Initial bronchoscopic treatment for patients with intraluminal bronchial carcinoids

OBJECTIVE

Carcinoid of the lung is considered low-grade malignancy, and less invasive treatment may therefore be considered. We analyzed the long-term outcome of initial bronchoscopic treatment in patients with intraluminal bronchial carcinoids.

METHODS

Initial bronchoscopic treatment was applied to improve presurgical condition, to obtain tissue samples for proper histologic classification, and to enable less extensive parenchymal resection. For intraluminal bronchial carcinoid, complete tumor eradication with initial bronchoscopic treatment was attempted. High-resolution computed tomography in addition to bronchoscopy was used to determine intraluminal versus extraluminal tumor growth. Surgery followed in cases of atypical carcinoid, residue, or recurrence.

RESULTS

Seventy-two patients, 43 of them female, have been treated (median age 47 years, range 16-80 years). Median follow-up has been 65 months (range 2-180 months). Fifty-seven (79%) had typical carcinoids and 15 (21%) had atypical carcinoids. Initial bronchoscopic treatment resulted in complete tumor eradication in 33 of 72 cases (46%), 30 typical and 3 atypical. Thirty-seven of 72 cases (51%), 11 atypical, required surgery (2 for late detected recurrences). Two patients had metastatic atypical carcinoid, 1 already at referral. Of the 6 deaths, 1 was tumor related.

CONCLUSIONS

Initial bronchoscopic treatment is a potentially more tissue-sparing alternative than immediate surgical resection in patients with intraluminal bronchial carcinoids. For successful tumor eradication with initial bronchoscopic treatment in central carcinoids, assessment of intraluminal versus extraluminal growth may be of much more importance than histologic division between typical and atypical carcinoid. Disease-specific mortality is low, and long-term outcome has been excellent. Implementation of initial bronchoscopic treatment had no negative impact on surgical treatment outcome.

Endoscopic ultrasound guided fine-needle aspiration and 18FDG-positron emission tomography in the evaluation of patients with non-small cell lung cancer

The accuracy of mediastinal staging is of paramount importance in the management of patients with non-small cell lung cancer (NSCLC) to select only those patients who might benefit from upfront resection or multimodality treatment. Although CT is the imaging technique of first choice, its performance characteristics have led to an increased use of both EUS-FNA and (18)FDG-PET to improve (mediastinal) staging. In view of the relatively few studies employing both techniques simultaneously, we evaluated 20 consecutive patients (median age 70 years, range 48-83 years) with NSCLC in whom CT suggested N2 and/or N3 involvement. The sensitivity, specificity, PPV and NPV of EUS-FNA and (18)FDG-PET was 86%, 100%, 100%, 90%, and 100%, 89%, 88% and 100%, respectively. EUS-FNA confirmed the absence of malignancy in all patients with a negative (18)FDG-PET scan. Similarly, in the PET-positive patients, EUS-FNA confirmed malignancy in seven out of nine (78%) sites. Unnecessary surgery was prevented in six out of 16 patients otherwise considered as surgical candidates (37%). We conclude that both EUS-FNA and (18)FDG-PET have excellent operating characteristics. However, initial (18)FDG-PET findings should guide the complementary use of EUS-FNA to define treatment options and to prevent unnecessary surgery in selected patients.

Rupture of the right main bronchus: a case of a 4-year-old girl

Tracheobronchial rupture after a blunt chest trauma is rare, especially in children. If the diagnosis is overlooked, severe ventilatory complications or mediastinitis may occur. We describe a case of a 4-year-old girl with a rupture of the right main bronchus after she was hit by a frame of steel (like a mini goal) that fell down while she was playing. The diagnosis was initially missed owing to a variety of symptoms. Difficulty with ventilation and persistent air leak after insertion of a chest tube in the case of a pneumothorax is suspect for a tracheobronchial rupture. This emphasizes once again the importance of the concept of rechecking and searching for the underlying cause when a pneumothorax persists. Bronchoscopy is the gold standard in establishing the diagnosis. Surgical treatment is in most cases the best option, especially in a ventilated patient. Without treatment mortality rates are up to 30%. In conclusion, tracheobronchial rupture should be excluded if mediastinal emphysema or a persistent air leak is present after a blunt thoracic trauma.

An unusual cause of hematemesis: Goiter

Downhill varices are located in the upper part of the esophagus and are usually related to superior vena cava obstruction. Bleeding from these varices is extremely rare. We describe a 77-year-old patient with hematemesis due to downhill varices as a result of recurrent goiter. A right lobe thyroidectomy was carried out with disappearance of the varices.

Multicenter phase II trial of accelerated cisplatin and high-dose epirubicin followed by surgery or radiotherapy in patients with stage IIIa non-small-cell lung cancer with mediastinal lymph node involvement (N2-disease)

To assess the therapeutic activity of accelerated cisplatin and high-dose epirubicin with erythropoietin and G-CSF support as induction therapy for patients with stage IIIa-N2 non-small-cell lung cancer (NSCLC). Patients with stage IIIa-N2 NSCLC were enrolled in a phase II trial. They received cisplatin 60 mg m⁻² and epirubicin 135 mg m⁻² every 2 weeks for three courses combined with erythropoietin and G-CSF. Depending on results of clinical response to induction therapy and restaging, patients were treated with surgery or radiotherapy. In total, 61 patients entered from March 2001 to April 2004. During 169 courses of induction chemotherapy, National Cancer Institute of Canada (NCI-C) grade III/IV leucocytopenia was reported in 35 courses (20.7%), NCI-C grade III/IV thrombocytopenia in 26 courses (15.4%) and NCI-C grade III/IV anaemia in six courses (3.6%). Main cause of cisplatin dose reduction was nephrotoxicity (12 courses). Most patients received three courses. There were no chemotherapy-related deaths. Three patients were not evaluable for clinical response. Twenty-eight patients had a partial response (48.3%, 95% CI: 36–61.1%), 24 stable disease and six progressive disease. After induction therapy, 30 patients underwent surgery; complete resection was achieved in 19 procedures (31.1%). Radical radiotherapy was delivered to 25 patients (41%). Six patients were considered unfit for further treatment. Median survival for all patients was 18 months. Response rate of accelerated cisplatin and high-dose epirubicin as induction chemotherapy for stage IIIa-N2 NSCLC patients is not different from more commonly used cisplatin-based regimen.

Systemic Treatment of Malignant Thymoma

OBJECTIVES

Thymic malignancies are rare tumors on the superior anterior mediastinum. Treatment of advanced stages includes chemotherapy. The objective of this analysis was to review the treatment of this disease in the past decade.

METHODS

This is a retrospective analysis of the results obtained in a total of 29 patients with advanced malignant thymomas who underwent systemic chemotherapy in the past 10 years at our institution. Sixteen received neoadjuvant chemotherapy in the attempt to shrink the tumor and then perform a radical operation. The others received chemotherapy as palliation. Platinum based chemotherapy was mainly used.

RESULTS

The response rate to first-line chemotherapy was 50% in the neoadjuvant setting and 31% in the advanced setting. A better survival was observed in patients who underwent chemotherapy as part of their combined modality treatment, in patients with thymomas, and in patients without visceral metastases. Some patients responded to targeted therapies at relapse.

CONCLUSIONS

A better understanding of the biology of this rare tumor may allow in the future the development of better therapies for the more aggressive tumor types (WHO type C), which appear to be increasing in frequency.

Traditional versus up-front [18F] fluorodeoxyglucose-positron emission tomography staging of non-small-cell lung cancer: a Dutch cooperative randomized study

PURPOSE

We investigated whether application of positron emission tomography (PET) immediately after first presentation might simplify staging while maintaining accuracy, as compared with traditional strategy in routine clinical setting.

METHODS

At first presentation, patients with a provisional diagnosis of lung cancer without overt dissemination were randomly assigned to traditional work-up (TWU) according to international guidelines or early PET followed by histologic/cytologic verification of lesions, or imaging and follow-up. Patients with [18F] fluorodeoxyglucose (18FDG) -avid, noncentral tumors without suspicion of mediastinal or distant metastases on PET proceeded directly to thoracotomy. Follow-up in presumed benign lesions was at least 12 months. In patients treated with surgery or neoadjuvant therapy, the quality of staging was measured by comparing the clinical stage to the final stage (combination of peroperative staging and 6 months of follow-up). To investigate test substitution, we analyzed the number of (non)invasive tests to achieve clinical TNM staging, and its associated costs.

