El economista de la salud Vicente Ortúm, miembro del Centro de Investigación en Economía de la Salud (CRES), ofrece su receta, en esta entrevista concedida a “Gaceta Médica”, de cómo se puede “refundir” la Atención Primaria. Desde su punto de vista, algunos de los ingredientes clave están en: acabar con la idea de que la frecuentación es exógena; organizar los centros de salud con sentido lógico, es decir, distribuyendo las funciones de atender a la población y otorgando al médico mayor capacidad resolutiva; y tener un mayor control sobre los recursos, en el sentido de gastarlos mejor.
Es ahora, cuando hay un mayor número de población pluripatológica y con problemas de dependencia en la vida cotidiana, cuando, a su juicio, más falta haría tener una AP fuerte y resolutiva, “si así fuera –añade- reducir gastos sería sencillísimo”, ya que, según este experto, "el médico de familia sabe de dónde se puede recortar". Y es que, desde su punto de vista, el recorte que hace menos daño es el recorte clínico, y éste es el que puede hacer el profesional. En este punto, describe dos escenarios: "el profesional informado, que está a favor, que entiende las cosas, que se da cuenta de que hay que rebajar gastos sin que se note, y el profesional enfadado, aquel que pone el muerto encima de la mesa, no me refiero a matar a gente, me refiero a poner los datos fríos sobre la mesa. Es aquí donde aparece la presión".
*La entrevista íntegra se puede consultar en la web de "Gaceta Médica": www.gacetamedica.com/articulo.aspx?idart=581643&idcat=797&tipo=2
16 January 2012
El Foro de la Profesión Médica denuncia el deterioro y los recortes indiscriminados que está sufriendo el SNS
Ante la gran preocupación que está generando entre la profesión médica el deterioro que está sufriendo la calidad asistencial, el Foro de la Profesión Médica ha hecho una llamada de atención y de denuncia en forma de manifiesto respecto a lo que considera "formas inadecuadas y de recortes indiscriminados" que se están realizando en el Sistema Nacional de Salud. El documento se sustenta en seis puntos que la profesión médica considera fundamentales: un pacto por la Sanidad que permita hacer posible la financiación sanitaria de un SNS; un plan estructural de reformas que contemple la reducción al mínimo de la burocracia; el funcionamiento del Consejo Interterritorial del SNS con criterios de cohesión y con carácter ejecutivo; el desarrollo de la LOPS, tras ocho años de paralización; un cambio de modelo retributivo de los profesionales que permita vincular buena parte del mismo a los resultados y a la calidad; el rechazo de la aplicación de los recortes que están provocando pérdidas ostensibles de la calidad asistencial de los pacientes. El manifiesto concluye instando a los médicos y a sus organizaciones la máxima responsabilidad, disponibilidad y coordinación para responder con las medidas necesarias en defensa de la salud de los ciudadanos
Llamada de atención y de denuncia del Foro de la Profesión Médica ante el deterioro del SNS
La actual coyuntura de crisis económica en España complica enormemente la vida social y la vida sanitaria. Con poca trasparencia, las distintas Administraciones van imponiendo medidas de recortes en función de intereses políticos y de calendarios electorales.
Como profesionales médicos, no podemos negar ni ignorar la realidad pero los recortes sanitarios indiscriminados condicionan seriamente la respuesta a las necesidades asistenciales de los ciudadanos. La forma y modelo de aplicación de las restricciones económicas impuestas son erróneos e injustos porque con idéntico presupuesto se puede hacer de diferente manera con menores daños.
Nuestra primera crítica es a la clase política por no haber sabido prever y gestionar una situación que, si bien se enmarca en una crisis de carácter internacional, en nuestro país presenta caracteres específicos.
El Sistema Nacional de Salud (SNS) acumula progresivas deudas. Se habla de 20.000 millones de euros pero no se conoce la verdad definitiva, ni como está distribuida entre las diferentes CC.AA. ni tampoco como está estructurada por partidas presupuestarias.
Los médicos españoles llevamos años reclamando una política sanitaria que, primero, garantice los recursos suficientes y acto seguido vele por su calidad y gestión óptima.
Tenemos un sistema sanitario fragmentado, heterogéneo, que no ofrece las mismas prestaciones según las CC.AA. de que se trate, con una inadecuada gestión de recursos, una desprofesionalización de la clase directiva y una excesiva burocratización.
Los médicos tenemos derecho a criticar la falta de medidas ante ineficiencias económicas en el sector público y oponernos a las formas inadecuadas y de recortes indiscriminados que se están realizando y por eso exigimos:
1. Un pacto de Estado por la Sanidad que permita hacer posible la financiación sanitaria de un SNS que ya ha demostrado ser de los mejores y sostenible a un precio razonable. Este Pacto, a nuestro entender, ha de cumplir
las siguientes premisas:
a) Un acuerdo al máximo nivel político para no utilizar la sanidad con fines partidistas, que permita alcanzar
unos presupuestos reales y finalistas, que responda a una cartera de servicios claramente definida y que respete los principios de equidad, universalidad y solidaridad.
b) Una política de recursos coordinada y coherente para todas las CC.AA.
c) Desarrollo de una política de recursos humanos que permita la planificación futura de los médicos, que termine con las diferencias de condiciones laborales entre las CC.AA.
2. Incrementar la productividad y eficiencia del SNS mediante un plan estructural de reformas que contemple la reducción al mínimo de la burocracia.
3. El Consejo Interterritorial del SNS ha de funcionar con criterios de cohesión y con carácter ejecutivo.
4. Desarrollar la LOPS, que se encuentra parada tras ocho años de ser aprobada.
5. Cambiar el modelo retributivo de los profesionales para vincular buena parte del mismo a los resultados y a la calidad.
6. Rechazar la aplicación de los recortes que están provocando pérdidas ostensibles de la calidad asistencial de los pacientes.
Llamamos la atención de los médicos, que la situación que denunciamos acaba de comenzar, amenaza ser larga, compleja y de imprevisibles consecuencias.
Debemos alertar ante cualquier señal de deterioro progresivo del SNS y pérdida de calidad del mismo.
En tal sentido, pedimos a los médicos y a sus organizaciones la máxima responsabilidad, disponibilidad y coordinación para responder con las medidas necesarias en defensa de la salud de los ciudadanos.
Integran el Foro de la Profesión Médica: la Organización Médica Colegial (OMC), la Confederación Estatal de Sindicatos Médicos (CESM), la Federación de Asociaciones Científico- Médicas Españolas (FACME), el Consejo Nacional de Especialidades en Ciencias de la Salud (CNECS), la Conferencia Nacional de Decanos de Facultades de Medicina (CNDFM), y el Consejo Estatal de Estudiantes de Medicina (CEEM).
**MANIFIESTO DEL FORO 13-1-12.pdf
*Publicado en "MEDICOS Y PACIENTES"
Un estudio en EEUU demuestra por primera vez en humanos que el alcohol libera endorfinas
Un estudio de la Universidad de California de San Francisco (Estados Unidos) ha demostrado por primera vez en humanos que el alcohol libera endorfinas. Tras especularse desde hace 30 años la teoría de que la ingesta de bebidas espirituosas provoca la secreción de estas proteínas en determinadas zonas del cerebro -lo que produce sensaciones de placer que podrían conducir a la adicción- esta universidad lo confirma definitivamente.
El artículo, publicado en 'Science Translational Medicine' y recogido por Europa Press, confirma que las endorfinas desencadenan las emociones positivas que se experimentan en el estado de embriaguez. "Nuestro estudio aporta las primeras pruebas directas de cómo el alcohol hace que la gente se sienta bien", asegura la autora principal e investigadora de la universidad americana, Jennifer Mitchell.
Las endorfinas tienen efectos opiáceos y se liberan en el núcleo accumbens y en la corteza orbitofrontal, ambas del cerebro. Pero en el estudio elaborado han descubierto que el receptor opioide que actúa con ellas "es el receptor Mu". Para los autores, este conocimiento permitirá "mejorar los métodos y medicaciones para tratar los problemas con el alcohol".
Para llegar a estas conclusiones, que publica la Agencia SINC, los investigadores analizaron las respuestas cerebrales de 13 personas con un alto consumo de alcohol, y de otras 12 que no bebían de manera habitual. En todos los casos la ingesta de alcohol produjo una liberación de endorfinas, pero las sensaciones de placer sólo fueron unánimes "cuando lo hicieron en el núcleo accumbens".
Sin embargo, al liberarse estas proteínas en la corteza orbitofrontal "solo se incrementaron los sentimientos positivos en los bebedores habituales". Este hecho indica que "el cerebro de los alcohólicos está modificado, de manera que encuentran más placentero el consumo de alcohol", explica Mitchell.
Otro de los datos de interés que arroja el estudio es las posibles vías sugeridas por el mismo para el tratamiento contra el alcohol. Según esto, la naltrexona puede mejorar la eficacia de las medicinas habituales. Este fármaco "bloquea más de un receptor, y mucha gente deja de tomarlo porque no les gusta cómo les hace sentir", apunta Mitchell.
Para observar los efectos del alcohol en el cerebro, los investigadores americanos utilizaron la técnica de tomografía por emisión de positrones, método que no es invasivo. Previamente suministraron bebidas alcohólicas a los sujetos y dos dosis de carfentanil.
**EUROPA PRESS
El artículo, publicado en 'Science Translational Medicine' y recogido por Europa Press, confirma que las endorfinas desencadenan las emociones positivas que se experimentan en el estado de embriaguez. "Nuestro estudio aporta las primeras pruebas directas de cómo el alcohol hace que la gente se sienta bien", asegura la autora principal e investigadora de la universidad americana, Jennifer Mitchell.
Las endorfinas tienen efectos opiáceos y se liberan en el núcleo accumbens y en la corteza orbitofrontal, ambas del cerebro. Pero en el estudio elaborado han descubierto que el receptor opioide que actúa con ellas "es el receptor Mu". Para los autores, este conocimiento permitirá "mejorar los métodos y medicaciones para tratar los problemas con el alcohol".
Para llegar a estas conclusiones, que publica la Agencia SINC, los investigadores analizaron las respuestas cerebrales de 13 personas con un alto consumo de alcohol, y de otras 12 que no bebían de manera habitual. En todos los casos la ingesta de alcohol produjo una liberación de endorfinas, pero las sensaciones de placer sólo fueron unánimes "cuando lo hicieron en el núcleo accumbens".
Sin embargo, al liberarse estas proteínas en la corteza orbitofrontal "solo se incrementaron los sentimientos positivos en los bebedores habituales". Este hecho indica que "el cerebro de los alcohólicos está modificado, de manera que encuentran más placentero el consumo de alcohol", explica Mitchell.
Otro de los datos de interés que arroja el estudio es las posibles vías sugeridas por el mismo para el tratamiento contra el alcohol. Según esto, la naltrexona puede mejorar la eficacia de las medicinas habituales. Este fármaco "bloquea más de un receptor, y mucha gente deja de tomarlo porque no les gusta cómo les hace sentir", apunta Mitchell.
Para observar los efectos del alcohol en el cerebro, los investigadores americanos utilizaron la técnica de tomografía por emisión de positrones, método que no es invasivo. Previamente suministraron bebidas alcohólicas a los sujetos y dos dosis de carfentanil.
**EUROPA PRESS
Pan-European Stroke Prevention in Atrial Fibrillation Registry - PREFER in AF - Enrols First Patient
Daiichi Sankyo Europe GmbH today announced the enrolment of the first patient into the PREvention oF thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF). Taking a comprehensive approach to the patient registry, PREFER in AF will gather data on the full spectrum of AF patients including those with valvular and non valvular forms of the condition. The registry will also track the impact of new anticoagulant therapies on stroke prevention, in addition to collating insights into patients' satisfaction with their entire AF management, the impact of AF and its management on patient quality of life, and the overall health economic burden of AF across Europe.
