La PET/TC con 18F-Colina en la estadificación y recidiva bioquímica de pacientes con cáncer de próstata: cambios en la clasificación y planificación de radioterapia / 18F-Choline PET/CT scan in staging and biochemical recurrence in prostate cancer patients: Changes in classification and radiotherapy planning

Objetivo: Valorar la utilidad de la 18F-Colina PET/TC en la detección de enfermedad a distancia en la estadificación inicial de pacientes con cáncer de próstata de alto riesgo y en pacientes con recidiva bioquímica, con intención de planificación con radioterapia, así como valorar los cambios en el manejo terapéutico influenciados por los resultados de la misma. Material y métodos: Se evaluaron de manera retrospectiva los estudios 18F-Colina PET/TC de pacientes con diagnóstico de adenocarcinoma de próstata, con indicación de estadificación inicial en pacientes de alto riesgo (o con sospecha de afectación a distancia) y/o planificación de radioterapia y en pacientes con recidiva bioquímica con intención de rescate con radioterapia con un seguimiento adecuado durante al menos 9 meses. Se seleccionaron un total de 56 estudios, 33 (58,93%) de estadificación y 23 (41,07%) de planificación de radioterapia. Para el estudio PET/TC se empleó un equipo multimodal PET/TC, la dosis empleada fue de 296-370MBq de 18F-Colina, con un protocolo de adquisición en 2 fases. Resultados: Del total de los 56 estudios, 43 (76,8%) fueron considerados positivos (para enfermedad local, a distancia o ambas) y 13 (23,2%) negativos. En 13 estudios (23,2%) los hallazgos de la 18F-Colina PET/TC modificaron la clasificación NM. En 4 de los 13 estudios (30,7%) bajó la clasificación (descartando afectación a distancia sospechada por otras técnicas) y en 9 (69,3%) detectó enfermedad a distancia no conocida. Conclusiones: La 18F-Colina PET/TC es una técnica útil en la estadificación, recurrencia bioquímica y planificación de radioterapia en el cáncer de próstata para localizar enfermedad a distancia no detectada con pruebas de imagen convencionales, por lo que deberían ampliarse sus indicaciones en las guías de manejo del mismo (AU)

Objective: To evaluate the role of the 18F-Choline PET/CT in prostate cancer management when detecting distant disease in planning radiotherapy and staging and to evaluate the therapy changes guided by PET/TC results. Material and methods: A retrospective evaluation was performed on 18F-Choline PET/CT scans of patients with prostate cancer. Staging and planning radiotherapy scans were selected in patients with at least 9 months follow up. There was a total of 56 studies, 33 (58.93%) for staging, and 23 (41.07%) for planning radiotherapy. All scans were obtained using a hybrid PET/CT scanner. The PET/CT acquisition protocol consisted of a dual-phase procedure after the administration of an intravenous injection of 296-370MBq of 18F-Choline. Results: There were 43 out of 56 (76.8%) scans considered as positive, and 13 (23.2%) were negative. The TNM staging was changed in 13 (23.2%) scans. The PET/CT findings ruled out distant disease in 4 out of 13 scans, and unknown distant disease was detected in 9 (69.3%) scans. Conclusions: 18F-Choline PET/CT is a useful technique for detecting unknown distant disease in prostate cancer when staging and planning radiotherapy. The inclusion of 18F-choline PET/CT should be considered in prostate cancer management protocols (AU)

18F-Choline PET/CT scan in staging and biochemical recurrence in prostate cancer patients: Changes in classification and radiotherapy planning. / La PET/TC con 18F-Colina en la estadificación y recidiva bioquímica de pacientes con cáncer de próstata: cambios en la clasificación y planificación de radioterapia.