RESULTS

Between 1999 and 2001, 465 patients (233 TWU, 232 PET) were enrolled at 22 hospitals. The mean (standard deviation) number of procedures to finalize staging was equal in the TWU arm and the PET arm: 7.9 (2.0) v 7.9 (1.9), P = .90, respectively. Mediastinoscopies occurred significantly less often in the PET arm. Agreement between clinical and final stage was good in both arms (kappa = .85 v .78; P = .07). Costs did not differ significantly.

CONCLUSION

Up-front 18FDG-PET in patients with (suspected) lung cancer does not reduce the overall number of diagnostic test, but it maintains quality of TNM staging with the use of less invasive surgery.

Isolated lung perfusion with melphalan: Pharmacokinetics and toxicity in a pig model

BACKGROUND

In patients with unresectable lung cancer or pulmonary metastases, isolated lung perfusion (ILP) has been described as an alternative method to deliver high-dose chemotherapy to the lungs, thereby minimizing systemic toxicity. Pharmacokinetics of ILP have not been extensively investigated. Therefore, we studied the feasibility of ILP with melphalan in a pig model with emphasis on pharmacokinetics and acute lung damage.

METHODS

Five pigs underwent ILP with melphalan. Blood and tissue samples were obtained for determination of melphalan levels. Tissue biopsies were taken for microscopic evaluation of lung damage.

RESULTS

During ILP, no hemodynamic effects of importance were noted. No systemic leakage of melphalan was observed in any of the animals. Compared with normal lung tissue, microscopic examination of lung tissue after perfusion without melphalan showed pulmonary edema. Directly after melphalan perfusion additional hemorrhagic areas were seen; however, electron microscopy displayed no irreversible endothelial damage.

CONCLUSION

This study on pigs proved to be a well reproducible model for ILP with melphalan. Pharmacokinetics show a safety profile with no systemic toxicity, which could justify further patient studies, necessary to determine its effect on pulmonary metastases in humans, especially in case of adjuvant therapy after surgical resection or in unresectable disease.

The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring > or =16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

The natural history of carcinoma in situ involving bronchial resection margins

STUDY OBJECTIVES

Microscopic residual disease in the bronchial resection margins after surgical resection of lung cancer is rare, and its clinical significance remains unsettled. We studied the natural history of patients with carcinoma in situ (CIS) at their bronchial resection margins to focus on the issue of stump recurrence.

METHODS

Eleven individuals who had undergone radical surgery for N0M0 lung tumors were found to have CIS at the bronchial resection margins. All of the resection specimens were reviewed with respect to the pattern of CIS extension and reclassified as follows: superficial CIS, involving surface epithelium only (CIS-S), CIS extending into the submucosal gland ducts but not deeper (CIS-D), and CIS extending into submucosal gland acini (CIS-A). Patients were followed using autofluorescence bronchoscopy and high-resolution computer tomography. Clinical parameters and the local extent of CIS at histology review were correlated with outcome.

RESULTS

Median follow-up was 35 months (range, 15 to 89). Histology review showed two CIS-S cases, six CIS-D cases, and three CIS-A cases. All of the patients with CIS-A developed stump recurrences in contrast with those with only CIS-S. Three patients with CIS-D have developed metachronous primaries in the contralateral lung, whereas the stump region remained free of tumor.

CONCLUSIONS

The presence of CIS in the bronchial resection margin after resection of lung cancers is associated with stump recurrences. Although absolute numbers are too small for firm conclusions, our data suggest that those with deep glandular extension of CIS bear the highest risk of early recurrence. However, the development of new primaries away from the stump region and the possible development of distant disease are equally relevant considerations with respect to the choice of additional therapy.

Emergency Endovascular Repair of an Aortoesophageal Fistula Caused by a Foreign Body

PURPOSE

To report stent-graft treatment of an aortoesophageal fistula caused by a foreign body.

CASE REPORT

A 32-year-old man was admitted with massive upper gastrointestinal bleeding 10 days after swallowing a fish bone. Computed tomography demonstrated a fistula from the proximal descending thoracic aorta to the mid esophagus. The bleeding was initially controlled by inflating a Sengstaken-Blakemore tube. A 28-mm x 16-cm Talent stent-graft was delivered transfemorally to repair the aortic defect; the esophageal injury was repaired primarily using a pedicled intercostal muscle flap via a right thoracotomy. Chest radiography at 12 months showed no migration of the stent-graft. Blood parameters of infection were normal; the patient remains well 18 months after stent-graft implantation.

CONCLUSIONS

This case illustrates stent-graft treatment of a life-threatening hemorrhage from an aortoesophageal fistula.

[Sternal pain: not always harmless]

In two patients, men aged 39 and 66 years, a sternal mass in combination with pain developed. One patient was diagnosed with a non-Hodgkin lymphoma located in the sternum and the other one with a primary chondrosarcoma of the sternum. They both recovered after treatment. The differential diagnosis of disorders of the chest wall is troublesome and includes haematologic, rheumatologic and infectious processes. Tietze's syndrome is a rare cause of pain and non-suppurative swelling of the costosternal joints. However, tumours of the anterior chest wall can also cause these symptoms and these must therefore be excluded if the complaints persist or the swelling progresses. The most common malignant tumours of the chest wall are non-Hodgkin lymphoma, primary chondrosarcoma and metastases. Diagnostics should consist of blood tests and X-rays. CT and MRI scans are more helpful in establishing the diagnosis. A definitive diagnosis can only be determined by biopsy.

['Palm reading' as a diagnostic aid]

In four patients, a man aged 53, a woman aged 63 and two men aged 67 and 53 years, respectively, inspection of the hand led to the final diagnosis. In the first patient who presented with clubbing of the fingers and pulmonary hypertension, a small atrial septal defect was detected. The second patient had thick curved yellow nails and recurrent pleural effusions as part of this yellow nail syndrome. The third patient presented with clubbing and hypertrophic osteoarthropathy, a secondary complaint to adenocarcinoma of the lung. The fourth patient had increasing pulmonary hypertension as a secondary complaint to recurrent multiple pulmonary embolism from deep venous malformations of his right hand, arm and shoulder as a part of the Klippel-Trenaunay syndrome. These cases show that inspection of the hand may give a clue to the diagnosis.

Immunoparalysis as a cause for invasive aspergillosis?

Aspergillus infections are among the most feared opportunistic infections in humans. These organisms are ubiquitous in nature; protection against infection is usually provided by anatomical barriers and by the immune system. Tissue invasion by Aspergillus is uncommon, occurring primarily in the setting of immunosuppression. The prognosis of invasive aspergillosis is very poor. Although it is widely recognised that critically ill patients in the Intensive Care Unit (ICU) are at risk for nosocomial infections, it is not generally appreciated that such patients may also be at risk for opportunistic infections usually seen only in immunocompromised patients. This might be explained by a biphasic immunological pattern during sepsis: an early hyperinflammatory phase followed by an anti-inflammatory response, leading to a hypo-inflammatory state, the so-called compensatory anti-inflammatory response syndrome (CARS or immunoparalysis). We describe four patients admitted to our ICU for various reasons, without a history of abnormal immune function, who developed invasive pulmonary aspergillosis. We hypothesise that the occurrence of these opportunistic infections in our patients may have been due to immunoparalysis, and that perhaps all ICU patients with sepsis and multiple organ dysfunction syndrome (MODS) may be at risk for opportunistic infections such as aspergillosis as a result of this syndrome. Physicians treating critically ill patients in the ICU should be aware of the CARS/immunoparalysis syndrome and its potential to cause opportunistic infections, even in patients with normal immune function prior to ICU admission.

