Clinical value of baseline 18F-FDG PET/CT in soft tissue sarcomas.

BACKGROUND: The use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described. METHODS: A retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan-Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method. RESULTS: The SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG. CONCLUSIONS: The SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.

Is the result of breast Tc-99m mibi scintigraphy a prognostic factor for survival in invasive breast cancer? / ¿Es el resultado de la gammagrafía con Tc-99m MIBI un factor pronóstico para la supervivencia en el cáncer invasor de mama?

Background Breast scintigraphy with Tc-99m MIBI showed utility in diagnosing and monitoring response to neoadjuvant treatment. This work studies if there are differences in long-term survival in breast carcinomas depending on the result of Tc-99 MIBI scintigraphy and to analyze their relationship with other variables of prognostic value. Material and methods A prospective observational study on a series of cases of breast cancer in which scintigraphy with Tc-99m MIBI was carried out prior to its treatment, and which had a minimum follow-up of ten years. Clinical–epidemiological, histopathological and immunohistochemical variables were recorded. Bivariate and multivariate analysis were performed studying the result of Tc99m-MIBI scintigraphy. Differences in OS and DFS were studied using Kaplan Meier curves with the log-rank test between factors. Results The significant relationship was found between Tc-99m-MIBI positive result and palpable tumors (p=0.0001), poorly differentiated (p=0.003), with lymph node involvement (p=0.038) and high cell proliferation (p=0.007), although only the palpability and tumor size are related after multivariate analysis. Patients with Tc-99m MIBI positive tumors showed a worse OS (p=0.043) and DFS (p=0.026), independently of size and palpability of the lesión. Conclusion Tc-99m MIBI scintigraphy showed prognostic importance in invasive breast cancer, relating its positivity to reduced long-term survival. (AU)

Introducción La gammagrafía mamaria con Tc-99m MIBI ha mostrado su utilidad en el diagnóstico y la monitorización de la respuesta al tratamiento neoadyuvante. Este trabajo estudia si hay diferencias en la supervivencia por cáncer de mama a largo plazo dependiendo del resultado de la gammagrafía con Tc-99m MIBI y analizar su relación con otras variables de valor pronóstico. Material y métodos Se realizó un estudio observacional prospectivo sobre una serie de pacientes con cáncer de mama en las que se realizó una gammagrafía con Tc-99m MIBI previa a su tratamiento, y con un seguimiento mínimo de 10 años. Se registraron variables clínico-epidemiológicas, histopatológicas e inmunohistoquímicas. Se realizaron análisis bivariante y multivariante para el resultado de la gammagrafía con Tc-99m MIBI. Se estudiaron la supervivencia glogal y libre de enfermedad mediante la curva de Kaplan-Meier y el test de log-rank entre factores. Resultados Se encontró una relación significativa entre la gammagrafía con Tc-99m MIBI positiva y las lesiones palpables (p=0,0001), pobremente diferenciadas (p=0,003), con afectación ganglionar (p=0,038) y alta proliferación celular (p=0,007), aunque solo la palpabilidad y el tamaño tumoral fueron significativos en el análisis multivariante. Las pacientes con gammagrafía positiva mostraron peor supervivencia global (p=0,043) y libre de enfermedad (p=0,026), independientemente del tamaño o la palpabilidad de la lesión. Conclusión La gammagrafía mamaria con Tc-99m MIBI presenta una relevancia pronóstica en cáncer invasor de mama, relacionando su positividad con menor supervivencia a largo plazo. (AU)

Analysis of performance and stress caused by a simulation of a mass casualty incident.

OBJECTIVE: To determine the stress that is potentially produced in professional health workers due to a mass casualty incident (MCI) simulated exercise, and its relation to prior academic training and the role played in the simulation. METHODS: Observational study of stress in a MCI. For this work, two MCI drills comprised of 40 victims each were conducted. Two randomized groups of 36 students each were created: Master's Students Group (MSG) and Undergraduate Student Group (USG). The role performed by each student (triage or sectorization) was assessed. The stress level was determined by prior and subsequent measurements of alpha-amylase (αA), HR, SBP and DBP. RESULTS: The percentage of victims that were correctly triaged was 88.6%, 91.84% for MSG and 83.76% for the USG (p=0.004). The basal αA was 97,107.50±72,182.67IU/L and the subsequent αA was 136,195.55±90,176.46±IU/L (p<0.001). The baseline HR was 78.74±14.92beats/min and the subsequent HR was 95.65±23.59beats/min (p=0.000). We found significant differences in the αA between students who performed the triage and those who performed sectorization but there were no differences between undergraduate and Masters' students. CONCLUSION: Conducting a simulated exercise caused stress in personnel involved in the MCI, with a greater impact on participants who performed triage, although it was not influenced by their prior academic level. The stress level in our case did not affect or determine the performance of acquired skills.

Biopsia selectiva del ganglio centinela en el melanoma mediante localización con linfogammagrafía preoperatoria y sonda de detección gamma intraoperatoria / Sentinel node biopsy in melanoma using preoperative lymphoscintigraphy and intraoperative handheld gamma probe

FUNDAMENTOS: Se refiere la experiencia para la detección del ganglio centinela en el melanoma utilizando únicamente la linfogammagrafía preoperatoria y trazador radiactivo con sonda de detección de radiación gamma intraoperatoria. PACIENTES Y MÉTODO: Se estudió a 60 pacientes con melanoma en estadios I-II, a quienes se realizó biopsia selectiva del ganglio centinela mediante su localización con sulfuro coloidal marcado con Tc-99m. A todos se les efectuó una gammagrafía preoperatoria y se trató de localizar el ganglio centinela con una sonda de detección de radiación gamma. Se han estudiado los resultados de la gammagrafía preoperatoria, la eficacia técnica en la localización intraoperatoria, así como los resultados anatomopatológicos y del seguimiento de los pacientes. RESULTADOS: La tasa de detección preoperatoria fue del 98,3 por ciento, con una media de 1,17 drenajes por lesión, siendo múltiples especialmente en los melanomas de tronco. La localización intraoperatoria (eficacia técnica) fue del 98,48 por ciento, con dificultades para su localización en la región parotídea. En el estudio histopatológico fueron fundamentales las técnicas de inmunohistoquímica con HMB45, resultando positivos un 10 por ciento, por lo que se evitó la linfadenectomía en el 90 por ciento de los casos. No se observaron recidivas y las metástasis se dieron en casos inabordables. La morbilidad de la técnica fue significativamente menor que la de la linfadenectomía. CONCLUSIONES: La linfogammagrafía preoperatoria y el uso de sonda de detección de radiación gamma, como técnica de localización del ganglio centinela en el melanoma, tienen una elevada eficacia técnica, permiten detectar drenajes múltiples y posibilitan un abordaje muy selectivo y con disección mínima (AU)