OBJECTIVE: To evaluate the role of the 18F-Choline PET/CT in prostate cancer management when detecting distant disease in planning radiotherapy and staging and to evaluate the therapy changes guided by PET/TC results. MATERIAL AND METHODS: A retrospective evaluation was performed on 18F-Choline PET/CT scans of patients with prostate cancer. Staging and planning radiotherapy scans were selected in patients with at least 9 months follow up. There was a total of 56 studies, 33 (58.93%) for staging, and 23 (41.07%) for planning radiotherapy. All scans were obtained using a hybrid PET/CT scanner. The PET/CT acquisition protocol consisted of a dual-phase procedure after the administration of an intravenous injection of 296-370MBq of 18F-Choline. RESULTS: There were 43 out of 56 (76.8%) scans considered as positive, and 13 (23.2%) were negative. The TNM staging was changed in 13 (23.2%) scans. The PET/CT findings ruled out distant disease in 4 out of 13 scans, and unknown distant disease was detected in 9 (69.3%) scans. CONCLUSIONS: 18F-Choline PET/CT is a useful technique for detecting unknown distant disease in prostate cancer when staging and planning radiotherapy. The inclusion of 18F-choline PET/CT should be considered in prostate cancer management protocols.

Aportación de una gammacámara portátil en la localización intraoperatoria del ganglio centinela en el cáncer de mama / Contribution of the portable gamma camera to detect the sentinel node in breast cancer during surgery

Objetivo. Mostrar nuestra experiencia en el uso de una gammacámara portátil en la localización intraoperatoria del ganglio centinela en el cáncer de mama. Material y métodos. 46 mujeres diagnosticadas de cáncer de mama fueron incluidas. Se realizo inyección periareolar intradérmica del radiotrazador. Se realizaron imágenes planares y SPECT-TAC. El día siguiente se emplearon una sonda y una gammacámara portátil para la detección del ganglio centinela intraoperatorio. Se tomaron imágenes en las proyecciones anterior y lateral de la axila antes y después de la extracción del ganglio centinela. Resultados. Las imágenes obtenidas intraoperatoriamente no mostraron actividad en todos los pacientes después de la extracción de todos los ganglios centinela. En cuatro de los 46 casos la gammacámara dio información importante (en dos casos localizó ganglios no detectados en las imágenes prequirúrgicas y en otros dos orientó al cirujano en localizar ganglios de baja actividad cuando el rastreo con sonda fue negativo). Conclusiones. El uso de la gammacámara portátil intraoperatoria en la localización del ganglio centinela en cáncer de mama es útil para asegurar, con independencia del cirujano, que todos los ganglios han sido extirpados. Puede guiar además al cirujano en la localización de ganglios de baja actividad(AU)

Aim. To show our experience using the portable gamma camera during surgery in the detection of the sentinel node in breast cancer. Material and methods. A total of 46 women diagnosed with breast cancer were included. This study was carried out by means of the periareolar intradermal injection. Planar images and SPECT/CT were acquired. On the following day, the sentinel nodes were localized intraoperatively with a portable gamma camera and a gamma probe. Images of the anterior axillary line projection and lateral axillary line projection were acquired before and after extraction of all the sentinel nodes. Results. The images acquired with the portable gamma-camera during the operation showed no activity in all of the patients after the removal of the sentinel nodes. In four out of the 46 cases, the portable gamma camera provided relevant information during the procedure (it detected a sentinel node in two cases in which it had not been detected prior to the surgery and it oriented the surgeon in the localization of low activity nodes when the probe screening had been negative). Conclusions. The use of the intraoperative portable gamma camera to detect the sentinel node in breast cancer patients is useful in order to ensure, independently of the surgeon, that all the sentinel nodes have been removed. It can also help guide the surgeon in the event of a single low activity sentinel node(AU)

Significación de captaciones incidentales en colon en estudios 18F-FDG PET-TAC en pacientes sin tumor colorrectal conocido. Valoración del impacto en el manejo del paciente / Clinical relevance of incidental finding of focal uptakes in the colon during 18F-FDG PET/CT studies in oncology patients without known colorectal carcinoma and evaluation of the impact on management

