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Open access

Maja Podkrajšek, Janez Žgajnar and Marko Hočevar

What is the most common mammographic appearance of T1a and T1b invasive breast cancer?

Background. Data about the mammographic appearance of breast cancer smaller than 10 mm are very limited and different authors use different mammographic criteria. The aim of this study was to determine the most common mammographic appearance of small invasive breast cancers (T1a and T1b).

Patients and methods. The study group consisted of 100 women with 102 small (1-10 mm) invasive breast cancers detected on mammography at a single institution in 16 months period. The mammographic appearance of tumours was classified as: mass, mass with associated calcifications, only calcifications or others (asymmetric density and architectural distortion).

Results. The most common mammographic appearance was a mass without calcifications (60/102; 59%). Additional 12/102 (11%) tumours had a mammographic appearance of a mass with associated calcifications. Only microcalcifications were detected in 12 (11 %) and asymmetric density and architectural distortion in 18 breast cancers (18 %). Most (44/60) cancers which presented mammographically as a mass had stellate margins. The proportion of castig type calcifications was higher in women under 50 years.

Conclusions: The most common mammographic finding of small breast cancer is a mass with stellate margins independent of the age of patients. Calcifications with/without mass are more common in woman under 50 years.

Open access

Nebojsa Glumac, Marko Hocevar, Vesna Zadnik and Marko Snoj

Inguinal or inguino-iliac/obturator lymph node dissection after positive inguinal sentinel lymph node in patients with cutaneous melanoma

Background. The aim of the study was to determine whether the presence of inguinal sentinel lymph node (SLN) metastases smaller than 2 mm (micrometastases) subdivided according to the number of micrometastases predicts additional, non-sentinel inguinal, iliac or obturator lymph node involvement in completion lymph node dissection (CLND).

Patients and methods. Positive inguinal SLN was detected in 58 patients (32 female, 26 male, median age 55 years) from 743 consecutive and prospectively enrolled patients with primary cutaneous melanoma stage I and II who were treated with SLN biopsy between 2001 and 2007.

Results. Micrometastases in inguinal SLN were detected in 32 patients, 14 were single, 2 were double, and 16 were multiple. Twenty-six patients had macrometastases.

Conclusions. No patient with any micrometastases or a single SLN macrometastasis in the inguinal region had any iliac/obturator non-sentinel metastases after CLND in our series. Furthermore, no patient with single SLN micrometastasis in the inguinal region had any non-sentinel metastases at all after CLND in our series. In these cases respective CLND might be omitted.

Open access

Nikola Besic, Spela Zagar, Gasper Pilko, Barbara Peric and Marko Hocevar

Influence of magnesium sulphate infusion before total thyroidectomy on transient hypocalcemia — a randomised study

Background. Transient hypocalcemia is the most common complication after thyroidectomy. Normomagnesemia is needed for normal secretion of PTH and end-organ responsiveness. Our aim was to determine the influence of infusion of magnesium sulphate before thyroidectomy on the incidence of laboratory and clinical transient hypocalcemia.

Methods. In our prospective study, 48 patients (5 men, 43 women; age 22-73 years, median 45 years), who underwent total or near-total thyroidectomy, were randomised preoperatively. Half of them received intravenously 4 ml of 1M magnesium sulphate at the beginning of the surgical procedure, the other half were the control group. Serum concentrations of calcium, ionised calcium, magnesium, phosphate, albumin and PTH were measured prior to surgery and on the first day after surgery.

Results. Laboratory postoperative hypocalcemia was present in 27% of patients and 23% of patients had clinical signs and/or symptoms of postoperative hypocalcemia. The concentration of total calcium (p=0.024) and of albumin (p=0.01) was lower in the group that received magnesium sulphate.

Conclusions. The patients who received infusion of magnesium sulphate before total thyroidectomy had lower concentration of total serum calcium and albumin in comparison to the control group. There was no statistical difference in the incidence of clinical transient hypocalcemia.

Open access

Gasper Pilko, Janez Zgajnar, Maja Music and Marko Hocevar

Lower tumour burden and better overall survival in melanoma patients with regional lymph node metastases and negative preoperative ultrasound

Background. The purpose of the study was to evaluate the ability of ultrasound (US) and fine needle aspiration biopsy (FNAB) in reducing the number of melanoma patients requiring a sentinel node biopsy (SNB); to compare the amount of metastatic disease in regional lymph nodes in SNB candidates with clinically uninvolved lymph nodes and of those with US uninvolved lymph nodes; and to compare the overall survival (OS) of both groups.

Methods. Between 2000 and 2007, a SNB was successfully performed in 707 patients with melanoma. The preoperative US of the regional lymph node basins was performed in 405 SNB candidates. In 14 of these patients, the US-guided FNAB was positive and they proceeded directly to lymph node dissection. In 391 patients, the preoperative US was either negative (343 patients) or suspicious (48 patients) (US group). In the remaining 316 patients the preoperative US was not performed (non-US group).

