Diagnostic relevance of 2-[18 F]-FDG PET/CT in patients recently diagnosed with monoclonal gammopathy of undetermined significance.

2-[18 F]-FDG PET/CT is a useful diagnostic technique to assess bone and soft tissue disease in multiple myeloma (MM) but is not recommended by the International Myeloma Working Group for the evaluation of monoclonal gammopathy of undetermined significance (MGUS). The objective of this study was to evaluate the role of 2-[18 F]-FDG PET/CT in the management of these patients. An observational retrospective study was conducted on 338 patients with MGUS who underwent 2-[18 F]-FDG PET/CT. The mean age was 70.80 ± 11.84 years, and 69.2% of patients had cardiovascular risk factors. Patients were classified according to their progression risk (Mayo Clinic). The mean post-diagnosis follow-up was 8.35 ± 14.46 months. Pathological findings were recorded in 49 patients: 30 with myeloma bone lesions (15 in the initial study and 15 in follow-up) and 19 with other neoplastic (n = 13) or pathologically significant findings (n = 6). Body mass index, monoclonal component rate (MCR) > 1 g/dL and ≥1 risk factors for MM were significant in univariate logistic regression analyses. The MCR emerged as the main predictor of a positive 2-[18 F]-FDG PET/CT in adjusted multivariate regression analysis, with an area under the receiver operating characteristic curve of 0.785 and cutoff for optimal sensitivity/specificity of 1.0 ng/mL (71.4% sensitivity, 71.2% specificity). 2-[18 F]-FDG PET/CT results correctly classify patients with MGUS and could improve the detection of bone lesions over existing techniques, with the additional possibility of detecting neoplastic processes. The best parameter to predict a positive 2-[18 F]-FDG PET/CT was the MCR.

[Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women.] / Valoración del tromboembolismo pulmonar relacionado con infección SARS-CoV-2 activa en pacientes embarazadas.

AIM: To analyze the sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out the pulmonary embolism (PE) suspicion during the acute COVID-19 infection hospitalization period in our hospital. MATERIAL AND METHODS: SPECT scintigraphy with a reduced dose (111 MBq) of 99mTc-macroaggregated albumin was performed in all of the patients (n=5). The obtained images were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. RESULTS: Only one of the 5 patients was diagnosed with PE. Two patients obtained pathological findings of the scintigraphy attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfussion. CONCLUSION: Given the non-specific features of the clinical manifestations and D-dimer values in COVID-19, as well as their similarity to those of PE, the pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance related to the absence of scientific publications on this group of patients within the context of COVID-19 pandemic exceptional situation.

Is FDG-PET suitable for evaluating neoadjuvant therapy in non-small cell lung cancer? Evidence with systematic review of the literature.

BACKGROUND: Neoadjuvant therapy response assessment is crucial in patients with non-small cell lung cancer (NSCLC). FDG-PET has emerged as a valuable tool for defining therapy response assessment in other tumours. AIM: To systematically review publications appearing in the literature describing induction therapy response assessment with FDG-PET in NSCLC. METHODS: We performed a bibliographic search and selected only prospective studies in order to include the highest levels of evidence. RESULTS: Nine of 497 potentially relevant publications were selected. The ranges of sensitivity, specificity, positive predictive value and negative predictive value for primary tumour response assessment were 80-100%, 0-100%, 42.9-100%, and 66.7-100%, respectively. Pooling data for N2 restaging after neoadjuvant response the overall sensitivity was 63.8% (95% CI, 53.3-73.7%) and overall specificity was 85.3% (95% CI, 80.4-89.4%). CONCLUSION: The results of the analysis do not support the use of FDG-PET as the only re-assessment tool for mediastinal lymph node evaluation for routine clinical use. FDG-PET seems to predict primary tumour response to induction therapy but it could not be shown by pooling analysis.

18F-fluorodeoxiglucose positron emission tomography for the evaluation of neoadjuvant therapy response in esophageal cancer: systematic review of the literature.

