ABSTRACT
Objetivo. Evaluar la validez diagnóstica de la tomografía por emisión de positrones con 18F-fluoro-2-deoxi-D-glucosa y la tomografía computarizada (PET/TAC) en la estadificación ganglionar mediastínica (N2) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) y analizar el papel de la estadificación mediante pruebas invasivas para la verificación de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computerizada (TAC). Material y métodos. Estudio retrospectivo incluyendo a pacientes con diagnóstico histopatológico de CPCNP, estadificados como N2 mediante TAC+C y estudiados con PET/TAC. Se confirmaron mediante análisis histopatológico de la pieza quirúrgica cuando se dispuso o por consenso iconográfico en el comité de tumores torácicos. Se ha calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del estudio PET/TAC en la correcta clasificación de los pacientes N2. Resultados. Se incluyeron 34 pacientes clasificados como N2 mediante TAC+C. El PET/TAC clasificó a 30 pacientes como estadio N2. Se encontraron discrepancias en 4 pacientes, dos clasificados como N1 y dos como N0. Los resultados fueron confirmados histológicamente en 20 pacientes. El estudio PET/TAC no mostró falsos positivos. La sensibilidad fue del 94,7%, la especificidad y el valor predictivo positivo fue del 100% y el valor predictivo negativo del 50%. Conclusiones. El estudio PET/TAC presenta una alta sensibilidad y valor predictivo positivo en la correcta clasificación de pacientes con afectación ganglionar mediastínica (N2). Nuestros resultados sugieren que en pacientes con cáncer de pulmón potencialmente resecable, candidatos a tratamiento con quimioterapia neoadyuvante, la mediastinoscopia podría reservarse para la re-estadificación(AU)
Purpose. To evaluate the accuracy of integrated positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. Material and methods. A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. Results. A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. Conclusions. Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Lung Neoplasms , Mediastinoscopy , Sensitivity and Specificity , Positron-Emission Tomography , /methods , /methods , Mediastinoscopy/trends , Mediastinal Neoplasms , Retrospective Studies , Predictive Value of Tests , Epidermal Cyst/complications , Lymph NodesABSTRACT
PURPOSE: To evaluate the accuracy of integrated positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. MATERIAL AND METHODS: A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. RESULTS: A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. CONCLUSIONS: Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Mediastinum/diagnostic imaging , Multimodal Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lung Neoplasms/pathology , Male , Mediastinum/pathology , Middle Aged , Neoplasm Staging/methods , Retrospective StudiesABSTRACT
Presentamos y describimos el caso de una mujer mayor con un cuadro de deterioro cognitivo asociado a diversos trastornos biopsicológicos y de comportamiento. Destacamos, como principal característica, la tendencia habitual a adquirir, coleccionar y acumular en el domicilio, plantas y flores en macetas de todo tipo. Realizada la valoración geriátrica integral, la semiología del proceso y la sintomatología abigarrada nos indican la clínica de una enfermedad típicamente geriátrica. Describimos el cuadro sindrómico, el diagnóstico precoz y la actuación integral para resolver o detener la patología. El contexto personal, familiar y social de la paciente, así como las características de la enfermedad, hacen interesante su conocimiento, sus implicaciones y el abordaje terapéutico multidisciplinar. A este novedoso cuadro psicogeriátrico lo denominamos Síndrome de Loto, alusivo a la antigua flor de la Mitología Griega
We present and we describe the case of an older woman with symptoms of cognitive deterioration associated to diverse biopsychological dysfunctions and of behavior. We highlight as main characteristic the habitual tendency to acquire, to collect and to accumulate in the home plants and flowers in gavels of all type. Carried out the comprehensive geriatric assessment, the semiology of the process and the motley sintomathology, indicate us typically the clinic of a geriatric illness. We describe the syndromic symptoms, the precocious diagnose and the integral performance to solve or stop the pathology. The personal, familiar and social context of the patient, as well as the characteristics of the illness, make interesting their knowledge, their implications and the therapeutic multidisciplinar boarding. To this novel psicogeriatric symtom we denominate it Syndrome of Lotus, allusive to the old flower of the Greek Mythology