Results. The proportion of macrometastatic sentinel lymph nodes (SN), number of metastatic lymph nodes per patient and proportion of nonsentinel lymph node metastases were found to be lower in the US group compared to the non-US group. The smaller tumour burden of the US group was reflected in a significantly better OS of patients with SN metastases.

Conclusions. The preoperative US of regional lymph nodes spares some patients with melanoma from undergoing a SNB. Patients with regional metastases and a negative preoperative US have a significantly lower tumour burden in comparison to those with clinically negative lymph nodes, which is also reflected in a better OS.

Open access

Mirjam Cvelbar, Marko Hocevar, Srdjan Novakovic, Vida Stegel, Andraz Perhavec and Mateja Krajc

Abstract

Background

In Slovenia like in other countries, till recently, personal history of epithelial ovarian cancer (EOC) has not been included among indications for genetic counselling. Recent studies reported up to 17% rate of germinal BRCA1/2 mutation (gBRCA1/2m) within the age group under 50 years at diagnosis. The original aim of this study was to invite to the genetic counselling still living patients with EOC under 45 years, to offer gBRCA1/2m testing and to perform analysis of gBRCA1/2m rate and of clinico-pathologic characteristics. Later, we added also the data of previously genetically tested patients with EOC aged 45 to 49 years.

Patients and methods

All clinical data have to be interpreted in the light of many changes happened in the field of EOC just in the last few years: new hystology stage classification (FIGO), new hystology types and differentiation grades classification, new therapeutic possibilities (PARP inhibitors available, also in Slovenia) and new guidelines for genetic counselling of EOC patients (National Comprehensive Cancer Network, NCCN), together with next-generation sequencing possibilities.

Results

Compliance rate at the invitation was 43.1%. In the group of 27 invited or previously tested patients with EOC diagnosed before the age of 45 years, five gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within the group was 18.5%. There were 4 gBRCA1 and 1 gBRCA2 mutations detected. In the extended group of 42 tested patients with EOC diagnosed before the age of 50 years, 14 gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within this extended, partially selected group was 33.3%. There were 11 gBRCA1 and 3 gBRCA2 mutations detected.

Conclusions

The rate of gBRCA1/2 mutation in tested unselected EOC patients under the age of 50 years was higher than 10%, namely 18.5%. Considering also a direct therapeuthic benefit of PARP inhibitors for BRCA positive patients, there is a double reason to offer genetic testing to all EOC patients younger than 50 years. Regarding clinical data, it is important to perform their re-interpretation in everyday clinical practice, because this may influence therapeutic possibilities to be offered.

Open access

Gašper Rak, Marko Hočevar and Franci Steinman

Abstract

The complexity of flow conditions at junctions amplifies significantly with supercritical flow. It is a pronounced three-dimensional two-phased flow phenomenon, where standing waves with non-stationary water surface are formed. To analyse the hydrodynamic conditions at an asymmetric right-angled junction with incoming supercritical flows at Froude numbers between 2 and 12, an experimental approach was used. For a phenomenological determination of the relations between the integral parameters of incoming flows and the characteristics of standing waves at the junction area, water surface topographies for 168 scenarios at the junction were measured using non-intrusive measurement techniques. The new, phenomenologically derived equations allow for determination of location, height and extent of the main standing waves at the junction. Research results give important information on the processes and their magnitude for engineering applications.

Open access

Sebastijan Rep, Luka Lezaic, Tomaz Kocjan, Marija Pfeifer, Mojca Jensterle Sever, Urban Simoncic, Petra Tomse and Marko Hocevar

Abstract

Background. Parathyroid adenomas, the most common cause of primary hyperparathyroidism, are benign tumours which autonomously produce and secrete parathyroid hormone. [18F]-fluorocholine (FCH), PET marker of cellular proliferation, was recently demonstrated to accumulate in lesions representing enlarged parathyroid tissue; however, the optimal time to perform FCH PET/CT after FCH administration is not known. The aim of this study was to determine the optimal scan time of FCH PET/CT in patients with primary hyperparathyroidism.

Patients and methods. 43 patients with primary hyperparathyroidism were enrolled in this study. A triple-phase PET/CT imaging was performed five minutes, one and two hours after the administration of FCH. Regions of interest (ROI) were placed in lesions representing enlarged parathyroid tissue and thyroid tissue. Standardized uptake value (SUVmean), retention index and lesion contrast for parathyroid and thyroid tissue were calculated.

Results. Accumulation of FCH was higher in lesions representing enlarged parathyroid tissue in comparison to the thyroid tissue with significantly higher SUVmean in the second and in the third phase (p < 0.0001). Average retention index decreased significantly between the first and the second phase and increased significantly between the second and the third phase in lesions representing enlarged parathyroid tissue and decreased significantly over all three phases in thyroid tissue (p< 0.0001). The lesion contrast of lesions representing enlarged parathyroid tissue and thyroid tissue was significantly better in the second and the third phase compared to the first phase (p < 0.05).

Conclusions. According to the results the optimal scan time of FCH PET/CT for localization of lesions representing enlarged parathyroid tissue is one hour after administration of the FCH.