UNLABELLED: Neoadjuvant treatment is a relatively new therapeutic approach for locally advanced esophageal cancer. Response assessment is crucial for the treatment of these patients. Cross sectional imaging has traditionally being used as the elective method of response assessment. Recently, 18F fluorodeoxyglucose- positron emission tomography (FDG-PET) has emerged as a new valuable tool defining therapy response assessment in other tumors. AIM: We systematically reviewed the increasing number of publications appearing in the literature analyzing the utility of FDG-PET in the evaluation of neoadjuvant therapy response assessment. METHODS: We performed a bibliographic search according to the COSI protocol and selected only prospective studies to achieve the highest levels of evidence. Quality assessment was defined with the QUADAS questionnaire. RESULTS: Eight of 237 potentially relevant publications were selected for the analysis. Ranged sensitivity, specificity, positive predictive value, and negative predictive value for primary tumor response assessment were 27.3% to 93.3%, 41.7% to 95.2%, 70.8% to 93.3% and 71.4% to 93.5%, respectively, and for N restaging, 16.0% to 67.5%, 85.7% to 100%, 33% to 100% and 91.7% to 93.3%, respectively. The heterogeneity of the publications ruled out the possibility of meta-analysis. FDG-PET is more precise compared with computed tomography in the evaluation of induction therapy response assessment. CONCLUSION: FDG-PET seems to be the best available imaging modality for neoadjuvant therapy response assessment in esophageal cancer. But more prospective studies with larger populations are needed to confirm the power of this imaging tool in this aim and to determine the best analytical interpretation method and threshold to differentiate responders from nonresponding patients.

Osificación heterotópica tras artroplastia de cadera: papel de la gammagrafía SPECT/TC ósea / Heterotopic ossification after hip arthroplasty: role of bone SPECT/CT scintigraphy

La osificación heterotópica es una condición limitante, que afecta predominantemente a la cadera. Dada su relación con patología postraumática/posquirúrgica, la gammagrafía ósea SPECT/TC resulta de especial utilidad en el diagnóstico diferencial con movilización protésica, aun cuando no hay alteraciones radiológicas. Además, resulta ser una herramienta eficaz para planificación quirúrgica atendiendo al grado de maduración ósea y la posibilidad de fabricar biomodelos mediante impresión 3D.(AU)

Heterotopic ossification is a limiting condition that predominantly affects the hip. Because of its association with post-trau-matic/postoperative pathology, bone SPECT/CT scintigraphy has proven to be especially useful regarding differential diag-nosis involving prosthetic mobilization, even in the absence of radiological abnormalities. Additionally, it is an effective toolfor surgical planning, considering the degree of bone maturation and the possibility of creating biomodels using 3Dprinting.(AU)

Biopsia del ganglio centinela y quimioterapia neoadyuvante en pacientes con cáncer de mama: nuestra experiencia / Sentinel lymph node biopsy and neoadjuvant chemotherapy in breast cancer patients: our experience

