[Use of platelet concentrates: a regional experience]. / Utilisation des concentrés plaquettaires : expérience d'une région.

PURPOSE OF THE STUDY: The Établissement français du sang (EFS) distributes two types of platelet concentrates: using a single donor in aphaeresis platelet concentrate (SDAP), versus pooled platelet concentrates (PPC). A retrospective study performed by the Blood Derivatives Group at Observatory for Drugs, Medical Devices and Therapeutic Innovations (OMEDIT), in collaboration with EFS and haemovigilance correspondents from eight regional health care establishments, has analyzed platelet concentrates prescriptions and the position of the prescribers concerning PPC supply. MATERIAL AND METHODS: Between the 2nd and 6th June 2008, 151 platelet concentrates were supplied by ESF. Data were collected for 144 platelet concentrates and in 83 transfused patients with an average age of 50years. During this study, 33 PPC (23%) and 111 SDAP (77%) were supplied. RESULTS: With regards to the 111 SDAP, the supply of PPC was refused in 47 cases (42%), accepted in 18 cases (16%) and unknown for 46 cases (42%). A total of 51 PPC could be supplied during this period, which represented 35% of platelet concentrates prescriptions. The rate of platelets before transfusion was known for 121 platelet concentrates, the median was 32G·L(-1) for SDAP and 44G·L(-1) for PPC. CONCLUSION: More frequent PPC use, with comparable therapeutic efficacy, could be interesting in a context of increasing platelet concentrates consumption in health care establishments. Moreover, prescribers did not seem to be against the idea. An information pamphlet on platelet concentrates was drafted and distributed to prescribers in order to promote the prescription of PPC. A second assessment is planned to measure the impact of this communication.

[Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer]. / Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama.

OBJECTIVE: The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. MATERIAL AND METHODS: 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24 h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. RESULTS: No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (>90 %) and FNR (< or = 6 %) were found in both groups. CONCLUSIONS: The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group.

Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama / Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer

Objetivo. Analizar las detecciones radioisotópica y quirúrgica del ganglio centinela (GC) en el carcinoma no palpable de mama (CNPM) y comparar los resultados en este grupo con los del grupo de tumores palpables de mama (CPM). Material y métodos. Se estudian 199 pacientes. Se les realizó biopsia del GC y linfadenectomía axilar (LDNA). Se establecen dos grupos: CNPM y CPM. La cirugía tuvo lugar entre las 4-24 horas de la administración peritumoral de 111MBq de 99mTc-nanocoloide. La histopatología del GC fue mediante impronta peroperatoria y estudio diferido. Se analiza el porcentaje de detección gammagráfica y quirúrgica y la vía de drenaje del GC según la palpación del tumor y su localización en la mama; los verdaderos positivos (VP), verdaderos negativos (VN), falsos negativos (FN), la sensibilidad (S), el valor predictivo negativo (VPN), la tasa de falsos negativos (TFN) y la precisión global (PG) de la técnica. Resultados. No se observaron diferencias estadísticamente significativas (p > 0,05) ni en la detección gammagráfica y quirúrgica del GC, ni en la existencia de drenaje a mamaria interna (p = 0,211) entre ambos grupos. La prevalencia de metástasis axilar fue menor en el grupo CNPM (p = 0,019). La S, el VPN y la PG de la técnica fue similar en los dos grupos (> 90 %), así como la TFN (<= 6 %). Conclusiones. La fiabilidad de la técnica es similar en los dos grupos. El drenaje predominante es axilar. El drenaje a mamaria interna predominó en los tumores mediales y en CNPM. La prevalencia metastásica axilar es menor en el CNPM

Objective. The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. Material and methods. 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. Results. No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (> 90 %) and FNR (<= 6 %) were found in both groups. Conclusions. The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group

[Clinical utility of fused 67Ga SPECT/CT scan images in patients with lymphoma]. / Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma.

AIM: The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. MATERIAL AND METHOD: 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. RESULTS: 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. CONCLUSION: To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46% of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies.

Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma / Clinical utility of fused 67GA SPECT/CT scan images in patients with lymphoma

Objetivo. El objetivo de este trabajo es la valoración de la utilidad clínica de las imágenes de fusión SPECT 67Ga/TC en los pacientes afectos de procesos linfoproliferativos. Material y método. Se estudiaron 44 pacientes (22 hombres) con linfoma (22 enfermedad de Hodgkin, 22 linfoma no Hodgkin). Se realizaron 59 estudios con una gammacámara híbrida, adquiriéndose consecutivamente un rastreo de cuerpo entero, un SPECT y una tomografía computarizada (TC) de la zona/s afecta/s para su fusión con el SPECT. El estudio de fusión se centró en las siguientes áreas: 33 tóraco-cervical (T), 24 abdomen (A) y 2 cráneo-cervical (CC). Las imágenes fueron evaluadas por 2 médicos nucleares sin conocimiento de los datos del paciente, clasificando la aportación de la fusión de imágenes respecto al SPECT como: no cambia, mejora la localización o extensión de las lesiones y cambia la estadificación. Se confirmaron los resultados con la realización de una TC de alta resolución en el periodo de un mes. Resultados. En 32/59 estudios no se observaron cambios (20 T, 12 A), en 23/59 estudios cambió la localización o extensión de las lesiones (12 T, 9 A y 2 CC) y en 4/59 estudios (1 T y 3 A) el cambio de localización implicó un cambio de estadificación respecto al observado en el SPECT. Conclusión. La realización de estudios de fusión de imágenes SPECT 67Ga/TC en pacientes con linfoma permite mejorar la precisión diagnóstica en un 46 % de los casos, principalmente en los estudios abdominales, óseos y del área diafragmática

Aim. The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. Material and method. 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. Results. 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. Conclusion. To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46 % of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies

Subdermal re-injection: a method to increase surgical detection of the sentinel node in breast cancer without increasing the false-negative rate.

PURPOSE: The aim of this study was to evaluate in breast cancer whether subdermal (SB) re-injection improves surgical detection (SD) of the sentinel node (SN) in patients with negative lymphoscintigraphy on peritumoral (PT) injection, without increasing the false-negative (FN) rate. METHODS: Group I comprised 261 patients with invasive breast cancer >3 cm and clinically negative axilla treated with primary chemotherapy. Axillary lymphadenectomy was performed in all of these patients. Group IA comprised 201 patients with PT injection, while group IB comprised 60 patients with SB injection in the tumour quadrant. Group II comprised 652 patients with breast cancer <3 cm; in 73 of these patients with negative lymphoscintigraphy, SB re-injection was performed. For lymphoscintigraphy, 37-55 MBq (99m)Tc-albumin nanocolloid in 1 ml was used for PT injection, and 18 MBq in 0.2 ml for SB injection. Five-minute images were obtained 2 h p.i. for PT injection and 20-30 min p.i. for SB injection. SD was performed 4 or 24 h p.i. Lymphoscintigraphic (LD), surgical and internal mammary (IM) detection rates were calculated. In group I, FN, negative predictive value (NPV) and accuracy (A) were calculated. Statistical analysis was performed using the chi-square test. RESULTS: In percentages, results were as follows: Group IA: SD: 84.1, FN: 13.6, NPV: 88.9, A: 78.6, IM: 14.5*. Group IB: SD: 90, FN: 0, NPV: 100, A: 90, IM: 1.7* (*p<0.025). Group II: PT injection only: LD: 82.4, SD: 94; PT injection+SB re-injection: LD: 90, SD: 98.5. SD was 97.8** in patients with positive lymphoscintigraphy and 58.5** when lymphoscintigraphy was negative (**p<0.001). CONCLUSION: For correct staging, including extra-axillary drainage, peritumoural injection should first be performed. When the SN is not visualised, and only in those cases, SB re-injection should be performed, which increases the SD rate without increasing the FN rate.