Can we use gonadotropin plasma concentration as surrogate marker for BMI-related incomplete estrogen suppression in breast cancer patients receiving anastrozole?

BACKGROUND

BMI has been suggested to impact on estrogenic activity in patients receiving anastrozole resulting in a reduced treatment efficacy in obese women. Current evidence in this regard is controversially discussed. Since estradiol is inversely correlated with gonadotropins it can be assumed that an impact of BMI is also reflected by gonadotropin plasma concentrations. We aim at investigating the impact of BMI on the hormonal state of breast cancer (BC) patients receiving anastrozole indicated by LH, FSH and SHBG as well as estradiol.

METHODS

We determined gonadotropin-, estradiol- and anastrozole- serum concentrations from postmenopausal, early stage breast cancer patients receiving upfront anastrozole within routine after care. Gonadotropin plasma concentrations were derived from the routine laboratory examination report. A liquid chromatography tandem mass spectrometry method was used for the measurement of anastrozole serum concentrations. BMI was assessed within the routine after-care check-up.

RESULTS

The overall sample comprised 135 BC patients with a mean age of 65.3 years. BMI was significantly correlated with LH, FSH and SHBG. This association was neither influenced by age nor by anastrozole serum concentrations according to the regression model. Despite aromatase inhibition 12% of patients had detectable estrogen levels in routine quantification.

CONCLUSION

Obese women have an altered hormonal situation compared to normally weight women under the same dose of anastrozole. Our study findings are a further indicator for the relevance of BMI in regard of anastrozole metabolism and possible estrogenic activity indicated by gonadotropin plasma level.

Strain Elastography of Breast and Prostata Cancer: Similarities and Differences

Typically both breast and prostate cancer present as tissue with decreased elasticity. Palpation is the oldest technique of tumor detection in both organs and is based on this principle. Thus an operator can grade a palpable mass as suspicious for cancer. Strain elastography as modern ultrasound technique allows the visualization of tissue elasticity in a color coded elastogram and can be understood as technical finger. The following article shows similarities and differences of ultrasound strain elastography in the diagnosis of breast and prostate cancer.

KEY POINTS

• In prostata cancer elastography, in breast cancer B-mode is the primary sonographic search modality. • The diagnostic value of the search modalities change with increasing age.• A cut-off value for a strain ratio is hard to obtain in the elastography of the prostata, because there is no stabile reference tissue in the prostata.

The value of the World Wide Web for tele-education in radiology

We assessed Websites for radiological education. Of several hundred sites identified, 30 were randomly selected for evaluation by two groups of observers. All Web pages were rated with respect to time required to access the information; structure and organization of the site; image quality; and information content and relevancy. Rapid access was gained to many educational radiology Websites, which contained large numbers of interesting radiological images of good quality. A weak point was the structure and organization of the sites. The greatest variability in ratings was found in the information content and relevancy of the Websites.

MRI findings in cerebral fat embolism

The purpose of this retrospective study was to demonstrate the MRI features of cerebral manifestations in patients with fat embolism syndromes in comparison with cerebral CT (CCT). Magnetic resonance imaging was performed according to standard protocols revealing multiple small non-confluent hyperintense intracerebral lesions larger than 2 mm on proton-density and T2-weighted images to various extents in three of four patients with clinically suspected cerebral fat embolism. Cerebral CT was negative in all patients. Our findings confirm that MRI can detect cerebral fat embolism with a higher sensitivity than CCT. Thus, MRI should be the first choice for imaging of cerebral fat embolism.

Prevention of local scar formation after operative discectomy for lumbar disc herniation

This was a prospective study. The study evaluated the use of Preclude Spinal Membrane to inhibit peridural fibrosis and reduce fibroses-related problems after first-time lumbar discectomy. Peridural scarring causes tethering of dura and nerve roots. Following discectomy Preclude Spinal Membrane was applied to patients of first group (10 patients). The second group (10 patients) was operated on without Preclude Spinal Membrane. Outcome was evaluated with MRI, 3 and 6 month after operation for all patients. No peridural or epidural scar tissue could be found in patients with Preclude Spinal Membrane, in the control group who were operated on without the preclude Spinal Membrane scar tissue of varying degree with complete enclosure of the nerve roots and dura was found.