Objetivos. Valorar la significación y el impacto de acumulaciones de FDG en el colon en pacientes con tumores no colorrectales. Material y métodos. Se revisaron retrospectivamente 2.220 estudios PET-TAC realizados de manera consecutiva en el Servicio de Medicina Nuclear de nuestro hospital del 2 de diciembre de 2008 al 31 de mayo de 2010. Se incluyeron aquellos pacientes en los que se describían captaciones focales de FDG a nivel colorrectal y no explicables por la historia clínica. Se excluyeron pacientes diagnosticados previamente de carcinoma colorrectal. Cumplieron el criterio de inclusión 86 pacientes (57 hombres, media de edad de 63,4 años, rango 46-85). Se estableció como prueba de referencia la colonoscopia con toma de biopsia. Se valoró el impacto de estos hallazgos en la actitud diagnóstico-terapéutica de estos pacientes. Resultados. En 54 de los 86 pacientes se realizó correlación colonoscópica, en los 32 restantes no se había realizado dicha exploración hasta la fecha. De los 54 en los que se realizó colonoscopia se tomó biopsia en 43 lesiones. Se detectó patología colónica en 49 pacientes, con un total de 54 focos incidentales de FDG, siendo estas patologías: 10 cánceres colorrectales primarios insospechados, tres metástasis, 27 pólipos adenomatosos con diferentes grados de displasia y 14 procesos inflamatorios. En los 5 pacientes restantes la colonoscopia fue normal (9%). La PET-TAC modificó la actitud diagnóstico-terapéutica en la mayoría de pacientes (49/ 54, 91%). Conclusiones. Estos resultados constatan la necesidad de confirmar mediante colonoscopia y biopsia las captaciones focales colorrectales de FDG en PET-TAC. Esta estrategia permite detectar y tratar precozmente lesiones malignas y premalignas(AU)

Aims. To assess the significance and the impact of focal FDG uptake in the colon in oncology patients without known colorectal carcinoma. Materials and methods. A retrospective study was undertaken on 2,220 18F-FDG PET/CT studies carried out consecutively in the Nuclear Medicine Department in our hospital from 2 December 2008 to 31 May 2010. Inclusion criteria were patients with abnormal 18F-FDG uptake in colorectal area that could not be explained (or not previously known) by their clinical histories. Patients previously diagnosed with colorectal carcinoma were excluded. A total of 86 patients (57 male, average age 63.4, range 46-85) were finally included. Colonoscopy with biopsy was established as a reference test. The impact of these findings on the diagnostic-therapeutic management in these patients was evaluated. Results. A colonoscopy was performed in 54 of the 86 patients, this examination not having been done up-to-date in the remaining 32 patients. Biopsy was obtained in 43 lesions of the 54 patient in whom a colonoscopy was performed. Colon disease was detected in 49 of these 54 patients, obtaining 54 FDG incidental foci which corresponded to 10 previously unsuspected primary colorectal carcinoma, 3 metastases, 27 adenomatous polyps with different degrees of dysplasia and 14 inflammatory processes. In the remaining 5 patients, the colonoscopy was normal. PET/CT modified the diagnostic and treatment management in most of the patients (49/54, that is 91%). Conclusions. These results confirm the need to determine the cause of abnormal 18F-FDG colorectal uptakes in the PET/CT studies by using colonoscopy and biopsy. This approach allows for the detection and early treatment of malignant and premalignant lesions(AU)

Clinical relevance of incidental finding of focal uptakes in the colon during 18F-FDG PET/CT studies in oncology patients without known colorectal carcinoma and evaluation of the impact on management.

