The role of 18F-FDG PET/CT in the management of Merkel cell carcinoma: The experience of 51 studies in our institution. / Papel de la 18F-FDG PET/TC en el manejo del carcinoma de células de Merkel: experiencia de 51 estudios en nuestra institución.

OBJECTIVES: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with limited evidence on the role of 18F-FDG PET/CT. The aim of this study was to assess the impact of the 18F-FDG PET/CT in the management of MCC. METHODS: Fifty-one studies of 18F-FDG PET/CT of 35 patients (19 men [54.30%]; 72.17±14.63years) with histologic diagnosis of MCC were retrospectively evaluated. The change in tumor staging and the impact on the treatment were analysed. RESULTS: There were 23 PET/CT positive studies (45.10%) and 28 (54.90%) negative. Thirty four (66.7%) studies were performed for assessment of stage at initial presentation and 17 (33.3%) were performed during the follow up: 6 (35.29%) for suspected recurrence; 7 (41.18%) for restaging; 4 (23.53%) as a part of ongoing surveillance. On the basis of PET/CT results, there was a change in disease stage (SC) in 20 studies (39.20%) and impact in the management (MI) in 28 (54.90%): 11 (32.40%) SC and 12 (35.30%) MI in the initial staging; 5 (71.43%) SC and 7 (100%) MI in the restaging; 3 (50.00%) SC and 6 (100%) MI in suspected recurrence; 1 (25.00%) SC and 3 (75.00%) MI in the surveillance. 18F-FDG PET/CT incidentally detected one additional histologically confirmed cancer. The presence of nodal involvement in the beginning (0.0098; HR 3.82; 95%CI: 1.38-10.6), chemotherapy treatment (6e-04; HR 7.06; 95%CI: 2.30-21.60), size of primary tumor >2cm (6e-04; HR 7.06; 95%CI: 2.30-21.60) and positive resection margin (0.00069; HR 4.01; 95%CI: 1.46-11.00) were statistically significant prognostic factors for overall survival. There was a trend towards significance for worse overall survival with initial positive 18F-FDG PET/CT but the trend did not reach statistical significance. CONCLUSION: 18F-FDG PET/CT altered the stage in 2 out of 5 studies and changed the treatment in more than half of the studies performed. The study confirms the important impact of 18F-FDG PET/CT on the management of MCC patients.

Influencia de la cirugía mamaria previa en la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama / Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer

Objetivo. Revisar la aplicabilidad de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama y antecedente de cirugía mamaria previa, y examinar los factores que podrían influir en la detección del ganglio centinela. Material y métodos. Revisamos retrospectivamente la biopsia selectiva del ganglio centinela en 91 pacientes con cáncer de mama dividiéndolas en 2 grupos según el antecedente quirúrgico de la mama: cirugía estética en 30 (grupo I) y conservadora en 61 (grupo II). Se realizó linfogammagrafía prequirúrgica tras inyección intratumoral en 21 casos y periareolar en 70. Se analizaron los patrones de drenaje linfático y la detección global del ganglio centinela según características clínicas, patológicas y quirúrgicas. Resultados. La detección global del ganglio centinela en la linfogammagrafía fue del 92,3%, con un 7,7% de drenajes extraaxilares. La detección fue similar en el grupo I (93,3%) y grupo II (91,8%). En 2 pacientes (2,2%) detectamos ganglios centinelas en la axila contralateral, estando afectados en el estudio anatomopatológico. El porcentaje de no detección del ganglio centinela en la gammagrafía fue del 7,7%. Se encontró una proporción de no detección significativamente mayor en tumores con mayor grado histológico (28,6% grado III, 4,5% grado I y 3,6% grado II). Conclusión. Se puede realizar la biopsia selectiva del ganglio centinela en pacientes con antecedente de cirugía mamaria previa, pero serían necesarios más estudios para valorar la influencia en la detección del ganglio centinela de diferentes aspectos en este escenario clínico. Un elevado grado histológico se relaciona significativamente con una menor detección (AU)

Aim. The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection. Material and methods. A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables. Results. The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II). Conclusion. Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection (AU)

Influence of previous breast surgery in sentinel lymph node biopsy in patients with breast cancer. / Influencia de la cirugía mamaria previa en la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama.

AIM: The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection. MATERIAL AND METHODS: A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables. RESULTS: The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II). CONCLUSION: Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection.