Defecto escrotal en una gammagrafía ósea / Scrotal defect on bone scintigraphy

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[Sentinel node localization in breast cancer. Periareolar injection of radiocolloid]. / Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide.

Traditional lymphadenectomy is being replaced by sentinel node biopsy in initial management of early stage breast cancer. The aim of this study was to validate the technique in our center, where we perform preoperative lymphoscintigraphy and intraoperative detection of sentinel node, after periareolar radiotracer and peritumoral blue dye injection. Sixty patients, breast cancer stages I and II, were included. Lymphatic mapping was performed the day before surgery, after the administration of 74 MBq 99mTc sulfur colloid in periareolar subdermal tissue. Surgical detection of sentinel node through gamma probe was followed by intraoperative and occasionally delayed biopsies. Finally, full axillary node dissection was completed. Lymphoscintigraphy identified sentinel node in 78% of the patients (47/60): 43 in axilla, 4 in internal mammary chain. Probe guided axillary detection was achieved in 88% (53/60): in every patient with axillar migration in scan, in 9/13 without imaged drainage and in 1/4 with internal mammary chain migration. Sensitivity of blue dye technique was 75% (45/60), the concordance between both procedures being high. Considering both, the overall success rate of surgical detection was 90% (54/60); if we exclude those patients who showed exclusive extraaxillar drainage, the success rate reaches 95%. Malignancy was found in 24% of sentinel nodes removed (13/54); it being the only metastatic axillary node in 4/13. No false negative sentinel nodes were found. Therefore, negative predictive value and accuracy were 100%. These results allow us to validate the technique in our center.

Agenesia bilateral de glándulas parótidas: demostración gammagráfica / Bilateral agenesis of parotid glands: scintigraphic demonstration

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Hepatobiliary scintigraphy for the diagnosis of bile leaks produced after T-tube removal in orthotopic liver transplantation.

Choledochocholedochostomy (CC) over a T-tube is a well-recognized technique for biliary reconstruction in orthotopic liver transplantation (OLT). Bile leaks after T-tube removal are common, having a significant morbidity. The aim of this study was to evaluate the utility of hepatobiliary scintigraphy (HBS) for diagnosing bile leaks in liver transplant patients who develop abdominal pain after T-tube removal. Twenty consecutive patients (14 males, 6 females; mean age 44 years) were studied. The interval between T-tube removal and HBS ranged from 8 to 120 h. Hepatobiliary scintigraphy was carried out after the intravenous injection of 185 MBq 99Tc(m)-mebrofenin. A final diagnosis of bile leak was based on surgical, endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound data, and clinical outcome. There were 13 patients with and 7 without bile leaks. On the scintigraphic images, bile leaks were defined as activity outside the biliary tract which moved along the right paracolic gutter, or the progressive accumulation of activity related to fluid collections as seen on ultrasound. Nine of 12 patients needed surgical repair; the other 3 were treated with endoscopic sphincterotomy. One patient with a negative HBS developed an abdominal abscess after aspirative puncture of a biloma. In the seven patients without bile leaks, all scintigrams showed normal biliary transit of activity. A diagnosis of no bile leaks was based on clinical follow-up in five patients and by ERCP in two patients. Based on these results, we conclude that HBS is an effective method for the diagnosis of bile leaks after T-tube removal in liver transplant patients.

Contribution of 99mTc-MIBI scintimammography to the diagnosis of non-palpable breast lesions in relation to mammographic probability of malignancy.

The low positive predictive value of mammography results in unnecessary biopsies. We present a prospective evaluation on the contribution of 99mTc-MIBI Scintimammography (SMM) to the diagnosis of breast cancer in 41 patients with non-palpable breast lesions detected by mammography. In all cases mammographical findings were indicative of biopsy and according to the probability of malignancy they were classified into three groups: high probability (17), intermediate (15), and low (9). There were 22 malignant lesions and 19 benign. In the high probability group. MIBI-SMM changed the only false positive into true negative, and showed 2 false negatives. In the intermediate group, MIBI-SMM changed 7 of 11 false positives on mammography into true negatives, and showed 1 false negative. In the low probability group MIBISMM changed 3 of the 7 false positive into true negatives without false negatives. In the 24 patients included in the intermediate and low probability groups, 10 of the 18 false positives were changed into true negatives by MIBI-SMM at the expense of 1 false negative. The addition of SMM may to reduce up to 55% of the number of unnecessary biopsies in non-palpable breast lesions.

Assessment of cerebral blood flow in diabetic patients with no clinical history of neurological disease.

We assessed cerebral blood flow in 78 diabetic patients (40 Type 1 and 38 Type 2) with no previous history of central nervous system disease using 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) single photon emission tomography (SPET) and found areas of severe hypoperfusion in 36% of them. All cerebral anatomical regions showed abnormalities related to hypoperfusion, but they were most frequently seen in the fronto-temporal region, followed by the occipital and parietal regions. 99Tcm-HMPAO SPET has been shown to be able to detect subclinical alterations in blood flow in diabetes, a finding that may account for the high prevalence of cerebrovascular disease seen in these patients. This technique could, therefore, play an important role in future preventative strategies.