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1.
In Vivo ; 34(3 Suppl): 1667-1673, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503827

RESUMO

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/métodos , Mastectomia/estatística & dados numéricos , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/enfermagem , Carcinoma/tratamento farmacológico , Carcinoma/epidemiologia , Carcinoma/enfermagem , Técnicas de Laboratório Clínico , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Feminino , Unidades Hospitalares/organização & administração , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Metástase Linfática/diagnóstico por imagem , Linfocintigrafia , Mastectomia Segmentar/estatística & dados numéricos , Terapia Neoadjuvante , Alta do Paciente , Equipamentos de Proteção , Biópsia de Linfonodo Sentinela , Avaliação de Sintomas , Telemedicina , Triagem
2.
Phys Ther ; 100(5): 766-772, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-31944248

RESUMO

BACKGROUND: Primary lower limb lymphedema is a chronic debilitating disorder without curative treatment. The initial treatment phase is dedicated to reducing lymphedema volume, whereas the second aims to stabilize that volume. OBJECTIVE: The objective of this study was to analyze clinical and lymphoscintigraphic characteristics during complete decongestive physical therapy as predictors of primary unilateral lower limb lymphedema-volume reduction. DESIGN: This observational, retrospective study included 222 consecutive patients (January 2009-January 2017; median age: 45.8 years) with lymphedema affecting the entire lower limb, who received complete decongestive physical therapy for the first time in a specialized lymphedema management center. METHODS: Complete decongestive physical therapy consisted of low-stretch bandaging, manual lymph drainage, exercises, and skin care for all patients. Lymphoscintigraphy preceded treatment. RESULTS: Median lymphedema evolution was 73 months, and median excess volume was 34%. Median (interquartile range) lymphedema volumes were 2845 (1038-3487) mL before and 1276 (601-2195) mL after a median of 11 days of complete decongestive physical therapy, with 34% median reduction. Multivariate analyses retained age, body mass index >40 kg/m2, and previous cellulitis, as independently associated with lymphedema volume reduction. For each additional year of age, volume reduction increased 0.16%. Unexpectedly, log-transformed initial lymphedema volumes indicated a negative impact, that is, 4.95%, for each log-unit gain. Patients with previous cellulitis episode(s) obtained 6.9% and those with BMI >40 kg/m2 17.1% higher lymphedema volume reductions. Lower limb lymphoscintigraphy was available for 150 (67.6%) patients. Having dermal back flow was associated with greater lymphedema volume reduction than not (respectively, 39% vs 31%). LIMITATIONS: This study was retrospective, and only 67.6% of patients underwent lymphoscintigraphy. CONCLUSION: Our analysis identified clinical and scintigraphic predictors of primary lymphedema volume reduction for patients with unilateral disease. Lymphoscintigraphy helps confirm lymphedema and predict volume reduction. Further study is required to confirm these observations.


Assuntos
Bandagens Compressivas , Extremidade Inferior , Linfedema/diagnóstico por imagem , Linfedema/terapia , Linfocintigrafia , Modalidades de Fisioterapia , Feminino , Humanos , Masculino , Drenagem Linfática Manual , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
J Surg Oncol ; 121(1): 37-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31209893

RESUMO

Appropriate diagnosis, staging and a further selection of the best treatment are fundamental for the management of patients with extremity lymphedema. Several clinical and imaging tools have been described for these purposes. Lymphoscintigraphy is still considered the gold standard imaging modality for diagnosing lymphedema. However, protocol variability and poor image resolution can make the interpretation challenging. Here, we reviewed technical aspects of lymphoscintigraphy, interpretation of the lymphoscintigraphy findings, staging, and its clinical application.


Assuntos
Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Humanos , Linfocintigrafia/normas
4.
J Surg Oncol ; 121(1): 51-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31612513

RESUMO

BACKGROUND: The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)-lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. MATERIALS AND METHODS: In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. RESULTS: In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2-6) at each patient. Of the ultrasound-detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. CONCLUSION: Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG-lymphangiography.


Assuntos
Anastomose Cirúrgica/métodos , Vasos Linfáticos/diagnóstico por imagem , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Linfocintigrafia , Masculino , Ultrassonografia/métodos
5.
J Surg Oncol ; 121(3): 422-434, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31875981

RESUMO

BACKGROUND: This study was to investigate the lymphoscintigraphy findings for the diagnosis and severity in unilateral gynecological cancer-related lymphedema (GCRL) and to correlate lymphoscintigraphy stages with the clinical findings. METHODS: Patients with unilateral GCRL who underwent lymphoscintigraphy were staged using the presence of ileo-inguinal lymph nodes, distal-lymphatic ducts, and dermal backflow findings. Taiwan Lymphoscintigraphy Staging (TLS) was divided into three patterns and seven stages: normal drainage (L-0); partial obstruction (P-1, P-2, and P-3); and total obstruction (T4, T-5, and T-6). Correlations between clinical lymphedema severity and TLS were evaluated using analysis of variance and multivariable linear regression analyses. RESULTS: A total of 141 patients with unilateral GCRL were divided as follows: 6 (4.3%) in normal drainage, 56 (39.7%) in partial-obstruction, and 79 (56%) in total obstruction. Cellulitis episodes, circumferential difference, and computed tomography (CT) volumetric difference were shown to be statistically different between TLS stages (P < .001 for all). Total obstruction stages were the most significant factors associated with the severity of circumferential difference (ß = 19.72, 25.54, 32.42, respectively; P < .05) and CT volumetric difference (ß = 36.04, 45.12, 52.78, respectively; P < .01). CONCLUSIONS: Total lymphatic obstruction was present in 56% of unilateral GCGL. Lymphoscintigraphy stages were statistically correlated with episodes of cellulitis, circumferential difference and CT volumetric difference in unilateral GCRL.


Assuntos
Neoplasias dos Genitais Femininos/diagnóstico por imagem , Sistema Linfático/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/complicações , Humanos , Linfedema/etiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
6.
PLoS One ; 14(12): e0224457, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31821335

RESUMO

No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.


Assuntos
Algoritmos , Fibrose/diagnóstico , Imageamento Tridimensional/métodos , Linfedema/complicações , Tomografia Computadorizada por Raios X/métodos , Estudos de Coortes , Estudos Transversais , Impedância Elétrica , Estudos de Viabilidade , Feminino , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Humanos , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade
7.
Medicine (Baltimore) ; 98(49): e18274, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804367

RESUMO

Chikungunya fever (CHIKF) is an arbovirus characterized by acute fever, myalgia and polyarthralgia. Lymphedema in the lower limbs (LL) was observed in several patients during an outbreak of CHIKF in the state of Pernambuco (Brazil) in 2016. No reports on lymphatic vessels disease due to CHIKF have been described. The aim of the study was to follow lymphatic abnormalities in the LL of 16 patients with CHIKF, using lymphoscintigraphy.An observational, prospective study with patients in the acute phase of CHIKF (confirmed serological diagnosis) with LL edema submitted to clinical evaluation and lymphoscintigraphy at baseline and after 90 days.Sixteen patients (81% females) participated in this study. All patients presented with lower limb lymphedema, being 15 (94%) bilateral. Of the 31 limbs affected by lymphedema, 24 (77%) presented abnormalities in lymphatic drainage by lymphoscintigraphy. The delay to visualize pelvic lymph nodes was the most frequent lymphoscintigraphic abnormality, observed in 16 (51,6%) LL. Nine (56%) patients were clinically reevaluated after 90 days, and all 18 LL remained with lymphedema. A second lymphoscintigraphy showed persistent abnormalities in 13 (72%) of the 18 LL.CHIKF can lead to lymphedema, and lymphedema may persist or progress after 3 months of the acute phases of the disease.


Assuntos
Febre de Chikungunya/complicações , Extremidade Inferior , Linfedema/virologia , Feminino , Humanos , Linfedema/diagnóstico por imagem , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia
8.
Lymphology ; 52(3): 149-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31874127

RESUMO

Single site Multiple Lymphatic-Venous Anastomoses (MLVA) provides optimal functional and cosmetic results with low complication rates in treatment of lower limb lymphedema. However, no evidence exists in literature concerning the use of this technique in treatment of peno-scrotal lymphedema. We report a case of a 44-year-old male patient who developed secondary peno-scrotal lymphedema with severe lymphorrhea, following a laser treatment for scrotal pustolosis, leading to recurrent infections and finally an established peno-scrotal lymphedema. Utilizing MLVA, a complete remission of scrotal lymphedema was achieved with significant volume reduction of the penile lymphedema. The post-operative course was uneventful with clear improvement in lymphatic flow demonstrable on lymphoscintigraphy (6 months) and no recurrence of scrotal lymphedema at 2 years follow-up. This article reports very promising results of a novel application of MLVA in the treatment of genital lymphedema and suggests that MLVA provides the possibility to shunt both superficial and deep lymphatics to improve the lymphatic drainage from the peno-scrotal area using a single surgical site.