Objetivo. Revisar nuestra experiencia en la biopsia selectiva del ganglio centinela (BGC) en pacientes con cáncer de mama operable tratadas con quimioterapia neoadyuvante (QTN). Material y métodos. Estudio prospectivo, enero de 2008/diciembre de 2014, 235 BGC en pacientes con cáncer de mama infiltrante T1-3/N0-1, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se estableció por exploración física, ecografía axilar y punción de ganglios sospechosos. El día antes de la cirugía se inyectaron periareolarmente 74-111 MBq de 99mTc-nanocoloide de albúmina. Al finalizar el tratamiento se realizó BGC y linfadenectomía axilar. El GC se analizó por cortes de congelación, hematoxilina-eosina, inmunohistoquímica o one-step nucleic acid amplification. Se determinaron tasa de identificación (Id.GC) y falsos negativos (FN). Resultados. Grupo I BGC pre-QTN pacientes cN0 de inicio: n = 73, Id.GC 97,2% (IC 95% 90,5-99,2). Grupo II 2.a BGC pos-QTN pacientes pN1(gc) de inicio: n = 31, Id.GC 61,3% (IC 95% 43,8-76,3), FN 18,2% (IC 95% 5,1-47,7). Grupo III BGC pos-QTN pacientes cN0 de inicio: n = 54, Id.GC 96,3% (IC 95% 87,5-99,0), FN 9,5% (IC 95% 2,7-28,9). Grupo IV BGC pos-QTN pacientes cN1 de inicio, ycN0 posneoadyuvancia: n = 77, Id.GC 83,1% (IC 95% 73,2-89,8), FN 8,3% (IC 95% 2,9-21,8). Conclusiones. La identificación de la BGC pre-QTN es excelente. En pacientes pN1(gc) al diagnóstico, una 2.a BGC pos-QTN no es válida para su aplicación clínica. La BGC pos-QTN puede realizarse con fiabilidad en pacientes cN0 y cN1 de inicio, con axila clínicamente negativa al finalizar la neoadyuvancia (ycN0), y linfadenectomía axilar si el resultado del GC es positivo o no se identifica en la cirugía, en el ámbito de un equipo multidisciplinar con experiencia (AU)

Aim. To analyze our experience of sentinel lymph node biopsy (SLNB) in patients with operable breast cancer treated with neoadjuvant chemotherapy (NAC). Material and methods. A prospective study was conducted between January 2008 and December 2014 in 235 SLNB in patients with infiltrating breast carcinoma T1-3/N0-1 treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination and ultrasound, with guided core needle biopsy of any suspicious lymph nodes. The day before surgery, 74-111 MBq of 99mTc-albumin nanocolloid was injected periareolar. Following NAC, patients underwent SLNB and axillary lymph node dissection. SLN were examined with hematoxylin-eosin staining and immunohistochemical analysis or one-step nucleic acid amplification. The identification rate (IR) and false-negative rate (FNR) were determined. Results. Group I SLNB pre-NAC in patients cN0 at diagnosis: n = 73, IR 97.2% (95%CI: 90.5-99.2). Group II 2nd SLNB pos-NAC in patients pN1(sn) at diagnosis: n = 31, IR 61.3% (95%CI: 43.8-76.3), FNR 18.2% (95%CI: 5.1-47.7). Group III SLNB pos-NAC in patients cN0 at diagnosis: n = 54, IR 96.3% (95%CI: 87.5-99.0), FNR 9.5% (95%CI: 2.7-28.9). Group IV SLNB pos-NAC in patients cN1 at diagnosis and ycN0 post-treatment: n = 77, IR 83.1% (95%CI: 73.2-89.8), FNR 8.3% (95%CI: 2.9-21.8). Conclusions. The detection rate for SLNB prior to NAC is excellent. A second SLNB after NAC in women with a positive SLN at diagnosis is not useful. SLNB after NAC is feasible in cN0 and cN1 patients at diagnosis, clinically axillary node-negative after therapy (ycN0), with subsequent axillary lymph node dissection if the SLNB is positive or not identified during surgery, when performed by an experienced multidisciplinary team (AU)

Segunda biopsia del ganglio centinela después de quimioterapia neoadyuvante en pacientes con cáncer de mama, axila negativa y ganglio centinela metastásico al diagnóstico inicial. Resultados preliminares / Second sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with negative axilla and metastatic sentinel lymph node at presentation. Preliminary results