In 2010, the World Heart Federation highlighted the need for new multi-national registries to help fill knowledge gaps around AF management and outcomes. Enrolling 5,000 patients from across seven European countries, PREFER in AF will tackle this need by generating robust data on patient attitudes and management approaches, across a broad spectrum of different AF severities. As the AF treatment paradigm continues to change rapidly, these data will also help to establish whether current treatment developments are translating into optimally-balanced anticoagulation in practice, to give patients the best chance of a normal life.
Endorsing the urgent need for this study, Professor José Luis Zamorano, co-Chair of the PREFER in AF Steering Committee and Professor of Cardiology at the University Clinic San Carlos, Madrid, Spain, said, "The potential impact of AF to Europeans is staggering, with numbers affected estimated to rise over the coming years. PREFER in AF is a timely patient registry, which will give us highly valuable insights into the current management of AF patients and the health economic impact of the condition, whilst informing us about how to move forward with patient treatment."
Collecting data from Austria, France, Germany, Italy, Spain, Switzerland and UK, the size of the PREFER in AF registry will generate nationally representative data on stroke prevention management approaches, patient satisfaction scores regarding anticoagulant treatment and management, and quality of life markers. Additionally, health economic data on drug treatment, disease and treatment complications including hospitalisation will be collected to estimate the true cost of AF for the European healthcare systems.
Professor José Luis Zamorano further comments on the registry: "This essential patient registry is important as it is focused on patients' quality of life and treatment satisfaction, which are key factors when considering optimal patient care. AF is a condition associated with high morbidity and mortality and when patients are satisfied with their treatment, they stay on treatment."
AF is a leading cause of hospitalisation amongst all cardiac diseases and is the most frequent cardiac arrhythmia in clinical practice, with approximately one to two per cent of the general population being affected. AF is also a major cause of stroke and strokes associated with AF are more severe and have a poorer prognosis than non-AF related strokes.
Daiichi Sankyo, a global leader in cardiovascular medicine, is the sponsor of this registry study. Reinhard Bauer, CEO of Daiichi Sankyo Europe GmbH, comments on the start of the study today: "Daiichi Sankyo is proud to support such a valuable pan-European patient registry and we are very excited that the first patient has enrolled in this important observational study. This registry is an example of our on-going commitment to cardio-vascular medicine striving to further improve the treatment of AF patients and to better understand the real impact of AF on patients, physicians and the health care system."
In 2010, the World Heart Federation highlighted the need for new multi-national registries to help fill knowledge gaps around AF management and outcomes. Enrolling 5,000 patients from across seven European countries, PREFER in AF will tackle this need by generating robust data on patient attitudes and management approaches, across a broad spectrum of different AF severities. As the AF treatment paradigm continues to change rapidly, these data will also help to establish whether current treatment developments are translating into optimally-balanced anticoagulation in practice, to give patients the best chance of a normal life.
Endorsing the urgent need for this study, Professor José Luis Zamorano, co-Chair of the PREFER in AF Steering Committee and Professor of Cardiology at the University Clinic San Carlos, Madrid, Spain, said, "The potential impact of AF to Europeans is staggering, with numbers affected estimated to rise over the coming years. PREFER in AF is a timely patient registry, which will give us highly valuable insights into the current management of AF patients and the health economic impact of the condition, whilst informing us about how to move forward with patient treatment."
Collecting data from Austria, France, Germany, Italy, Spain, Switzerland and UK, the size of the PREFER in AF registry will generate nationally representative data on stroke prevention management approaches, patient satisfaction scores regarding anticoagulant treatment and management, and quality of life markers. Additionally, health economic data on drug treatment, disease and treatment complications including hospitalisation will be collected to estimate the true cost of AF for the European healthcare systems.
Professor José Luis Zamorano further comments on the registry: "This essential patient registry is important as it is focused on patients' quality of life and treatment satisfaction, which are key factors when considering optimal patient care. AF is a condition associated with high morbidity and mortality and when patients are satisfied with their treatment, they stay on treatment."
AF is a leading cause of hospitalisation amongst all cardiac diseases and is the most frequent cardiac arrhythmia in clinical practice, with approximately one to two per cent of the general population being affected. AF is also a major cause of stroke and strokes associated with AF are more severe and have a poorer prognosis than non-AF related strokes.
Daiichi Sankyo, a global leader in cardiovascular medicine, is the sponsor of this registry study. Reinhard Bauer, CEO of Daiichi Sankyo Europe GmbH, comments on the start of the study today: "Daiichi Sankyo is proud to support such a valuable pan-European patient registry and we are very excited that the first patient has enrolled in this important observational study. This registry is an example of our on-going commitment to cardio-vascular medicine striving to further improve the treatment of AF patients and to better understand the real impact of AF on patients, physicians and the health care system."
Thousands of seniors lack access to lifesaving organs, despite survival benefit
Thousands more American senior citizens with kidney disease are good candidates for transplants and could get them if physicians would get past outdated medical biases and put them on transplant waiting lists, according to a new study by Johns Hopkins researchers. The Hopkins investigators estimate that between 1999 and 2006, roughly 9,000 adults over 65 would have been "excellent" transplant candidates and approximately 40,000 more older adults would have been "good" candidates for new kidneys. None, however, were given the chance.
"Doctors routinely believe and tell older people they are not good candidates for kidney transplant, but many of them are if they are carefully selected and if factors that really predict outcomes are fully accounted for," says transplant surgeon Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study being published in the January issue of the Journal of the American Geriatric Society. "Many older adults can enjoy excellent transplant outcomes in this day and age," he says, and should "be given consideration for this lifesaving treatment."
Those ages 65 and older make up over one-half of people with end-stage renal disease in the United States, and appropriately selected patients in this age group will live longer if they get new kidneys as opposed to remaining on dialysis, Segev says. The trouble is, he adds, that very few older adults are even put on transplant waiting lists. In 2007, only 10.4 percent of dialysis patients between the ages of 65 and 74 were on waiting lists, compared to 33.5 percent of 18- to 44-year-old dialysis patients and 21.9 percent of 45- to 64-year-old dialysis patients.
Segev cautions that some older kidney disease patients are indeed poor transplant prospects, because they have other age-related health problems. But he says his team's new findings, in addition to other recent research, show that new organs can greatly improve survival even in this age group.
Segev and his team constructed a statistical model for predicting how well older adults would be expected to do after kidney transplantation by taking into account age, smoking, diabetes and 16 other health-related variables. Using those data to define an "excellent" candidate, the information was then applied to every person 65 and older on dialysis during the seven-year study period. The researchers also determined whether these candidates were already on the waiting list.
"We have this regressive attitude toward transplantation in older adults," Segev says, "one based on historical poor outcomes in older patients, which no longer hold up. Anyone who can benefit from kidney transplantation should at least be given a chance. They should at least be put on the list."
Segev says he knows there is a shortage of kidneys and some will question whether scarce organs would be put to better use in younger patients. But Segev's study predicts that more than 10 percent of older patients would get kidneys from living relatives or friends, which would have little impact on the nationwide shortage of deceased donor kidneys. But finding a living donor first requires referral for transplantation.
"By not referring older adults for transplant, we're not just denying them a chance at a kidney from a deceased donor, but we're potentially denying them a kidney from a live donor," he adds.
According to research by Segev and his team published last year in the Journal of the American Medical Association, live kidney donation is very safe for both donor and recipient, and more older adults are donating their kidneys to relatives. Other research done by Segev has shown that older kidney transplant recipients do well with kidneys from older donors, organs that are otherwise be rejected for use in younger patients.
*Source: Johns Hopkins Medicine
"Doctors routinely believe and tell older people they are not good candidates for kidney transplant, but many of them are if they are carefully selected and if factors that really predict outcomes are fully accounted for," says transplant surgeon Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study being published in the January issue of the Journal of the American Geriatric Society. "Many older adults can enjoy excellent transplant outcomes in this day and age," he says, and should "be given consideration for this lifesaving treatment."