Assuntos
Anastomose Cirúrgica/métodos , Drenagem/métodos , Linfedema/diagnóstico , Linfedema/cirurgia , Microcirurgia , Pênis/patologia , Escroto/patologia , Adulto , Anastomose Cirúrgica/efeitos adversos , Humanos , Vasos Linfáticos/cirurgia , Linfedema/etiologia , Linfocintigrafia , Masculino , Microcirurgia/métodos , Pênis/cirurgia , Escroto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias/cirurgia
9.
Plast Reconstr Surg ; 144(5): 1214-1224, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688769

RESUMO

BACKGROUND: Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive. METHODS: From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors' hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post-lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded. RESULTS: No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green-enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent). CONCLUSION: With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Microcirurgia/métodos , Veias/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , China , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Extremidade Inferior/cirurgia , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
10.
Nucl Med Commun ; 40(11): 1138-1147, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31568193

RESUMO

OBJECTIVE: Oral cancer ranks in the top three of all cancers in India, accounting for over 30% of all cancers reported. Elective neck dissection (END) is the mainstay of treatment in early disease. Performing ENDs for node negative (N0) patients can result in significant morbidity with questionable benefit and impair the patients' quality of life. Sentinel Lymph Node Biopsy (SLNB), is an emerging investigation helping in risk stratification of patients with early oral cancer and node negative disease. SLNB is a simple, easy to perform investigation with a high sensitivity and plays a major role in avoiding neck dissection. Studies have compared SLNB-based neck dissection with END in early oral cancers, and also on survival benefit with prophylactic neck dissection at the time of primary surgery as compared to watchful waiting followed by therapeutic neck dissection for nodal relapse, in patients with clinical N0 (cN0) oral squamous cell carcinoma (OSCC) on literature search. AIM: Our primary aim was to determine the effectiveness of lymphoscintigraphy in OSCC in clinically neck node negative (cN0) patients in comparison to gold standard END for nodal metastases identification and secondly to assess the utility of gamma probe in guiding SLNB in this group of patients. MATERIALS AND METHODS: Fifty-eight patients (M:F = 42:16) with histologically confirmed OSCC of T1-3 stage with cN0 and planned for curative intent primary surgical treatment were divided into two arms. All patients underwent sentinel lymph node (SLN) imaging and biopsy. Arm 1 underwent nodal dissection based on SLNB positivity, while all patients in arm 2 had wide neck dissection irrespective of SLNB findings. RESULTS: SLN was detected in all 58 patients, 96.4% patients showed SLN immediately postinjection. More than one SLN was found in 94.3% patients and 6.8% patients showed contralateral SLN also. Higher proportion of nodal metastasis were observed in tongue cancers than in remaining floor of mouth and buccal mucosa cancers (38% vs 12%, P< 0.01). We also found significant association between T size and nodal metastasis in our series. Sensitivity of SLNB was 88.23% with a specificity of 100%, both for SLN imaging and gamma probing localization reflecting the reliability of this technique. Serial step sectioning at 150 micrometre is recommended. SLNB showed positive nodes in 29.3 % patients with cN0 neck. We found that the association between the outcome in both arms was not statistically significant. On follow-up, three patients with T3N0 OSCC of arm 2 had nodal recurrence/lung metastases. One patient of arm 1 had nodal recurrence. Two patients expired within one year. As high as 73% patients (22 negative necks out of 30) had unwarranted neck dissection in arm 2. CONCLUSION: SLNB is an effective method to circumvent unwarranted neck dissection in early OSCC and prevent complications. Gamma probing is a robust and easy tool to identify SLN in T1-3 stages with N0 necks clinically. A positive SLNB is found to be reliable in guiding neck dissection in this small study. Larger studies are warranted to establish its recommendation in routine clinical practice.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Raios gama , Linfocintigrafia , Neoplasias Bucais/diagnóstico por imagem , Esvaziamento Cervical , Linfonodo Sentinela/diagnóstico por imagem , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Estadiamento de Neoplasias
12.
BMC Cancer ; 19(1): 985, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640623