Objetivo. Valorar la validez diagnóstica de una segunda biopsia del ganglio centinela (GC) en pacientes con cáncer de mama operable y axila negativa al diagnóstico, con GC metastásico, tratadas con quimioterapia neoadyuvante (QTN). Pacientes y métodos. Estudio prospectivo realizado en 52 mujeres con cáncer de mama infiltrante (2 bilateral); estadio II-A (cT2N0M0): 50, II-B (cT3N0M0): 4. El estatus axilar se estableció por exploración física, ecografía y punción ecoguiada de los ganglios sospechosos. Pauta QTN: epirrubicina/ciclofosfamida × 4, y docetaxel × 4. El día antes de la cirugía se inyectó periareolarmente 74-111 MBq de nanocoloide de albúmina. El GC se analizó por amplificación de ácido nucleico de un solo paso. Se realizó linfadenectomía axilar en las pacientes con GC positivo al diagnóstico. Resultados. El GC axilar pre-QTN se identificó en el 96,3% de los casos; GC extirpados 1,8 ± 0,8 (rango 1-4). En el 55,8% el resultado del GC fue positivo. Actualmente, 44 pacientes (2 bilateral) han completado el tratamiento. Se ha realizado una segunda biopsia del GC posneoadyuvancia en 22 pacientes: 20 con GC pre-QTN positivo, 2 sin migración axilar preneoadyuvancia. Solo se identificó el GC en el 54,5% de las pacientes; GC resecados 1,5 ± 0,8 (rango 1-3). En 9 de las 10 mujeres sin migración la linfadenectomía axilar fue negativa. En 7 pacientes el GC fue un verdadero positivo, y en 4 de ellas los GC eran los únicos afectados de la axila. En 2 casos el resultado fue falso negativo (22,2%). Conclusiones. Los resultados de una segunda biopsia del GC post-QTN no son adecuados para su aplicación en la práctica clínica (AU)

Aim. To evaluate the accuracy of a second sentinel lymph node (SLN) biopsy in patients with operable breast cancer and clinically negative axilla, with metastatic SLN at diagnosis, treated with neoadjuvant chemotherapy (NAC). Patients and methods. A prospective study was performed in 52 women with invasive ductal carcinoma (2 bilateral); stage IIA (cT2N0M0): 50, IIB (cT3N0M0): 4. Axillary evaluation included physical examination and axillary ultrasound, with ultrasound-guided core needle biopsy of any suspicious lymph node. The NAC scheme consisted of epirubicin/cyclophosphamide × 4, and docetaxel × 4. The day before surgery, 74-111 MBq albumin nanocolloid was injected periareolarly. The SLN was analyzed by one-step nucleic acid amplification. Axillary lymph node dissection was performed in patients with positive SLN at presentation. Results. Pre-NAC axillary SLN was identified in 96.3% of the patients. The mean number of extirpated SLN was 1.8 ± 0.8 (range 1-4). In 55.8% of the patients, the SLN was positive. Currently, 44 patients (2 bilateral) have completed NAC and surgical treatment. A second SLN biopsy was performed post-NAC in 22 patients: 20 with positive pre-NAC SLN and 2 without pre-NAC SLN identification. SLN was only identified in 54.5% of cases. The mean number of extirpated SLN was 1.5 ± 0.8 (range 1-3). Non migration occurred in 10 patients, 9 patients without axillary lymph node dissection involvement. In 7 patients, the post-NAC SLN was a true positive and was the only axillary lymph node affected in 4. The false negative rate was 22.2%. Conclusions. A second SLN biopsy after NAC in women with a positive SLN at diagnosis is not a useful option (AU)

Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer.

