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The updated 2008 German Guideline for Early Detection of Breast Cancer provides evidence-based and consensus-based recommendations of the knowledge gained by the German Society for Surgery and the German Society of Plastic, Aesthetic, and Reconstructive Surgeons together with 29 professional societies, associations, and nonmedical organizations. The guideline is meant to assist physicians, healthy women, and patients in medical decisions with recommendations regarding the diagnostic chain in early detection of breast cancer. In addition to these recommendations, the guideline also includes descriptions of quality assurance for resources, procedures, outcomes, and evaluation using a set of quality indicators. It updates the previous version from 2003. The guideline's recommendations are presented. They are described in detail in the full publication (in German) Geburtsh Frauenh 2008; 68:251-261. The long version of the Guideline, methods report, and evidence report are available on the internet at www.awmf-leitlinien.de (reg. no. 077/001) with free access.

Ziel der aktualisierten Stufe-3-Leitlinie Brustkrebs-Fruherkennung in Deutschland ist es, Arzte sowie gesunde und betroffene Frauen durch evidenzbasierte und formal konsentierte Empfehlungen bei anstehenden medizinischen Entscheidungen im Rahmen der Diagnosekette zur Fruherkennung von Brustkrebs zu unterstutzen. Die aktualisierte Stufe-3-Leitlinie lost die 2003 erstellte Leitlinie ab. Die aktualisierte Stufe-3-Leitlinie dient als Grundlage fur die Entwicklung eines effektiven und effizienten Brustkrebs-Fruherkennungsprogramms, das die Anforderungen an Krebskontrollprogramme, wie sie vom Europarat und der WHO vorgegeben sind, erfullt. Kernelement eines Fruherkennungsprogramms ist die Mammographie, deren Ergebnisqualitat durch Einbettung in eine qualitatsgesicherte Diagnosekette deutlich verbessert werden kann. Die Leitlinie vermittelt den aktuellen wissenschaftlichen Kenntnisstand in evidenz- und konsensbasierter Form, fachubergreifend fur alle Teile der Diagnosekette, bestehend aus Anamnese und Risikoberatung, und Informationen zu Gesundheitsverhalten, klinischer Untersuchung, apparativer Diagnostik, interventioneller Gewebsentnahmetechniken, operativer Abklarung sowie pathohistologischer Befundung. Sie enthalt die als Messgrosen dienenden Qualitatsindikatoren fur die Sicherung von Struktur-, Prozess- und Ergebnisqualitat (Outcome) der Diagnosekette. Die Fruherkennung von Brustkrebs ist momentan die aussichtsreichste Moglichkeit, Diagnose und Behandlung von Brustkrebserkrankungen zu optimieren, in Folge die Brustkrebssterblichkeit zu senken und die gesundheits- und krankheitsbezogene Lebensqualitat von Frauen zu verbessern. Das Ziel dabei ist, die Entdeckung von Mammakarzinomen als prainvasive Form oder als fruhes invasives Stadium, in dem die Funfjahresuberlebensrate bei adaquater Therapie uber 90% liegt. Der zunehmende Nachweis prainvasiver Befunde lasst dabei auf einen praventiven Beitrag zur Senkung der Inzidenz hoffen. Die mit der sekundaren Pravention mogliche Verbesserung der Heilungschancen ist im fruhen Tumorstadium durch weniger radikale und damit weniger belastende Therapieansatze moglich.

The updated 2008 German Guideline for Early Detection of Breast Cancer provides evidence-based and consensus-based recommendations of the knowledge gained by the German Society for Surgery and the German Society of Plastic, Aesthetic, and Reconstructive Surgeons together with 29 professional societies, associations, and nonmedical organizations. The guideline is meant to assist physicians, healthy women, and patients in medical decisions with recommendations regarding the diagnostic chain in early detection of breast cancer. In addition to these recommendations, the guideline also includes descriptions of quality assurance for resources, procedures, outcomes, and evaluation using a set of quality indicators. It updates the previous version from 2003. The guideline's recommendations are presented. They are described in detail in the full publication (in German) Geburtsh Frauenh 2008; 68:251-261. The long version of the Guideline, methods report, and evidence report are available on the internet at www.awmf-leitlinien.de (reg. no. 077/001) with free access.

ZusammenfassungDie Schilddrüsenhormonwerte von Patienten mit einem autonomen Adenom der Schilddrüse wurden einer eingehenden statistischen Analyse unterzogen. Dabei konnten folgende Aussagen gesichert werden: Es besteht eine signifikante Korrelation zwischen dem szintigraphischen Bild, der Größe des Adenoms, den Hormonspiegeln im Serum und dem Delta-TSH. Bei Patienten mit szintigraphisch kompensiertem autonomem Adenom liegen die Hormonspiegel durchweg im euthyreoten, bei Patienten mit szintigraphisch dekompensiertem autonomem Adenom teils im euthyreoten, teils im hyperthyreoten Bereich. Dekompensierte autonome Adenome weisen stets einen negativen TRH-Test auf, bei kompensierten autonomen Adenomen kann dieser sowohl positiv als auch negativ ausfallen. Der TRH-Test erlaubt somit nicht die Abgrenzung zwischen kompensierten und dekompensierten autonomen Adenomen.

