Pacientes con afectación ganglionar inicial por cáncer de mama que han recibido quimioterapia neoadyuvante: técnica combinada ganglio centinela-cirugía radioguiada del ganglio patológico / Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node

Objetivo Estudiar la viabilidad y utilidad de la técnica combinada biopsia selectiva de ganglio centinela (BSGC)-biopsia radioguiada del ganglio patológico en pacientes con cáncer de mama y afectación axilar sometidas a quimioterapia neoadyuvante (QTNA). aterial y métodos Estudio prospectivo en el que se incluyeron 30 pacientes con cáncer de mama y estadificación axilar cN1, con indicación de QTNA. El ganglio biopsiado se marcó (GBM) mediante un clip, antes del tratamiento QTNA. Tras completar este se valoró la respuesta axilar con ecografía. En caso de buena respuesta ecográfica se procedió a realizar BSGC (99mTc-nanocoloides) y disección axilar dirigida mediante biopsia radioguiada del GBM (99mTc-macroagregados albúmina). Se procedía a realizar una linfadenectomía axilar si el ganglio centinela (GC) y/o el GBM contenían células tumorales. Se evaluaron las tasas de localización-exéresis del GC y del GBM. También se evaluaron la tasa de falsos negativos y el valor predictivo positivo de la BSGC sola. Resultados Se extirpó el GC en todas las pacientes, mientras que el GBM se extirpó exitosamente en 27 (90%). El GC coincidió con el GBM en 15 pacientes (50%). En 12 pacientes el GC fue negativo pero el GBM fue positivo para metástasis, lo que comportó una tasa de falsos negativos del 44,4% y un valor predictivo positivo del 37% para la BSGC sola. Tanto el GC como el GBM resultaron negativos en 5 pacientes (18,5%), lo que permitió evitar realizarles la linfadenectomía axilar. Conclusiones La técnica combinada descrita BSGC-biopsia radioguiada del ganglio patológico es un procedimiento útil y accesible para la reestadificación precisa de la axila tras QTNA, evitando la alta tasa de falsos negativos de la BSGC sola en este grupo de pacientes y evitando un número mayor de linfadenectomías axilares (AU)

Objective To study the feasibility and usefulness of the combined technique selective sentinel lymph node biopsy (SLNB)-radioguided biopsy of the pathological lymph node in patients with breast cancer and axillary involvement undergoing neoadjuvant chemotherapy (NAC). Material and methods Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN pathologic node radioguided biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate and positive predictive value of SLNB alone were also evaluated. Results Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44,4% for SLNB alone. We found a positive predictive value of 37% for the SLNB. In 5 patients (18,5%) both SLNB and MBN were negative, avoiding axillary lymph node dissection. Conclusions SLNB-MBN radioguided biopsy combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of false-negative rate of SLNB alone in this group of patients and avoiding a great number of axillary lymph node dissection (AU)

Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node.

OBJECTIVE: To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS: Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS: SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.

[SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up]. / Estudios SPECT-TAC con Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad.

INTRODUCTION: 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. MATERIAL AND METHODS: One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. RESULTS: Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). CONCLUSION: These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease.

Estudios SPECT-TAC con 67Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad / SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up

Introducción. La gammagrafía con 67Ga es un método establecido en la estadificación y seguimiento de los pacientes diagnosticados de linfoma. El objetivo de este estudio es valorar las ventajas de la gammagrafía con 67Ga y SPECT-TAC sobre los estudios planares y SPECT y sobre la TAC de alta resolución en la enfermedad linfomatosa. Material y métodos. Se analizaron 101 estudios con 67Ga pertenecientes a 74 pacientes (46 hombres), edad media 44 años. Treinta y ocho pacientes (51 %) estaban diagnosticados de linfoma de Hodgkin y 36 no hodgkinianos. Todos los pacientes fueron evaluados mediante estudio con 67Ga y TAC de alta resolución. La exploración con 67Ga se realizó en un sistema híbrido, obteniendo imágenes planares, SPECT y fusión SPECT-TAC. Los resultados obtenidos de los estudios con 67Ga se compararon con los de la TAC, tanto en número de lesiones como en su localización. Resultados. Los estudios planares, SPECT, SPECT-TAC y TAC detectaron 123, 146, 155 y 132 lesiones, respectivamente. La SPECT-TAC y la TAC fueron coincidentes en 52 estudios, mientras que en los otros 49 estudios no hubo concordancia en número de lesiones, detectando la SPECT-TAC más lesiones que la TAC en 28 de ellos, modificando la estadificación de la enfermedad en 18 ocasiones (18 % de los estudios). Conclusiones. Estos resultados muestran una mayor efectividad del estudio de 67Ga y fusión SPECT-TAC en comparación con los otros métodos de adquisición gammagráficos y con la TAC de alta resolución en la detección de lesiones linfomatosas. Este método mejora el rendimiento diagnóstico de los estudios con 67Ga, aportando una mejor localización anatómica de las lesiones y permitiendo detectar lesiones extraganglionares

Introduction. 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. Material and methods. One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. Results. Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). Conclusion. These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease

[123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma]. / SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma.

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion.

SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma / 123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma

Presentamos el caso de un hombre de 56 años con elevada sospecha de tumoración intraabdominal productora de catecolaminas. El paciente fue sometido a diversas pruebas diagnósticas, entre las que se incluyó un rastreo gammagráfico con 123I-metayodobencilguanidina (123I-MIBG), complementado con SPECT y TC de baja resolución para corrección de atenuación y posterior fusión de las imágenes anatómicas y funcionales. Después de un nuevo rastreo con 123I-MIBG el paciente fue intervenido quirúrgicamente con el apoyo intraoperatorio de una sonda gamma portátil, que facilitó la localización de la tumoración

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion

[Tumor redifferentiation in papillary thyroid carcinoma alter retinoic acid administration]. / Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico.

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months before 131I treatment. A radioiodine scan performed after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan.

Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico / Tumor redifferentiation in papillary thyroid carcinoma after retinoic acid administration

Paciente varón de 73 años con carcinoma papilar de tiroides tratado con cirugía, 131I y L-Tiroxina, que presentó metástasis óseas, objetivadas por gammagrafía ósea y TAC, que no captaban 131I. Con el fin de inducir rediferenciación tumoral, se administró ácido retinoico (70 mg/día) durante tres meses previos a tratamiento con 131I. El rastreo postratamiento evidenció captación de 131I en algunas metástasis óseas. Por este motivo, y debido a progresión de la enfermedad, nueve meses más tarde se realizó una segunda inducción con ácido retinoico previa a tratamiento con 131I. En esta ocasión el rastreo postratamiento mostró captación de 131I de mayor grado de intensidad y en más lesiones óseas que las detectadas por el rastreo anterior (AU)

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan (AU)