RESUMO

BACKGROUND: Breast cancer related lymphoedema (BCRL) is a common side effect of cancer treatment. Recently indocyanine green (ICG) fluorescent lymphography has become a popular method for imaging the lymphatics, however there are no standard protocols nor imaging criteria. We have developed a prospective protocol to aid in the diagnosis and therapeutic management of BCRL. METHODS: Lymphatic imaging procedures were conducted in three phases. Following initial observation of spontaneous movement of ICG in phase one, manual lymphatic drainage (MLD) massage was applied to facilitate ICG transit via the lymphatics in phase two. All imaging data was collected in phase three. Continuous lymphatic imaging of the upper limb was conducted for approximately an hour and lymphatic drainage pathways were determined. Correlations between the drainage pathway and MD Anderson Cancer Centre (MDACC) ICG lymphoedema stage were investigated. RESULTS: One hundred and three upper limbs with BCRL were assessed with this new protocol. Despite most of the patients having undergone axillary node dissection, the ipsilateral axilla drainage pathway was the most common (67% of upper limbs). We found drainage to the ipsilateral axilla decreased as MDACC stage increased. Our results suggest that the axillary pathway remained patent for over two-thirds of patients, rather than completely obstructed as conventionally thought to be the case for BCRL. CONCLUSIONS: We developed a new ICG lymphography protocol for diagnosing BCRL focusing on identification of an individual patient's lymphatic drainage pathway after lymph node surgery. The new ICG lymphography protocol will allow a personalised approach to manual lymphatic drainage massage and potentially surgery.


Assuntos
Linfedema Relacionado a Câncer de Mama/diagnóstico por imagem , Corantes/química , Verde de Indocianina/química , Linfografia/métodos , Drenagem Linfática Manual/métodos , Idoso , Axila/cirurgia , Feminino , Fluorescência , Humanos , Excisão de Linfonodo , Vasos Linfáticos/diagnóstico por imagem , Linfocintigrafia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Extremidade Superior/diagnóstico por imagem
13.
BMC Cancer ; 19(1): 956, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615471

RESUMO

BACKGROUND: 99mTc-Rituximab is a new specific radiopharmaceutical that binds to the CD20 receptor which is highly expressed on the surface of B cells. We conducted a study in which 99mTc-Rituximab was compared with filtered 99mTc-sulfur colloid (fTcSC) for sentinel lymph node (SLN) detection in patients with breast cancer. METHOD: The study is divided into three parts. 1. Initially, 25 patients were selected for an internal controlled trial to received both 99mTc-Rituximab and fTcSC, the interval time is separated by ≥2 days. 2. Then, 91 patients were selected for a randomized controlled trial (41 and 50 patients in the 99mTc-Rituximab and fTcSC groups, respectively). All patients were administered either agent at the 6- and 12-o' clock positions by subareolar injection technique. SLN mapping was then performed 2 h after injection. 3. Serial dynamic images were further acquired for 2 h in 31 patients (22 and 9 patients from 99mTc-Rituximab and fTcSC cohorts, respectively). RESULTS: The identification rate of lymphoscintigraphy and SLNB in all and axilla regions for 99mTc-Rituximab and 99mTc-SC were 98.5% vs 98.7, 100% vs 98.4%, respectively. The mean number of SLNs identified by 99mTc-Rituximab and fTcSC was respectively 2.72 and 3.28, with a significant difference of P = 0.013 (paired sample t-test). The difference exists in the internal mammary and clavicular area, not in the axillary. The mean number of axillary sentinel lymph node biopsy (SLNB) for 99mTc-Rituximab and fTcSC was 2.95 vs 3.14, respectively, and no significant difference existed. 99mTc-Rituximab also exhibited a significantly faster injection site clearance rate when compared with fTcSC (0.193 ± 0.057 h- 1 vs 0.021 ± 0.007 h- 1, respectively). CONCLUSION: No significant difference was observed in identification rate and number of axillary SLN imaging and SLNB, between the two tracers. Compared to fTcSC, 99mTc-Rituximab based imaging demonstrated a fewer number of secondary lymph nodes and had faster injection site clearance rate. TRIAL REGISTRATION: www.chictr.org.cn, ChiCTR1900024990 (retrospectively registered August 6, 2019).


Assuntos
Neoplasias da Mama/patologia , Coloides/química , Compostos de Organotecnécio/administração & dosagem , Rituximab/química , Linfonodo Sentinela/diagnóstico por imagem , Radioisótopos de Enxofre/química , Tecnécio/química , Adulto , Idoso , Axila , Estudos de Coortes , Feminino , Meia-Vida , Humanos , Linfocintigrafia/métodos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela
14.
Radiat Oncol ; 14(1): 159, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477153

RESUMO

BACKGROUND: This study aimed to evaluate the impact of previous local treatment on lymphatic drainage patterns in ipsilateral breast tumor recurrence (IBTR) based on our data on re-operative sentinel lymph node biopsy (re-SLNB) for IBTR. METHODS: Between April 2005 and December 2016, re-SLNB using lymphoscintigraphy with Tc-99 m phytate was performed in 136 patients with cN0 IBTR. Patients were categorized into two groups: the AX group included 55 patients with previous axillary lymph node dissection; the non-AX group included 69 patients with previous SLNB and 12 patients with no axillary surgery. The whole breast irradiation (RT) after initial surgery had performed in 17 patients in the AX group and 27 patients in the non-AX group. RESULTS: Lymphatic drainage was visualized in 80% of the AX group and 95% of the non-AX group (P < 0.01). The visualization rate of lymphatic drainage was associated with the number of removed lymph nodes in prior surgery. In the non-AX group, lymphatic drainage was visualized in 96% of patients without RT and 93% with RT. Lymphatic drainage was observed at the ipsilateral axilla in 98% of patients without RT and in 64% with RT (P < 0.0001). Aberrant drainage was significantly more common in patients with RT than without RT (60% vs. 19%, P < 0.001); it was observed mostly to the contralateral axilla (52% vs. 2%, P < 0.0001). In the AX group, patients with previous RT showed decreased lymphatic drainage to the ipsilateral axilla compared to those without RT (29% vs. 63%, P < 0.05) and increased aberrant drainage to the contralateral axilla (64% vs. 5%, P < 0.0001). CONCLUSION: Lymphatic drainage patterns altered in re-SLNB in patients with IBTR and previous ALND and RT were associated with alterations in lymphatic drainage patterns.


Assuntos
Neoplasias da Mama/patologia , Drenagem/métodos , Linfonodos/patologia , Recidiva Local de Neoplasia/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Linfocintigrafia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Reoperação , Estudos Retrospectivos
15.
Surg Oncol ; 30: 1-5, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31500769

RESUMO

INTRODUCTION: Sentinel node biopsy for axillary staging in node positive patients after neoadjuvant treatment is controversial, mainly due to high false negative rates. We examined the concordance between the location of the hot nodes identified on PET-CT at presentation with the location of the sentinel nodes. MATERAILS AND METHODS: Fifty-eight breast cancer patients undergoing neoadjuvant treatment between January 2013 and September 2018 who had positive regional lymph nodes on PET/CT, and a SPECT/CT lymphoscintigraphy completed before sentinel node biopsy were included. Patient, tumor and treatment characteristics were collected. Images of PET/CT were compared to images of SPECT/CT lymphoscintigraphy post treatment and concordance between location of the hot nodes on PET/CT with the sentinel nodes visualized on SPECT/CT was assessed. Association between patient, tumor and treatment characteristics and concordance between the sentinel node and the hot nodes was determined. RESULTS: Sentinel nodes were identified in 53 (91%) of the cases in surgery. In 25 (43%) patients, axillary nodes were positive after treatment. In 16 (28%; 95% CI 18, 40) the sentinel node was not one of the hot nodes seen on PET/CT at presentation. Twenty-three (40%) patients had excision of additional axillary nodes. In two patients with non-concordant sentinel nodes, the sentinel node was falsely negative. CONCLUSIONS: In node positive patients who undergo neoadjuvant treatment, the sentinel node visualized on lymphatic mapping is not necessarily one of the hot nodes identified on PET/CT at presentation. These findings underline the importance of marking the pathologically proven lymph node and excising it as well as the sentinel nodes after treatment.


