Uso de marcador ferromagnético para la detección intraoperatoria de metástasis ganglionar interpectoral de cáncer colorrectal / Use of a Ferromagnetic Marker for the Intraoperative Detection of Interpectoral Lymph Node Metastasis of Colorectal Cancer

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Semillas de 125I en la localización de lesiones no palpables en pacientes con cáncer de mama / 125I radioactive seed localization for non-palpable lesions in breast cancer

OBJETIVO: El marcaje de lesiones no palpables en cáncer de mama mediante semillas de 125I es una alternativa al arpón quirúrgico. El objetivo de este trabajo es presentar los resultados obtenidos con el uso de semillas de 125I frente a la que era la técnica de referencia en nuestro centro, el arpón quirúrgico. MATERIAL Y MÉTODO: Estudio longitudinal prospectivo en el que se incluyen pacientes con diagnóstico anatomopatológico de cáncer de mama, con lesiones no palpables, candidatas a tratamiento quirúrgico primario en las que se realizó marcaje con semilla de 125I (2016-2018) y con arpón (2015-2016). Se realizó análisis histopatológico de la pieza quirúrgica determinando la existencia de bordes afectos. Se calculó el volumen de la pieza quirúrgica. RESULTADOS: Se incluyeron un total de 146 pacientes, 95 a las que se les realizó tumorectomía guiada con semilla de 125I y 51 con arpón. El volumen cubo medio de las piezas resecadas fue de 135,67cm3 vs.190,77cm3 (p = 0,017). El volumen ortoedro fue de 58,75cm3 vs.80,60cm3 (p = 0,003). Once de las pacientes marcadas con semillas presentaron afectación de bordes (11,6%) frente a 7 (13,2%) del grupo arpón (p = 0,084). Se realizó reescisión en 9 de las pacientes marcadas con semillas y en 7 del grupo arpón (p = 0,49). CONCLUSIÓN: El uso de semillas de 125I es factible en la localización de lesiones no palpables de mama, con una baja tasa de reintervención y volúmenes de piezas quirúrgicas significativamente inferiores a los obtenidos con arpón

AIM: Marking of non-palpable breast lesions with 125I radioactive seeds is an alternative to the use of the surgical wire. The objective of this work is to present the results that we have obtained using radioactive seed localization compared to the reference technique in our center, the wire localization of non-palpable breast lesions. MATERIAL AND METHOD: Longitudinal prospective study that includes patients with histological diagnostic of breast cancer, with non-palpable lesions that are candidates to primary surgical treatment by radioactive seed localization (2016-2018) and by wire localization (2015-2016). Histological analysis of the surgical specimen was performed determining the status of surgical margins. The volume of the surgical specimen was calculated. RESULTS: A total of 146 patients were included, 95 who underwent surgery by radioactive seed localization and 51 by wire localization. The mean cube volume of the specimens were 135.67cm3 vs.190.77cm3 (p = 0.017), respectively. Eleven patients who underwent surgery by radioactive seed localization showed affected margins of the specimen (11.6%), versus 7 (13.2%) of wire localization group (p = 0.084). Reintervention was performed in 9 of the patients marked with seeds and in 7 marked with wires (p = 0.49). CONCLUSION: The use of 125I radioactive seeds is feasible in non-palpable breast lesions, with a low rate of reintervention and volumes of surgical specimens significantly lower than those obtained by wire localization

Endoscopic ultrasound-guided fiducial placement in pancreatic tumors: safety and technical feasibility

Background and aims: stereotactic body radiation therapy (SBRT) for pancreatic malignancies requires the placement of fiducials to guide treatment delivery. The aim of this study was to assess the safety and feasibility of endoscopic ultrasound (EUS) guided fiducial placement using a 22-gauge needle, in patients with pancreatic cancer undergoing SBRT. Methods: this single-center retrospective study included 47 patients with biopsy-proven advanced pancreatic cancer who underwent EUS-guided fiducial placement between February 2014 and February 2018. Primary outcome measurements included technical success, fiducial migration rate and procedural complications. Results: all 47 patients received a sufficient number of fiducials and could therefore undergo a successful SBRT. The mean number of fiducials inserted per case was 2 +/- 1 (range 1-3) and no fiducial migration was noted. The adverse event rate was 4.2%, as one patient developed mild pancreatitis and another patient required one week of hospitalization one month after fiducial placement due to a duodenal abscess. Conclusions: EUS-guided fiducial placement is a safe and technically feasible procedure in centers with endosonographers that are well trained in EUS with FNA

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Accuracy and the role of experience in dynamic computer guided dental implant surgery: An in-vitro study

Background: To compare the accuracy of implant placement using the conventional freehand method and a dynamic navigation system; to assess the role of the surgeon's experience in implant placement using these two methods. Material and Methdos: A randomized in-vitro study was conducted. Six resin mandible models and 36 implants were used. Two researchers with differing clinical experience (novice and experienced) placed implants using either the Navident dynamic navigation system (navigation group) or the conventional freehand method (freehand group). Accuracy was measured by overlaying the real position in the postoperative CBCT on the virtual presurgical placement of the implant in a CBCT image. Descriptive and bivariate analyses of the data were performed. Results: The navigation group showed significantly higher accuracy for all the variables studied except 3D entry and depth deviation. This system significantly enhanced the accuracy of the novice professional in several outcome variables in comparison with the freehand implant placement method. However, when the implants were placed by the experienced clinician the dynamic navigation system only improved angulation deviation. Significant differences were found between the 2 professionals when the freehand method was employed. Similar deviations were observed for the implants placed with the navigation system. Conclusions: Dynamic computer assisted surgery systems allow more accurate implant placement in comparison with the conventional freehand method, regardless of the surgeon's experience. However, this system seems to offer more advantages to novice professionals, since it allows them to reduce their deviations significantly and achieve similar results to those of experienced clinicians

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