Mitotic index does not predict prognosis in stage IA non-small cell lung cancer

Despite radical resection, many patients with stage IA non-small cell lung cancer (NSCLC) die of metastatic disease, showing that apparently there were already micrometastases at the time of surgery. To identify patients at risk for metastatic disease, accurate prognostic factors are needed. Because the mitotic activity index (MAI) is of good prognostic value in several other cancers, we assessed its value in stage IA NSCLC. We assessed the MAI in the sections of 133 patients with radically resected stage IA NSCLC. MAI, histologic subtype, age, sex, location of tumor, type of surgery and tumor diameter were correlated with survival. The mean MAI was 29, ranging from 0 to 89. MAI was not correlated to histologic tumor type or lymph node sample procedure, or any of the other clinicopathologic features. No correlation was found between MAI and survival. Univariate analysis showed that only age was a significant predictor of survival (P = 0.0007). This was confirmed by multivariate analysis. The mitotic index is not a predictor of prognosis in stage IA NSCLC. Therefore other prognostic factors have to be investigated.

CC130 pilot fatigue during re-supply missions to former Yugoslavia

PURPOSE

Deployment of troops in foreign theaters requires a massive airlift capability. The fatigue encountered in such operations can be severe enough to pose a flight safety hazard. The current study documents sleep and the effect of fatigue on aircrew performance during re-supply missions in support of Canadian troops in Bosnia in 1996.

METHODS

Ten routine re-supply missions from Trenton, Canada, to Zagreb, Croatia, were studied and involved 9 pilots and 9 co-pilots. To document their sleep hygiene, all pilots wore wrist actigraphs from approximately 5 d prior to the mission, until the mission was completed. Psychomotor performance was tested during the actual flights. Three psychomotor trials during the outbound transatlantic leg (Trenton to Lyneham, UK) were employed, one trial on the Lyneham-Zagreb-Lyneham leg, and three trials on the return transatlantic leg from Lyneham to Trenton.

RESULTS

The amount of daily sleep during the 3-d period prior to the mission steadily decreased from an average of 8 h 40 min per day to 6 h 30 min (p < 0.001). During the missions, the worst night of sleep occurred during the second night overseas. During both transatlantic legs, there were significant decrements in the subjective ratings of alertness (p < 0.001), and increases in physical (p < 0.001) and mental fatigue (p < 0.001). Performance on the logical reasoning task as well as the multitask showed probable fatigue effects during the outbound leg of the missions.

CONCLUSIONS

Our transport pilots showed a pattern of progressively decreasing sleep. Self-rated scores for alertness, mental and physical fatigue, indicate a deterioration of alertness, and an increase in fatigue throughout the long transatlantic flights.

Melatonin and zopiclone as pharmacologic aids to facilitate crew rest

PURPOSE

In response to mission imperatives, transport aircrews must often sleep at inappropriate circadian times resulting in inadequate sleep. This study was undertaken to determine whether either melatonin or zopiclone could facilitate early circadian sleep, and to assess whether either of these medications would result in a psychomotor performance decrement which would preclude their use in aircrew.

METHOD

Thirteen subjects from DCIEM completed a double-blind cross-over protocol. All subjects were assessed for psychomotor performance during 3 drug conditions (placebo, 10 mg melatonin, and 7.5 mg zopiclone), which were separated by one week. Each of these conditions involved 2 nights of sleep, back-to-back, with the first night being a normal circadian control sleep (23:00 h bedtime, arising at 06:45 h), and the second night being an early circadian drug sleep (drugs at 16:45 h, 17:00 h bedtime, arising at 23:45 h). All subjects were tested for psychomotor performance, on both nights of each of the 3 drug conditions, pre- and post-sleep. Further, during the early circadian drug night, all subjects were tested every hour after arising at 23:45 h (24:00 h until 07:00 h. At the beginning of each psychomotor test session, subjects were asked for their subjective levels of sleepiness and fatigue.

RESULTS

Relative to placebo (339.5 min) the subjects slept more on melatonin (370.2 min, p < 0.01), and zopiclone (373.3 min, p < 0.01). Performance in serial reaction time (SRT) task (p < 0.001), logical reasoning task (LRT) (p < 0.001), serial subtraction task (SST) (p < 0.02), and Multitask (MT) (p < 0.03) were impaired for all 3 drug conditions immediately on awakening, compared with pre-sleep performance, as a result of a sleep-inertia effect. With respect to the subjective data, sleep inertia effects were evident for sleepiness (p < 0.001), mental fatigue (p < 0.002), and physical fatigue (p < 0.05). For SRT, LRT, and SST, performance recovered to pre-sleep levels within 1.25 h of awakening, and for MT recovery occurred 2.25 h after awakening. There were no differences in performance or subjective measures between placebo, melatonin and zopiclone.