Assuntos
Neoplasias da Mama/patologia , Linfocintigrafia/métodos , Terapia Neoadjuvante/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Adulto Jovem
16.
Eur J Obstet Gynecol Reprod Biol ; 241: 30-34, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419693

RESUMO

OBJECTIVE: To evaluate the experience with sentinel lymph node (SLN) biopsy in patients with early-stage cervical cancer at our hospital, and to analyze factors influencing the rate of false negatives. STUDY DESIGN: This study was carried out at the Vall d'Hebron Hospital (Barcelona, Spain) between September 2000 and October 2016. All patients underwent SLN biopsy and systematic and bilateral pelvic lymphadenectomy, followed by radical hysterectomy. SLNs were analyzed by the pathologist by staining with hematoxylin-eosin and immunohistochemistry. RESULTS: Patients (N = 128) had been diagnosed with early-stage cervical cancer (FIGO-2009 stages 1A2, IB1, and IIA1). The combined SLN detection rate (99-technecium and a blue dye) was 98.4%, bilateral in 76% of the patients. Positive SLNs were found in 19 patients (14.8%). Sensitivity of detection was 79.2% (CI95, 57.9-92.9), false negative rate 20.8% (CI95, 7.1-42.2), and negative predictive value 95.4% (CI95, 89.6-98.5). False negative cases were observed in 5 patients with tumors >2 cm and presenting lymphovascular space invasion. Micrometastases were detected during SLN ultrastaging in 3 patients (2.3%). The median follow-up was 8.24 years and the 5-year overall survival (OS) was 88.4% (CI95, 80.9-93.1). CONCLUSION: SLN mapping and biopsy in early-stage cervical cancer is feasible and has high sensitivity to detect patients with initial metastases. The risk of false negatives could be lower in certain groups of patients, such as those with tumors ≤2 cm and no lymphovascular space invasion, but future studies will be required to test this hypothesis.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Reações Falso-Negativas , Feminino , Humanos , Linfonodos/patologia , Linfocintigrafia , Pessoa de Meia-Idade , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Espanha/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
18.
J Surg Oncol ; 120(6): 911-918, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376162

RESUMO

BACKGROUND: A new technique named "Selected Lymph Node" ("SeLyN") was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. METHODS: Bilateral lower-limb SPECT-CT was performed in the upper-limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor-site complications were recorded and lower-limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. RESULTS: A total of 41 patients underwent a "SeLyN" transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow-up period of 42.5 months. CONCLUSIONS: "SeLyN" is a safe and effective technique in selecting the most suitable LNs, minimizing the donor-site morbidity, and decreasing the overall operating time.


Assuntos
Neoplasias da Mama/cirurgia , Virilha/cirurgia , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/cirurgia , Linfocintigrafia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Masculino , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
19.
Ann Surg Oncol ; 26(11): 3550-3560, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313036

RESUMO

INTRODUCTION: The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS: Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS: Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS: With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.


Assuntos
Fluorescência , Verde de Indocianina , Linfocintigrafia/métodos , Melanoma/patologia , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Corantes , Feminino , Seguimentos , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Adulto Jovem
20.
Clin Nucl Med ; 44(8): 669-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274620

RESUMO

Stress-lymphoscintigraphy evaluates the effects of exercise on lymph drainage. Results may predict outcomes of complex physical therapy as a first-line lymphedema treatment. Microsurgical approaches are best in patients with lymphangectasia or dermal backflow. Lymphatic pathway mapping helps plan lympho-venous anastomoses. For improved lymphatic visualization, we suggest a scan at rest, after a quick exercise (stepping or weight lifting for 2 min) and delayed scanning after prolonged symptom limited exercise (walking or hand squeezing for 30-40 min). In advanced lymphedema, identification of lymph pathways and residual regional lymph nodes might be difficult. In these patients, lymph node transplant is suggested.


Assuntos
Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Idoso , Gerenciamento Clínico , Diagnóstico Precoce , Teste de Esforço/métodos , Feminino , Humanos , Linfedema/terapia , Pessoa de Meia-Idade
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