Biopsia selectiva del ganglio centinela en cáncer de cérvix: experiencia en fase de validación / Selective biopsy of the sentinel node in cancer of cervix: Experience in validation phase

Antecedentes y objetivo: La biopsia selectiva del ganglio centinela (BSGC) surgió para disminuir la morbilidad asociada a la linfadenectomía pélvica en estadios iniciales del cáncer cervical (CC), conservando la información pronóstica obtenida de ella. El objetivo es determinar la validez diagnóstica de la BSGC en CC en estadios iniciales (IA1 con infiltración linfovascular [ILV] +, IA2, IB1 y IIA1), evitando así linfadenectomías innecesarias en muchos de los casos. Material y método: Desde enero del 2012 hasta abril del 2017, 23 pacientes con estadios iniciales de CC fueron incluidas en un estudio transversal de evaluación de la eficacia de la BSGC usando la técnica mixta de inyección cervical de 99mTc-nanocoloide de albúmina y azul de metileno, empleando linfogammagrafía planar combinada con imagen multimodalidad SPECT/TC y posterior extirpación del GC mediante laparoscopia. Resultados: La tasa de detección de la BSGC con técnica mixta fue del 95,6%, siendo el valor predictivo negativo (VPN) del 95,4% y la sensibilidad (S) del 100% en caso de drenaje bilateral. La media de GC extirpados fue de 3 (rango 1-5). La tasa de detección bilateral en la laparoscopia fue del 85,3%. La concordancia entre SPECT/TC y laparoscopia para el número y bilateralidad del GC mediante el coeficiente de Pearson fue r = 0,73 y r = 0,83, respectivamente; p = 0,01. Solo encontramos un GC con resultado diferido de micrometástasis y se detectó un falso negativo. Conclusiones: La BSGC en CC mediante técnica mixta tiene una elevada tasa de detección y de drenaje bilateral, pero aún la S es baja si incluimos casos de drenaje unilateral. Un mayor número de casos y el desarrollo de la ultraestadificación intraoperatoria podrían aumentar la S de la técnica y reducir el número de falsos negativos

Background and objective: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. Material and method: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. Results: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. Conclusions: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives

Selective biopsy of the sentinel node in cancer of cervix: Experience in validation phase. / Biopsia selectiva del ganglio centinela en cáncer de cérvix: experiencia en fase de validación.

BACKGROUND AND OBJECTIVE: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. MATERIAL AND METHOD: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. RESULTS: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. CONCLUSIONS: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives.

Ascitis fetal aislada idiopática / Idiopathic isolated foetal ascites

La ascitis fetal aislada es un cuadro poco frecuente, ya que en la mayoría de ocasiones se diagnostica formando parte del cuadro de hidrops fetal. Presentamos el caso de una secundigesta de 31 años y 32 semanas y 5 días, que acude a urgencias por el hallazgo de polihidramnios y ascitis fetal masiva aislada en una ecografía rutinaria. La gestación había tenido una evolución normal hasta el momento. Como dato relevante presentó una translucencia nucal (TN) en el primer trimestre por encima del percentil 99, con un estudio de aneuploidías y ecocardiografía precoz normales, y una ecografía a las 20 semanas sin hallazgos patológicos. Una vez ingresada la paciente se indica tocólisis, maduración pulmonar fetal, se completa el estudio ecográfico morfológico fetal, Doppler fetal incluyendo pico de velocidad sistólica de la arteria cerebral media, anticuerpos irregulares, serologías TORCH y parvovirus B19, amniocentesis diagnóstica (estudio de infecciones congénitas) y evacuadora. Las pruebas realizadas resultaron negativas, por lo que se diagnosticó de ascitis fetal aislada, finalizándose la gestación mediante cesárea a las 33 semanas y 3 días por un registro cardiotocográfico (RCTG) patológico. La ascitis no tuvo repercusión en el desarrollo neonatal

Isolated foetal ascites is uncommon since, in most instances, it is diagnosed as being part of a clinical condition known as hydrops fetalis. We report the case of a 31-year-old secundigravida of 32 weeks and 5 days who came to A&E due to the finding of isolated massive foetal ascites and polyhydramnios in a routine ultrasound. The pregnancy had had a normal course until this point. Relevant data include a nuchal translucency (NT) in the first trimester above the 99th percentile with aneuploidy screening, normal early echocardiography and ultrasound at 20 weeks without pathological findings. Once the patient was admitted to hospital, tocolysis and foetal lung maturation were indicated as well as completion of a foetal morphological ultrasound study, foetal Doppler including middle cerebral artery peak systolic velocity, irregular antibodies, TORCH and parvovirus B19 serological tests, diagnostic (study of congenital infections) and reduction amniocentesis. The tests were negative; therefore the diagnosis was isolated foetal ascites. The pregnancy was terminated by caesarean section at 33 weeks and 3 days due to pathological cardiotocography (CTG) findings. The ascites had no effect on neonatal developmenT

Gestación heterotópica espontánea / Spontaneous heterotopic pregnancy

El embarazo heterotópico es una condición clínica poco frecuente en la que se pueden presentar varias gestaciones que coexisten dentro y fuera del útero. Su incidencia se ha incrementado en los últimos años debido a las técnicas de reproducción asistida. Tener un alto grado de sospecha puede ayudar en su diagnóstico precoz y tratamiento adecuado. Presentamos un caso de embarazo heterotópico en una mujer de 35 años que desarrolló a la vez un embarazo extra e intrauterino. Fue diagnosticado por ecografía a las 10 semanas de amenorrea (AU)

Heterotopic pregnancy is a rare clinical condition in which several pregnancies can coexist inside and outside the uterus. In recent years, the incidence of heterotopic pregnancy has increased due to assisted reproductive techniques. A high index of suspicion may help in the early diagnosis and appropriate treatment of this entity. We report a case of spontaneous heterotopic gestation in a 35-year-old woman who developed both an extra- and an intrauterine pregnancy diagnosed by ultrasound 10 weeks after the onset of amenorrhea (AU)