During evaluation of cardiac function using 99mTc human serum albumen (functional scintigraphy during contraction of the left ventricle), it is necessary to take account of the background radiation which is derived from the lungs and great vessels overlying the heart. Only after correction of the background radiation is it possible to evaluate the severity of various types of cardiac insufficiency; this can be obtained by integrating the impulse during systole and subtracting this from the impulse rate over the left ventricle during a complete cardiac cycle. Apart from the background correction derived from the systolic-diastolic variation, it is necessary to obtain adequate resolution by examining 100 frames per second, an adequate picture matrix (4-K) in order to obtain adequate spacial resolution and accurate measurements of systole and diastole. The latter should be obtained not from the E.C.G., but directly from the volume curve of the left ventricle as determined by the isotope method.

Radio-active plastic microspheres with an average diameter of 15 mu were used in eight dogs to measure renal perfusion and the results compared with time-activity curves before and after constriction of the left renal artery. It was shown that the values obtained for renal blood flow by functional scintigraphy are not accurate, particularly for moderate or low blood flow. The reason for this is primarily the distortion of the intravenously injected radio-active bolus and the consequent deviation from the so-called delta function.

During evaluation of cardiac function using 99mTc human serum albumen (functional scintigraphy during contraction of the left ventricle), it is necessary to take account of the background radiation which is derived from the lungs and great vessels overlying the heart. Only after correction of the background radiation is it possible to evaluate the severity of various types of cardiac insufficiency; this can be obtained by integrating the impulse during systole and subtracting this from the impulse rate over the left ventricle during a complete cardiac cycle. Apart from the background correction derived from the systolic-diastolic variation, it is necessary to obtain adequate resolution by examining 100 frames per second, an adequate picture matrix (4-K) in order to obtain adequate spacial resolution and accurate measurements of systole and diastole. The latter should be obtained not from the E.C.G., but directly from the volume curve of the left ventricle as determined by the isotope method.

Radio-active plastic microspheres with an average diameter of 15 mu were used in eight dogs to measure renal perfusion and the results compared with time-activity curves before and after constriction of the left renal artery. It was shown that the values obtained for renal blood flow by functional scintigraphy are not accurate, particularly for moderate or low blood flow. The reason for this is primarily the distortion of the intravenously injected radio-active bolus and the consequent deviation from the so-called delta function.

Although the clinical picture of autonomous adenoma of the thyroid gland has been well known for a long time, a series of connections has in some cases been unclarified, and in other cases contradictory so far. This applies in particular to the relationships between the scintigraphic image and the metabolic balance of the autonomous adenoma. In 98 patiets aged from 21 to 70 years old (80 women, 18 men) with autonomous adenoma unequivocally verified by suppression or stimulation test, it was therefore investigated whether such connections can be demonstrated. The following could be established: 1. In patients with an autonomous adenoma, there is an established connection between the scintigraphy image, the thyroxine and triiodothyronine levels in the serum as well as the delta-TSH. In patients with scintigraphically compensated autonomous adenomas, the hormone levels are all in the euthyroid range. In patients with scintigraphically decompensated autonomous adenoma, the values of thyroid hormones are found in some cases in the euthyroid, and in other cases in the hyperthyroid range. 2. Scintigraphically decompensated autonomous adenomas always display a negative TRH test, whereas this may be negative and in other cases also postivie in scintigraphically compensated autonomous adenomas. The TRH test may be negative in compensated and in decompensated autonomous adenoma even in patients in whom the thyroid hormone values in the serum are in the euthyroid range. The TRH test thus does not permit evaluation of the current functional activity of the autonomous adenoma. It is furthermore unsuitable for delimitation of a compensated from a decompensated autonomous adenoma as well as for different diagnosis between a nodular goiter and a scintigraphically compensated autonomous adenoma. 3. There is a statistically established relation between the size of the autonomous adenoma, the age of the patient as well as the thyroid hormone values. Autonomous adenomas accordingly become larger with increasing age. The values of thyroid hormones increase and lead to corresponding alterations in the TRH test.

In 31 patients with histologically proven hepatocellular jaundice hepatobiliary scintigraphy with Tc-99m labelled IDA derivatives was performed. Results were classified under morphological (demonstration of liver parenchyma, ductus choledochus, bile ducts, gallbladder, kidney) and functional (Tmax, half time of bile excretion, appearance of activity in ductus choledochus, gallbladder, and intestines) criteria. The liver parenchyma could be demonstrated in 90.3% of cases, ductus choledochus in 71%, and the gallbladder in 72.4%. The type of tracer excretion into the intestines showed 9.5% activity accumulation in the gallbladder with late bile excretion into the intestines and 90.5% early activity excretion into the duodenum with late filling of the gallbladder. The intrahepatic bile ducts were demonstrated in 22.6% (left hepatic duct) and 6.5% (right hepatic duct). In 35.5% of cases the kidneys were still visible after 15 min p.i. All cases showed - sometimes delayed - bile excretion into the GI tract. The time of appearance of activity in ductus choledochus (18.4 min) and gallbladder (39.5 min) was delayed. The liver histogram showed likewise delayed values concerning Tmax (14.3 min) and half life of tracer excretion (greater than 30 min) when compared to controls. The differentiation of hepatocellular jaundice from obstructive jaundice is possible by the demonstration of bile excretion into the intestines, normal width of the bile ducts, and filling of the gallbladder.

A retrospective study of 101 patients with histologically confirmed cirrhosis of the liver and portal hypertension was carried out in order to evaluate the accepted scintigraphic criteria. In only 20% were all the essential criteria present. The absence of generally accepted important scintigraphic signs does not exclude the diagnosis of cirrhosis of the liver. Specificity of liver scintigraphy in cirrhosis of the liver is fairly low, but sensitivity of the method is almost 100%.