Blocked drains

Oesophageal cancer is a particularly insidious disease, and its incidence is rising in the developed world. It has usually begun to metastasize by the time it is diagnosed, and cure rates are low. If the metastatic escape routes of cancer cells could be predicted, we might be able to block their migration. The many lymphatic vessels that drain a tumour are the logical pathways for cancer cells to follow, but which ones will tumour cells use to spread to distant sites? A team led by Michael Griffin at the University of Newcastle, UK, has developed a simple method that tracks the most likely metastatic highways for oesophageal cancer. By injecting a blue dye and a radiolabelled colloid into the tumour margins, they can follow lymphatic drainage during surgery and remove those lymph nodes to which the radioactivity — and hence the tumour cells — are draining. In the 40 patients monitored so far, immunohistochemistry has confirmed that the technique is 95% accurate.

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Mammography goes digital

Courtesy of the American College of Radiology.

Screening for breast cancer is currently performed using standard, film mammography, but digital mammography — a new technique that uses computers and detectors to produce an image of the breast — could replace it in the future. A large, multicentre trial — the digital mammographic imaging screening trial — has been launched to compare the efficacies of these screening methods, and the aim is to recruit 49,500 women in the USA and Canada over the next 18 months.

Potential benefits of digital mammography include increased effectiveness of detecting cancer in younger women — who have denser breasts — as it has better contrast resolution. This has traditionally been a problem with film mammography.

The trial also aims to evaluate cost effectiveness. Although the cost of equipment will initially be large, digital mammography might result in fewer false-positives and, consequently, fewer callbacks. In the long run, this could save money, as well as patient anguish.

The trial will run for several years, but the results, when announced, could change the future of breast-cancer screening.