Those ages 65 and older make up over one-half of people with end-stage renal disease in the United States, and appropriately selected patients in this age group will live longer if they get new kidneys as opposed to remaining on dialysis, Segev says. The trouble is, he adds, that very few older adults are even put on transplant waiting lists. In 2007, only 10.4 percent of dialysis patients between the ages of 65 and 74 were on waiting lists, compared to 33.5 percent of 18- to 44-year-old dialysis patients and 21.9 percent of 45- to 64-year-old dialysis patients.
Segev cautions that some older kidney disease patients are indeed poor transplant prospects, because they have other age-related health problems. But he says his team's new findings, in addition to other recent research, show that new organs can greatly improve survival even in this age group.
Segev and his team constructed a statistical model for predicting how well older adults would be expected to do after kidney transplantation by taking into account age, smoking, diabetes and 16 other health-related variables. Using those data to define an "excellent" candidate, the information was then applied to every person 65 and older on dialysis during the seven-year study period. The researchers also determined whether these candidates were already on the waiting list.
"We have this regressive attitude toward transplantation in older adults," Segev says, "one based on historical poor outcomes in older patients, which no longer hold up. Anyone who can benefit from kidney transplantation should at least be given a chance. They should at least be put on the list."
Segev says he knows there is a shortage of kidneys and some will question whether scarce organs would be put to better use in younger patients. But Segev's study predicts that more than 10 percent of older patients would get kidneys from living relatives or friends, which would have little impact on the nationwide shortage of deceased donor kidneys. But finding a living donor first requires referral for transplantation.
"By not referring older adults for transplant, we're not just denying them a chance at a kidney from a deceased donor, but we're potentially denying them a kidney from a live donor," he adds.
According to research by Segev and his team published last year in the Journal of the American Medical Association, live kidney donation is very safe for both donor and recipient, and more older adults are donating their kidneys to relatives. Other research done by Segev has shown that older kidney transplant recipients do well with kidneys from older donors, organs that are otherwise be rejected for use in younger patients.
*Source: Johns Hopkins Medicine
Una modelo de tallas grandes se convierte en la imagen de una conocida firma de lencería
Lucy Moore, que saltó a la fama hace algo más de un año como modelo de tallas grandes de lencería, acaba de ganar un concurso que le ha convertido en la nueva imagen de la firma de moda íntima Ann Summer's, tras barrer a más de 4.000 aspirantes con silueta filiforme, desprovista de curvas, según informa The Sun.
Esta británica de 20 años, que estudia la carrera de Derecho en la Universidad de Westminster, siempre ha defendido la estética de las mujeres reales y dice que pese a utilizar una talla 46, a sus prominentes curvas y sus kilos de más, puede lucir con gran sensualidad los diseños de ropa íntima.
Esta británica de 20 años, que estudia la carrera de Derecho en la Universidad de Westminster, siempre ha defendido la estética de las mujeres reales y dice que pese a utilizar una talla 46, a sus prominentes curvas y sus kilos de más, puede lucir con gran sensualidad los diseños de ropa íntima.
Researchers find new, noninvasive way to identify lymph node metastasis
Using two cell surface markers found to be highly expressed in breast cancer lymph node metastases, researchers at Moffitt Cancer Center, working with colleagues at other institutions, have developed targeted, fluorescent molecular imaging probes that can non-invasively detect breast cancer lymph node metastases. The new procedure could spare breast cancer patients invasive and unreliable sentinel lymph node (SLN) biopsies and surgery-associated negative side effects. Their study was published in a recent issue of Clinical Cancer Research (18:1), a publication of the American Association for Cancer Research.
