Ann Thorac Surg 1996;62:1416-1417
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
David A. Browdie, MD,
R. Varick Bernstein, MD
Department of Surgery MeritCare Hospital of Fargo and University of North Dakota School of Medicine 720 4th St N Fargo, ND 58122
See also page 1412.
This report documents the use of another method of white blood cell scanning in establishing the absence or presence of sternal wound infections after median sternotomy. The use of monoclonal antibody--99Tc, the prospective nature of the study, and the presence of a control group are notable, as is the zero hospital mortality rate in the albeit small group of patients with "scan-positive" infection. The advantages of tomographic scanning are demonstrated, and our radiologists have found this helpful in scans using in vitro white blood cell 111In and especially 99Tc agents. Bitkover and associates do not address the use of these scans to identify other sites of infection, or issues of costs, risks, and repeatability; nor do they discuss the statistical validity of their conclusions. The fact that these scans did not "light up" areas of bronchopneumonia in 3 patients taking antibiotics reminds us that false-negative scans can occur (partially treated infection, unusual organisms such as Serratia, leukopenia). Bitkover and associates emphasize that accuracy requires a two-scan technique and that this test does not replace careful clinical assessments.
Our experience with white blood cell scanning using in vitro labeling with 111In or 99Tc in conjunction with planar or tomographic scanning has continued since our 1991 report. During these years, the incidence of deep sternal wound infection has been 0.9% to 1.5%. Since 1991, we have had 14 patients with true-positive scans and 12 with true-negative scans. There have been no misleading studies. During this period, a contemporary group of 4 nonscanned patients with obvious sternal infection also have been identified. Of the patients with mediastinitis, one of 14 scanned patients did not survive. Two of 4 nonscanned patients died. All patients with mediastinitis were treated with aggressive operation, were culture positive, and received intensive antibiotic therapy. We also continue to assess suspicious findings by pacer wire cultures; although false-positive cultures continue to occur occasionally, we find these helpful. As the overall accuracy of white blood cell scans is equal to or greater than that of tests such as echocardiography and aortography in the diagnosis of aortic dissection, we consider white blood cell scans similar in terms of cost effectiveness in permitting prompt, early, and reasonably accurate diagnosis of this life-threatening disease.
Related Article
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Diagnosing Sternal Wound Infections With 99mTc-Labeled Monoclonal Granulocyte Antibody Scintigraphy
- Catarina Y. Bitkover, Bengt Gårdlund, Stig A. Larsson, Bengt Åberg, and Hans Jacobsson
Ann. Thorac. Surg. 1996 62: 1412-1416.
[Abstract]
[Full Text]
