RESUMEN
Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.
Lay abstract To study the clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) in axillary surgery for breast cancer, 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively reviewed with the aim to analyze the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.
Asunto(s)
Neoplasias de la Mama/patología , Metástasis Linfática/diagnóstico , Linfocintigrafia/estadística & datos numéricos , Mastectomía/estadística & datos numéricos , Anciano , Axila , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Incidencia , Periodo Intraoperatorio , Metástasis Linfática/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Ganglio Linfático Centinela/diagnóstico por imagen , Ganglio Linfático Centinela/patología , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricosRESUMEN
BACKGROUND: When managing patients with cancer, lymphedema of the lower limbs (LLL) is commonly reported as secondary to the surgical excision and/or irradiation of lymph nodes (LNs). In the framework of lymphoscintigraphic imaging performed to evaluate secondary LLL, some lympho-nodal presentations have been observed that could not be explained by the applied treatments, suggesting that these LLL might be primary. Therefore, all our lymphoscintigraphic examinations that were performed in patients for LLL after surgery for gynecological or urological cancer were retrospectively analyzed in order to evaluate the frequency in which these LLL might not be secondary (either completely or partially) but primary in origin. METHODS: Lymphoscintigraphies performed in 33 patients who underwent LN dissection (limited to the intra-abdominal LN) with or without radiotherapy for histologically confirmed ovarian cancer (n = 6), uterine cancer (n = 14 with cervical cancer and n = 7 with endometrial cancer), or prostate cancer (n = 6) were compared to lymphoscintigraphies obtained in primary LLL. RESULTS: In 12 (33% of the) patients (3 men plus 9 women, 4 with cervical cancer and 5 with endometrial cancer), scintigraphy of the lower limbs revealed lympho-nodal presentation that did not match with the expected consequences of the surgical and/or radiological treatments and were either suggestive or typical of primary lymphedema. CONCLUSIONS: This retrospective analysis of a limited but well-defined series of patients suggests that the appearance of LLL might not be related to cancer treatment(s) but that these LLL may represent the development of a primary lymphatic disease latent prior to the therapeutic interventions.
Asunto(s)
Neoplasias Endometriales/cirugía , Extremidad Inferior/patología , Escisión del Ganglio Linfático/efectos adversos , Linfedema/diagnóstico , Linfocintigrafia/estadística & datos numéricos , Neoplasias Ováricas/cirugía , Neoplasias de la Próstata/cirugía , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Endometriales/patología , Femenino , Estudios de Seguimiento , Humanos , Linfedema/etiología , Masculino , Persona de Mediana Edad , Neoplasias Ováricas/patología , Pronóstico , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Neoplasias del Cuello Uterino/patologíaRESUMEN
Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99m (Tc-99m) to quantify sentinel nodes before biopsy (SNB). However, recent research suggests that scintigraphy is not an essential adjunct. For service improvement, we stopped using lymphoscintigraphy so as to minimize delay to operating theater and reduce demand on the Nuclear Medicine Department. We audited early outcomes to ensure quality was maintained. 100 consecutive patients undergoing SNB with lymphoscintigrams were investigated. Lymphoscintigrams were reported by Consultant Radiologists. Reported node count (RNC) was compared to biopsied node count (BNC) using Cohen's kappa statistic. Lymphoscintigrams were then discontinued, and the results on the next 69 consecutive patients undergoing SNB were analyzed. The BNC was then compared to BNC in patients having lymphoscintigrams. Of the first 100 patients, RNC ranged from 0-5 (mean=1.84, mode=1) and BNC from 1-4 (mean=1.89, mode=1). 90% of lymphoscintigrams were performed on the day of surgery. Cohen's Kappa statistic was 0.34 (95%CI =0.195 to 0.482, i.e., Fair agreement). RNC was zero in two cases, but SNB was successful. Of 69 patients in the second group with no scan, BNC ranged from 0-4 (mean=1.80, mode=2). There were two cases of failed localization and no significant difference between BNC with or without scans (p=0.16). Sentinel node positivity rate was 36% for those with scans and 25.3% for those without scans, which was not significant (chi-squared, p=0.11). These results correlate to previously published studies. Correlation between RNC and BNC was only in fair agreement, and negative lymphoscintigrams did not result in failed SNB localization. Our study suggests that BNC without scans is safe and effective. Removing the lymphoscintigram will result in measurable cost savings, saving of clinical time (no delay to operating room while waiting for scan or multiple journeys to hospital), freeing the scanner for other scans, and allowing additional time for radiology physicians and staff.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Linfocintigrafia/estadística & datos numéricos , Biopsia del Ganglio Linfático Centinela/métodos , Ganglio Linfático Centinela/diagnóstico por imagen , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Radiofármacos/administración & dosificación , Estudios Retrospectivos , Colorantes de Rosanilina/administración & dosificación , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Azufre Coloidal Tecnecio Tc 99m/administración & dosificaciónRESUMEN
UNLABELLED: The metastatic status of sentinel lymph nodes (SLNs) might be the most important prognostic factor in breast cancer. In this paper, we report to our knowledge the first study of (99m)Tc-rituximab as a radiotracer for imaging of SLNs using lymphoscintigraphy in both preoperative and intraoperative breast cancer patients. METHODS: (99m)Tc-rituximab was designed as an SLN tracer targeting the CD20 antigen, which expresses extensively in LNs. A retrospective study was performed on 2,317 patients with primary breast cancer who underwent lymphoscintigraphy and sentinel lymph node biopsy (SLNB). Before imaging, all patients were administered a preoperative peritumoral injection of 37 MBq of (99m)Tc-rituximab. RESULTS: (99m)Tc-rituximab was synthesized in both high radiolabeling yield and high radiochemical purity (>95%), with molecular integrity and immune activity well maintained. The initial study of 100 breast cancer patients showed that the success rate of SLN lymphoscintigraphy by injection of (99m)Tc-rituximab, as compared with SLNB, was 100%, and the sensitivity, specificity, accuracy, and false negative rate were 97.4%, 100%, 98.0%, and 2.60%, respectively. Of the following 2,217 patients studied, the success rate of lymphoscintigraphy and SLNB was 98.8% and 99.9%, and the average number of SLN was 1.78 (range, 1-10) and 2.85 (range, 1-15). Age was an independent predictor of the number of SLNs identified by lymphoscintigraphy and intraoperative handheld γ-probe (P < 0.05), and other factors-such as sex, imaging time, primary tumor site, histopathologic subtype, clinical T stage, and immunochemistry-were not (P > 0.05). However, the SLN metastatic rates were different in patients with different histopathologic subtype, clinical T stage, and immunochemistry (P < 0.05). CONCLUSION: Here we report the first study of the new radiotracer (99m)Tc-rituximab for breast cancer lymphoscintigraphy. This tracer showed great feasibility, safety, and effectiveness for SLN mapping in breast cancer patients.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Linfocintigrafia/estadística & datos numéricos , Compuestos de Organotecnecio , Ganglio Linfático Centinela/diagnóstico por imagen , Ganglio Linfático Centinela/patología , Adulto , Anciano , Neoplasias de la Mama/epidemiología , China/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Variaciones Dependientes del Observador , Prevalencia , Radiofármacos , Factores de Riesgo , Rituximab , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricosRESUMEN
OBJETIVO: Describir las medidas adoptadas dentro del plan de contingencia del COVID-19 respecto a la biopsia selectiva de ganglio centinela (BSGC) y analizar su impacto sobre la actividad asistencial. METODOLOGÍA: Estudio cualitativo, descriptivo y retrospectivo de BSGC realizadas durante el período del 14/03 al 11/05 de 2020. Análisis de las medidas tomadas para minimizar las probabilidades de contagio y resultados de PCR de pacientes y personal. Comparativa de casos con los realizados en el mismo período de 2019. Actividad diaria de linfogammagrafía y de cirugía radioguiada (CRG) por indicación médica. Cálculo numérico y porcentual de CRG por hospital y recursos humanos diarios de medicina nuclear requeridos. RESULTADOS: Se realizaron 42 intervenciones con BSGC, un 31,1% menos que en 2019. La indicación médica de cáncer de mama experimentó el mayor descenso de actividad (n=18, 41,9%). Del total de CRG, Hospital Clínic realizó el 45,2%, Hospital Maternitat el 31,0%, Hospital Plató el 16,7% y Hospital Sant Joan de Déu el 7,1% restante. En relación con los recursos humanos, la planificación inicial se cumplió en un 77% de los días. El total de los controles PCR a pacientes (n=42) y personal de CRG (n=9) dio resultado negativo. CONCLUSIONES: El COVID-19 influyó negativamente en la actividad asistencial de la BSGC del Hospital Clínic, pero fue compensado por una planificación acertada, basada en el análisis previo de los procesos del procedimiento, que permitió adaptar los recursos de material y personal a las circunstancias cambiantes, otorgándole una flexibilidad que posibilitó el cumplimiento de la programación establecida
OBJECTIVE: To describe the measures taken within the COVID-19 contingency plan concerning sentinel lymph node biopsy (SNB) procedures and to assess their impact on healthcare activity. METHODOLOGY: Qualitative, descriptive and retrospective study of SNB procedures conducted during the lockdown period of COVID-19 (14/03 to 11/05 2020). Analysis of measures taken to minimise the chances of contagion and PCR outcomes of patients and staff. Comparison with SNB procedures conducted in the same time interval in 2019. Daily activity of lymphoscintigraphy and radioguided surgery (RGS) by medical indication. Numerical and percentage calculation of RGS by hospital and daily requirements for human resources in nuclear medicine. RESULTS: Forty-two SNB were performed, representing 31.1% less than those conducted in the same period in 2019. The medical indication of breast cancer showed the greatest activity decrease (n=18, 41.9%). RGS was performed in 45.2% of patients in Hospital Clínic, 31.0% in Maternitat, 16.7% in Plató and 7.1% in Sant Joan de Déu Hospital. Concerning the human resources required, the initial planning was accomplished in 77% of the days (24/31). All the PCR samples from patients (n=42) and RGS staff (n=9) were negative for COVID-19. CONCLUSIONS: COVID-19 negatively influenced the healthcare activity of SNB in Hospital Clínic, but was compensated by adequate planning, based on prior analysis of the procedure's processes, which allowed adaptation of material and personnel resources to the changing circumstances. This allowed flexibility, which in turn enabled compliance with the established schedule
Asunto(s)
Humanos , Neoplasias de la Mama/patología , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Reacción en Cadena de la Polimerasa/estadística & datos numéricos , Cirugía Asistida por Computador/estadística & datos numéricos , Linfocintigrafia/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Precauciones Universales/métodos , Pandemias/estadística & datos numéricos , Biopsia del Ganglio Linfático Centinela/métodos , Estudios Retrospectivos , Servicio de Medicina Nuclear en Hospital/estadística & datos numéricos , Administración de la Seguridad/métodosRESUMEN
AIM: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. METHODS: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. RESULTS: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. CONCLUSION: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/metabolismo , Carcinoma , Ganglios Linfáticos/diagnóstico por imagen , Linfocintigrafia/estadística & datos numéricos , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/farmacocinética , Adulto , Anciano , Neoplasias de la Mama/epidemiología , Carcinoma/diagnóstico por imagen , Carcinoma/metabolismo , Carcinoma/secundario , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Metástasis Linfática , Linfocintigrafia/métodos , Tasa de Depuración Metabólica , Persona de Mediana Edad , Prevalencia , Pronóstico , Radiofármacos/farmacocinética , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , España/epidemiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Linfocintigrafia/estadística & datos numéricos , Linfedema/diagnóstico por imagen , Lipomatosis/diagnóstico por imagen , Diagnóstico Diferencial , 24960/métodosRESUMEN
No disponible