"The majority of breast cancer patients, up to 74 percent, who undergo SLN biopsy are found to be negative for axillary nodal, or ALN, metastases," said corresponding author David L. Morse, Ph.D., an associate member at Moffitt whose research areas include experimental therapeutics and diagnostic imaging. "Determining the presence or absence of ALN metastasis is critical to breast cancer staging and prognosis. Because of the unreliability of the SLN biopsy and its potential for adverse effects, a noninvasive, more accurate method to assess lymph node involvement is needed."
The authors note that the postoperative complications to the SLN biopsy can include lymphedema, seroma formation, sensory nerve injury and limitations in patient range of motion. In addition, biopsies fail to identify disease in axillary lymph nodes in five to 10 percent of patients.
In developing targeted molecular probes to identify breast cancer in axillary lymph nodes, the research team from Moffitt, the University of Arizona and University of Florida used two surface cell markers -- CAIX and CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed in breast cancer lymph node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large extracellular components that are accessible for binding of targeted imaging probes, explained Morse. In addition, several studies have shown that CAIX expression is associated with negative prognosis and resistance to chemo and radiation therapy for breast cancer. CAXII is a protein expressed in over 75 percent of axillary lymph node metastases.
The researchers subsequently developed their targeting agents by using monoclonal antibodies specific for binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging procedures for SLN evaluation have been investigated, but the approaches have lacked the ability to target tumor metastasis biomarkers.
"These methods provide only anatomic maps and do not detect tumor cells present in lymph nodes," explained Morse. "Using mouse models of breast cancer metastasis and a novel, monoclonal anti-body-based molecular imaging agents, we developed a targeted, noninvasive method to detect ALN metastasis using fluorescence imaging."
In addition to the imaging study with mice, the researchers also reported that the combination of CAIX and CAXII covered 100 percent of patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity," explained Morse. "Either CAIX or CAXII were expressed in 100 percent of the breast cancer lymph node metasatsis samples we surveyed in this study. These imaging probes have potential for providing a noninvasive way to stage breast cancer in the clinic without unneeded and costly surgery."
*Source: Moffitt Cancer Center
"The majority of breast cancer patients, up to 74 percent, who undergo SLN biopsy are found to be negative for axillary nodal, or ALN, metastases," said corresponding author David L. Morse, Ph.D., an associate member at Moffitt whose research areas include experimental therapeutics and diagnostic imaging. "Determining the presence or absence of ALN metastasis is critical to breast cancer staging and prognosis. Because of the unreliability of the SLN biopsy and its potential for adverse effects, a noninvasive, more accurate method to assess lymph node involvement is needed."
The authors note that the postoperative complications to the SLN biopsy can include lymphedema, seroma formation, sensory nerve injury and limitations in patient range of motion. In addition, biopsies fail to identify disease in axillary lymph nodes in five to 10 percent of patients.
In developing targeted molecular probes to identify breast cancer in axillary lymph nodes, the research team from Moffitt, the University of Arizona and University of Florida used two surface cell markers -- CAIX and CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed in breast cancer lymph node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large extracellular components that are accessible for binding of targeted imaging probes, explained Morse. In addition, several studies have shown that CAIX expression is associated with negative prognosis and resistance to chemo and radiation therapy for breast cancer. CAXII is a protein expressed in over 75 percent of axillary lymph node metastases.
The researchers subsequently developed their targeting agents by using monoclonal antibodies specific for binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging procedures for SLN evaluation have been investigated, but the approaches have lacked the ability to target tumor metastasis biomarkers.
"These methods provide only anatomic maps and do not detect tumor cells present in lymph nodes," explained Morse. "Using mouse models of breast cancer metastasis and a novel, monoclonal anti-body-based molecular imaging agents, we developed a targeted, noninvasive method to detect ALN metastasis using fluorescence imaging."
In addition to the imaging study with mice, the researchers also reported that the combination of CAIX and CAXII covered 100 percent of patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity," explained Morse. "Either CAIX or CAXII were expressed in 100 percent of the breast cancer lymph node metasatsis samples we surveyed in this study. These imaging probes have potential for providing a noninvasive way to stage breast cancer in the clinic without unneeded and costly surgery."
*Source: Moffitt Cancer Center
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