INTRODUCTION: In patients with colorectal cancer (CC), preoperative evaluation and staging should focus on techniques that might alter the preoperative or intraoperative surgical plan. Conventional imaging methods (CT, MRI) have low accuracy for identifying the depth of tumour infiltration and have limited ability to detect regional lymph node involvement. The aim of this study was to evaluate the utility of FDG-PET in the initial staging of patients with CC in comparison with conventional staging methods and to determine its impact on therapeutic management. METHODS: One hundred and four patients with a diagnosis of CC (53 males and 51 females; mean age 66.76+/-12.36 years), selected prospectively, were studied for staging using a standard procedure (CT) and FDG-PET. When possible, the reference method was histology. RESULTS: In 14 patients, surgery was contraindicated by FDG-PET owing to the extent of disease (only 6/14 suspected by CT). FDG-PET revealed four synchronous tumours. For N staging, both procedures showed a relatively high specificity but a low diagnostic accuracy (PET 56%, CT 60%) and sensitivity (PET 21%, CT 25%). For M assessment, diagnostic accuracy was 92% for FDG-PET and 87% for CT. FDG-PET results led to modification of the therapy approach in 50% of patients with unresectable disease. FDG-PET findings were important, revealing unknown disease in 19.2%, changing the staging in 13.46% and modifying the scope of surgery in 11.54% (with a change in the therapeutic approach in 17.85% of those patients with rectal cancer). CONCLUSION: Compared with conventional techniques, FDG-PET appears to be useful in pre-surgical staging of CC, revealing unsuspected disease and impacting on the treatment approach.

Positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose in the evaluation of postoperative endometrial cancer patients

Objective To evaluate the usefulness of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET) in the follow-up of endometrial cancer patients with suspicion of recurrence due to elevated serum tumour markers and suggestive conventional imaging findings. Material and methods A retrospective review was conducted of 17 FDG-PET studies performed in 11 patients with a previous diagnosis of endometrial cancer (6 patients underwent 2 studies) between April 2002 and October 2005. Mean age of patients was 63.4 yrs (range, 52-69 yrs), and mean time since diagnosis was 56 months (range, 11 months - 12 yrs). Initially, 7 patients were in stage I, 3 in stage III, and 1 in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid and 3 non-endometrioid cancers. Results FDG-PET showed infradiaphragmatic uptake in three patients and disseminated disease in seven; findings were negative in one patient. Computed tomography (CT, n=7) or magnetic resonance (MRI, n=7) images revealed infradiaphragmatic lesions in five patients and visceral lesions in two. All patients showed elevated serum tumour markers (CA125, n=9; CA19.9, n=2; CA15.3, n=2). FDG-PET results modified the information provided by conventional imaging techniques in seven patients and provided no additional information in the remaining four. There was histological confirmation of lesions in two patients. Nine patients were clinically followed up, including imaging studies (mean follow-up, 8.7 months; range, 3-20 months).

Utilidad de la tomografía por emisión de positrones en el manejo de los cánceres de cuerpo de útero / Utility of positron emission tomography in the management of uterine body cancer

En la actualidad, la estadificación de los tumoresdel cuerpo uterino es esencialmente quirúrgica. Noexiste consenso ni protocolos definidos para elseguimiento de este tipo de neoplasias. Lastécnicas de diagnóstico por imagen son solicitadasa criterio del clínico, habitualmente ante lasospecha de recurrencia, recidiva o diseminaciónde la enfermedad. Las técnicas de imagenestructural (tomografía computarizada y resonanciamagnética) presentan ciertas limitaciones para ladetección de recurrencias. La tomografía poremisión de positrones es una técnica de imagenfuncional cuya utilidad se ha demostrado enmultitud de neoplasias, que está suscitando ungran interés en los últimos tiempos en el campo dela oncología ginecológica. Se ha realizado unanálisis de los resultados de la bibliografíacientífica disponible sobre la utilidad de estatécnica en los carcinomas endometriales y lossarcomas de útero, tanto en su diagnóstico inicialcomo en su seguimiento

Currently, uterine body tumors are basicallysurgically staged. Established consensus or definedprotocols for the follow up of these neoplasms arelacking. Imaging techniques are usually requestedbased on the clinician’s criteria, usually suspicionof disease recurrence or progression. Structuralimaging techniques, such as computed tomographyor magnetic resonance imaging, present somelimitations in the detection of recurrent disease.Positron emission tomography is a functionalimaging technique with proven utility inneoplasms. In the last few years, interest in thistechnique has grown in the field of gynecologiconcology. We performed a literature review on theutility of positron emission tomography in the evaluation of endometrial cancers and uterinesarcomas, both in initial diagnosis and follow-up