Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node.

OBJECTIVE: To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS: Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS: SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.

[SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up]. / Estudios SPECT-TAC con Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad.

INTRODUCTION: 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. MATERIAL AND METHODS: One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. RESULTS: Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). CONCLUSION: These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease.

[123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma]. / SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma.

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion.

[Tumor redifferentiation in papillary thyroid carcinoma alter retinoic acid administration]. / Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico.

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months before 131I treatment. A radioiodine scan performed after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan.