The diagnostic validity of the glycolytic enzyme phosphohexose isomerase (PHI) as a serum tumor marker was evaluated. For this purpose the sensitivity of PHI was determined in 435 patients with histopathologically defined, malignant gastrointestinal, kidney, and mammary tumors prior to primary treatment. To assess the specificity, PHI serum activities were measured in 181 patients with benign diseases and disorders from an internal practice. In gastrointestinal and kidney cancer, PHI reached an overall diagnostic sensitivity of about 70%, and a specificity of 92% was obtained. Even in early stages without metastasis, elevated PHI serum levels were found in about 60% of the patients. In mammary cancer, however, a sensitivity of only 40% was observed. PHI activity can be measured without the need for highly technical skills and equipment, in a short time and at low cost. These data suggest that serum PHI can be a useful indicator in the preventive checkup of gastrointestinal and renal cancer in medical practice.
Pathologic discharge from the nipple may be the only symptom of an early stage of carcinoma. Galactography is then the diagnostic method of choice to locate intraductal, nonpalpable lesions. The technique of galactography, the adequate surgical approach of pathologic galactographs (milk-duct segment resection), and the appropriate histological work-up of the surgical specimen are demonstrated. We report on 1918 galactographies in 1363 women with pathological discharge. In only 427 cases was a milk duct segment resection necessary (31.4%). In 8.5%, we found invasive intraductal cancer and in 2.9% ductal carcinomata in situ. Only 1 patient with breast cancer had axillary metastases. Extensive intraductal solid, papillary or adenomatous proliferations were found in 11.9% of the patients with excision. In 46.7% of the patients, papillomas were excised, a definitive treatment for this process. The supposition for success in the early diagnosis of cancer is close teamwork among the radiology, surgery and pathology services: the diagnostic result depends upon this. We attribute our yield of exact diagnosis to a very sophisticated histological work-up. We believe that this is necessary to avoid diagnostic failures.
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