CONCLUSIONS

Both zopiclone and melatonin improved sleep relative to placebo. After sleep inertia, performance recovered to pre-sleep levels for all tasks and was sustained at that level throughout the balance of the testing period. There was no impact of melatonin or zopiclone on performance measures compared with placebo.

Reaching affects saccade trajectories

The pre-motor theory suggests that, when attention is oriented to a location, the motor systems that are involved in achieving current behavioural goals are activated. For example, when a task requires accurate reaching, attention to a location activates the motor circuits controlling saccades and manual reaches. These actions involve separate neural systems for the control of eye and hand, but we believe that the selection processes acting on neural population codes within these systems are similar and can affect each other. The attentional effect can be revealed in the subsequent movement. The present study shows that the path the eye takes as it saccades to a target is affected by whether a reach to the target is also produced. This effect is interpreted as the influence of a hand-centred frame used in reaching on the spatial frame of reference required for the saccade.

Controlled introduction of the sentinel node biopsy in breast cancer in a multi-centre setting: the role of a coordinator for quality control

AIMS

It is proposed that sentinel node biopsy should replace axillary lymph-node dissection. We analysed the role of a coordinator in the introduction of the sentinel node biopsy in breast cancer in a multi-centre setting to assure standardization and quality control.

METHODS

We included 232 operable breast cancer patients. Part of the procedure was an ultrasound examination of the axilla with fine needle aspiration cytology. The sentinel node was identified with 99m-Technetium and Patent Blue.

RESULTS

The results of the procedure, sensitivity and false negativity, were the same for the three participating hospitals. We think this is mostly due to the coordinator who supplied information about the technique, pitfalls and results to all teams.

CONCLUSIONS

Our experience regarding the organization aspects of introducing the sentinel node procedure in a multi-centre setting now serves as a model in organizing its application in a much wider number of hospitals.

An enzyme-linked immunosorbent assay for the measurement of circulating antibodies to polymorphic epithelial mucin (MUC1)

INTRODUCTION

About one-third of breast and ovarian carcinoma patients have circulating antibodies reactive with polymorphic epithelial mucin (MUC1), either free or bound to immune complexes. While the presence of these immune complexes has prognostic significance in breast cancer patients, the significance of free MUC1 antibodies is less clear. The objective of this study was to develop a reliable assay for the accurate determination of circulating free antibodies to MUC1.

MATERIAL AND METHODS

We developed an enzyme-linked immunosorbent assay (ELISA) (PEM.CIg) employing a 60 mer peptide (a triple tandem repeat sequence of the MUC1 peptide core) conjugated to bovine serum albumin and peroxidase-labeled antihuman immunoglobulin G or M antibodies. The assay was standardized and its analytical performance evaluated. A total of 492 serum samples were obtained from 40 healthy men, from 201 healthy women (including 55 women without a history of pregnancy and 45 pregnant women), and (before primary treatment) from 62 benign breast tumor patients and 190 breast cancer patients. MUC1 serum levels were determined with commercial CA 15-3 tests.

RESULTS

Circulating antibodies to MUC1 are present both in healthy subjects and in breast cancer patients. The within- and between-assay coefficients of variation were, respectively, 2 and 12% for the IgG determinations and 1.2 and 3% for the IgM determinations. Correlation coefficients for serially diluted serum samples ranged from 0.9998 to 0.9920 for IgG and from 0.9996 to 0.9818 for IgM determinations. The reactivity of serum samples was partially blocked by the addition of various MUC1 peptides and by MUC1 mucin. The inhibiting effect of modified 60 mer peptides suggests the presence of antibodies directed to more than one epitope.

CONCLUSIONS

The PEM. CIg assay is a reliable ELISA for measuring free MUC1 antibodies in serum. We are in the process of relating the results obtained in the breast cancer group to disease outcome to evaluate its prognostic significance. In addition, the assay may become a useful tool for vaccine therapy monitoring.