[Notification of an adverse effect to human albumin (99m)Tc-nanocolloid]. / Notificación de una reacción adversa al (99m)Tc-nanocoloide de albúmina.

Allergic reactions to albumin nanocolloid are rare. Most of them are not potentially serious and in some cases treatment with antihistamines may be needed. We present a case of a patient with grade II right breast ductal carcinoma, in whom a lymphoscintigraphy was performed for sentinel lymph node detection. She had a type I hypersensitivity reaction following the administration of (99m)Tc-albumin nanocolloid, which abated spontaneously without subsequent sequels.

[Impact of (18)F-FDG PET/CT on the therapeutic management in the initial staging of the esophageal cancer]. / Impacto clínico de la PET/TAC con (18)F-FDG en el manejo terapéutico de pacientes con diagnóstico inicial de cáncer de esófago.

OBJECTIVE: The incidence of esophageal cancer has increased considerably over recent years, it now being the 6th most frequent cause of cancer-related death. Our study has aimed to compare the clinical value of PET/CT and CT scan in the initial staging of patients with esophageal cancer. MATERIAL AND METHODS: Fifty nine patients (6 women) diagnosed of esophageal cancer were assessed retrospectively. All patients underwent diagnostic CT scan and PET/CT for initial staging within 3 to 15 days following clinical diagnosis. RESULTS: PET/CT showed intracellular (18)F-FDG entrapment having pathological significance in all the tumors (100%), signs of locoregional lymph node infiltration (N1) in 34 and a total of 19 lesions consistent with metastasis (M1) in 14 patients (23.72%). The CT scan detected malignancy in 57 patients (96.6%), abnormal lymph node in 32 patients and 17 N1 in 12 patients (20.33%). In three cases, CT- PET detected synchronous esophageal lesion in staging studies for other neoplastic processes (lung and ear-nose-throat). CONCLUSION: PET/CT showed a higher detection rate of primary malignant lesions, abnormal lymph nodes and distant metastases. A change in stage was only observed in two patients.

[Positron emission tomography using 18-FDG-PET in radiologically indeterminate pulmonary lesions]. / Tomografía por emisión de positrones mediante PET-18FDG en lesiones pulmonares radiológicamente indeterminadas.

OBJECTIVE: Fluorine-18 deoxyglucose Positron Emission Tomography (FDG-PET) is a non-invasive technique that offers the possibility to define if the radiologically indetermined pulmonary lesions are benign or malignant with high positive and negative predictive values. Considering the indexed literature we can observe that there are few original studies performed with the diagnostic possibilities of our means. For this reason, our main objective is to evaluate the diagnostic accuracy of positron emission tomography in sixty-seven radiologically indetermined pulmonary nodular lesions. MATERIAL AND METHOD: Retrospectively, we evaluated the diagnostic ability of FDG-PET globally (by means of visual and semiquantitative analysis) and partially (only considering the Standardized Uptake Value (SUV)), in sixty-seven patients confirmed by pathology or clinical and radiological monitoring, in a time interval superior to one year. RESULTS: Globally, FDG-PET had a sensitivity (S) of 92%, specificity (SP) of 86.6%, positive predictive value (PPV) of 89.4%, negative predictive value (NPV) of 89.6% and diagnostic accuracy (DA) of 89%. The best results were obtained for an SUV equal or superior to 2.5. With this value, the clinical efficacy parameters were: S 0.92, SP 0.90, PPV 0.92, NPV 0.90 and DA 0.91. CONCLUSIONS: We can characterize most of the radiologically indetermined pulmonary lesions by FDG-PET. The additional use of SUV facilitates an increase in the positive predictive value and specificity of FDG-PET.

[Diagnostic accuracy of semiquantitative analysis of positron emission tomography in radiologically indeterminate lung lesions]. / Exactitud diagnóstica del análisis semicuantitativo de la tomografía por emisión de positrones en lesiones pulmonares radiológicamente indeterminadas.

OBJECTIVE: The objective of this work was to assess the Standardized Uptake Value (SUV) in the differential diagnosis of radiologically indeterminate lung lesions by means of ROC curves. MATERIAL AND METHOD: Forty seven patients were studied by Positron Emission Tomography with 18-fluorine-2-desoxy-D-glucose (FDG PET) analyzing the value of maximum SUV. The patients were classified into three groups. Group 1 = patients without previous neoplasia (WPN) + patients with previous neoplasia (PN). Group 2 = WPN. Group 3 = PN. RESULTS: The ROC curves showed a high diagnostic accuracy in the three groups, with area under the curve (AUC) values of 0.96, 0.98 and 0.91 respectively. The typical error was 0.03, 0.02 and 0.08. The maximum SUV cutoffs with the best diagnostic accuracy for the three groups were: 2.6; 3 and 2.4, with an accuracy (A) of 93.6%, 97% and 92.3%, respectively. Analyzing all the patients globally (group 1), we obtained one false positive result in a patient with hamartoma (max SUV = 2.8) and two false negative results in one patient with lung metastases from malignant fibrohistiocytoma (max SUV = 0.7) and in another patient with lung metastases from unknown origin adenocarcinoma (max SUV = 1.9). CONCLUSIONS: FDG PET permits differentiation with a very high diagnostic accuracy of benign and malignant lung lesions using the maximum SUV. The differences observed between the different groups are due to the different disease prevalence, obtaining a lower negative predictive value of max SUV in patients with previous neoplasia.

Derrame pericárdico que simula un tumor. Valor de la ecocardiografía Doppler a color para su diferenciación / Pericardial effusion simulating pericardial tumor. Color codified Doppler study

Existen múltiples publicaciones sobre el valor de la ecocardiografía para el reconocimiento de las masas pericárdicas, y algunas de ellas señalan cómo un derrame puede ocultar un tumor. Se describe el caso de un paciente de 64 años, portador de una valvulopatía aórtica y un derrame pericárdico, diagnosticado por ecocardiografía. En dicho estudio además de la confirmación diagnóstica, se observó una masa intrapericárdica, de unos 7 cm de diámetro, de aspecto grumoso, adherida a la hoja visceral, a nivel de la unión aurículo-ventricular derecha. Con motivo de tal hallazgo, se realizó estudio con Doppler codificado a color, observándose que dicha masa adquiría una tonalidad azul durante la diástole y una tonalidad en mosaico al final de la sístole. Así pudo concluirse que era debido a remanso de líquido y simulaba un tumor dentro de la cavidad pericárdica. En la intervención quirúrgica se demostró la ausencia de dicha masa