found also in patients ranged with stage I and II. We noticed 8.7 higher probabilities of bone metastases for patients with lobular invasive breast carcinoma than for patients with invasive ductal breast carcinoma. The sensitivity of bone scintigraphy was 98%, its specificity 95%, resulting in a diag-nostic efficiency of 98%. The positive predictive value was calculated to be 98% as compared to the negative predictive value of 95%. The concentrations of CA 15.3 were significantly higher in patients with bone metastasis than in those without bone metastasis (p<0.01). Conclusion: Our preliminary study results suggest that the application of bone scintigra-phy in primary breast cancer, before surgical intervention is very useful to evaluate initial stage and to perform the follow up examination.
Purpose: More than ¾ of bone cancers are metastases which derive from another primary cancer. Detection of bone metastases in their initially developed stage until the period without clinical signs was the goal of interest. Methods: One hundred five patients with cancer disease were included in our perspective study during 2002-2005. Patients without preliminary biochemistry analyses, radiological data and bone scintigraphy, were not included in the study, whereas we made exceptions for CT and MRI examinations because some patients didn’t made them. Bone scintigraphy was performed after clinical examination of all patients, three hours after intravenous administration of 555-740 MBq activity of 99mTc MDP. Results: From the overall number, seventy two patients were female (68.57%). The patients with breast cancer (62) were the most frequent group (59.04%). Prostate cancer was registered in 19 male patients (18.09%), whereas lung cancer was registered in 5 cases (4.7%). Bone metastases were registered in 85 patients (80.95%). The sensitivity of bone scintigraphy was 98%, its specificity 95%, resulting in a diagnostic efficiency of 98%. The positive predictive value was calculated to be 98% and the negative one to be 95%. The concentrations of the bone markers, TAP, ESR, blood calcium, CEA, CA 15.3 and PSA were significantly higher in patients with bone metastasis than in those without bone metastasis (p
Treatment of complicated case with subclavia steal syndrome and stenosis of common iliac artery Background. The aim of this case report is to describe the realization of complex radiological minimally invasive interventional procedures at the Institute of Radiology in KCU Sarajevo during which we treated a very complicated case with the left subclavia steal syndrome and the stenosis of the left common iliac artery. Case report. The patient was 57 years old with previous history of ischemic lesions in brain, with occlusion of the left arteria carotis communis (ACC) and stenosis of the right arteria carotis interna (ACI), with dizziness and inability to look upward. The patient was treated first with subintimal recanalization and introduction of self-expandable stent into the left subclavia artery to compensate for the very wide remnant of the occluded artery. After four months of follow up with no change, our team attempted to treat stenosis of the right ACI but failed to do so and during this procedure in-stent restenosis in the left subclavia artery was noted. After less than two weeks we performed balloon dilatation of in-stent restenosis of a previously installed stent into the left subclavia artery. The patient underwent CT and CT angiography (CTA), colour Doppler ultrasonography (CDUS), MRI and MR angiography (MRA) before and after the procedures. Conclusions. A follow up and, if needed, a balloon dilation are necessary to prevent the re-occlusion of the previously treated subclavia artery with stenting.
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