RESUMO
This audit describes the lymphatic flow from oral tumours seen on single-photon emission computed tomography (SPECT/CT) to help sentinel node (SN) identification. A total of 95 consecutive sentinel node biopsies (SNB) were taken between 2010 and 2019. Eligibility criteria for SNB were patients over 18 years of age with a T1-T2 oral or oropharyngeal squamous cell carcinoma and an N0 neck. SNs collect at high-frequency sites irrespective of the primary tumour (22.7% level Ib; 64.8% levels II/III; and 7.6% level IV), but with individual variation. Radiotracer activity did not influence the number of nodes identified, and metastatic deposits were found in the hottest nodes. SNs occur at the same high-frequency locations in the neck, so familiarity with anatomical detail may reduce false-negative results.
Assuntos
Neoplasias de Cabeça e Pescoço , Linfadenopatia , Neoplasias Bucais , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela , Tomografia Computadorizada por Raios XRESUMO
"Mutational signatures" are patterns of mutations that report DNA damage and subsequent repair processes that have occurred. Whole-genome sequencing (WGS) can provide additional information to standard diagnostic techniques and can identify therapeutic targets. A 32-yr-old male with xeroderma pigmentosum developed metastatic angiosarcoma that was unresponsive to three lines of conventional sarcoma therapies. WGS was performed on his primary cancer revealing a hypermutated tumor, including clonal ultraviolet radiation-induced mutational patterns (Signature 7) and subclonal signatures of mutated DNA polymerase epsilon (POLE) (Signature 10). These signatures are associated with response to immune checkpoint blockade. Immunohistochemistry confirmed high PD-L1 expression in metastatic deposits. The anti-PD-1 monoclonal antibody pembrolizumab was commenced off-label given the POLE mutation and high mutational load. After four cycles, there was a significant reduction in his disease with almost complete resolution of the metastatic deposits. This case highlights the importance of WGS in the analysis, interpretation, and treatment of cancers. We anticipate that as WGS becomes integral to the cancer diagnostic pathway, treatments will be stratified to the individual based on their unique genomic and/or transcriptomic profile, enhancing classical approaches of histologically driven treatment decisions.
Assuntos
Hemangiossarcoma/genética , Xeroderma Pigmentoso/tratamento farmacológico , Xeroderma Pigmentoso/genética , Adulto , Anticorpos Monoclonais/genética , Anticorpos Monoclonais Humanizados/uso terapêutico , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/genética , Análise Mutacional de DNA/métodos , DNA Polimerase II/genética , Humanos , Masculino , Instabilidade de Microssatélites , Mutação/genética , Proteínas de Ligação a Poli-ADP-Ribose/genética , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/genética , Sequenciamento Completo do Genoma/métodosRESUMO
With hybrid imaging playing an increasingly important role in nuclear medicine, this article reviews the literature on single-photon emission computed tomography/computed tomography (SPECT/CT) in parathyroid scintigraphy. An understanding of parathyroid and neck anatomy is important for accurate reporting of these scans, as this can have an impact on the surgical approach used. The contribution of SPECT/CT over and above SPECT alone is greatest in terms of localization, particularly for ectopic tumours. There remains controversy on the role of SPECT/CT in eutopic tumours, especially when considering such factors as imaging time and the additional radiation dose.