AIMS: To assess the significance and the impact of focal FDG uptake in the colon in oncology patients without known colorectal carcinoma. MATERIALS AND METHODS: A retrospective study was undertaken on 2,220 (18)F-FDG PET/CT studies carried out consecutively in the Nuclear Medicine Department in our hospital from 2 December 2008 to 31 May 2010. Inclusion criteria were patients with abnormal (18)F-FDG uptake in colorectal area that could not be explained (or not previously known) by their clinical histories. Patients previously diagnosed with colorectal carcinoma were excluded. A total of 86 patients (57 male, average age 63.4, range 46-85) were finally included. Colonoscopy with biopsy was established as a reference test. The impact of these findings on the diagnostic-therapeutic management in these patients was evaluated. RESULTS: A colonoscopy was performed in 54 of the 86 patients, this examination not having been done up-to-date in the remaining 32 patients. Biopsy was obtained in 43 lesions of the 54 patient in whom a colonoscopy was performed. Colon disease was detected in 49 of these 54 patients, obtaining 54 FDG incidental foci which corresponded to 10 previously unsuspected primary colorectal carcinoma, 3 metastases, 27 adenomatous polyps with different degrees of dysplasia and 14 inflammatory processes. In the remaining 5 patients, the colonoscopy was normal. PET/CT modified the diagnostic and treatment management in most of the patients (49/54, that is 91%). CONCLUSIONS: These results confirm the need to determine the cause of abnormal (18)F-FDG colorectal uptakes in the PET/CT studies by using colonoscopy and biopsy. This approach allows for the detection and early treatment of malignant and premalignant lesions.

Contribution of the portable gamma camera to detect the sentinel node in breast cancer during surgery.

AIM: To show our experience using the portable gamma camera during surgery in the detection of the sentinel node in breast cancer. MATERIAL AND METHODS: A total of 46 women diagnosed with breast cancer were included. This study was carried out by means of the periareolar intradermal injection. Planar images and SPECT/CT were acquired. On the following day, the sentinel nodes were localized intraoperatively with a portable gamma camera and a gamma probe. Images of the anterior axillary line projection and lateral axillary line projection were acquired before and after extraction of all the sentinel nodes. RESULTS: The images acquired with the portable gamma-camera during the operation showed no activity in all of the patients after the removal of the sentinel nodes. In four out of the 46 cases, the portable gamma camera provided relevant information during the procedure (it detected a sentinel node in two cases in which it had not been detected prior to the surgery and it oriented the surgeon in the localization of low activity nodes when the probe screening had been negative). CONCLUSIONS: The use of the intraoperative portable gamma camera to detect the sentinel node in breast cancer patients is useful in order to ensure, independently of the surgeon, that all the sentinel nodes have been removed. It can also help guide the surgeon in the event of a single low activity sentinel node.

[SPECT-CT in sentinel node detection in patients with melanoma]. / SPECT-TAC en la localización del ganglio centinela en pacientes con melanoma.

INTRODUCTION: The prognosis of patients with cutaneous melanoma is greatly influenced by the presence of lymph node metastases. One of the most innovative and fascinating concepts to emerge in the field of oncology in recent years is the use of sentinel lymph node biopsy (SLNB). AIM: The aim of this study was to determine what SPECT-CT images contribute to the search for sentinel nodes in patients with melanoma. METHODS: From March 2007 to October 2008, 18 patients were examined for sentinel nodes using dynamic scintigraphy, planar images, and SPECT-CT in the Nuclear Medicine Department of San Carlos University Hospital. The group contained 10 women and 8 men, age range 14-83 years, mean age 57 years (57+/-20.1). RESULTS: The sentinel node was located by conventional imaging techniques (dynamic scintigraphy and planar images) in 16 of 18 patients (88.88%). SPECT-CT identified the sentinel node in 18 of 18 patients (100%) and detected clinically relevant findings in 6 of 18 patients (33.33%) CONCLUSIONS: SPECT-CT imaging contributed clinically relevant information on sentinel nodes of melanoma, which is particularly important in patients with melanoma of the trunk or head and neck.

SPECT-TAC en la localización del ganglio centinela en pacientes con melanoma / SPECT-CT in sentinel node detection in patients with melanoma

IntroducciónEl pronóstico de los pacientes con melanoma está fuertemente influenciado por la presencia de afectación tumoral ganglionar. Uno de los conceptos más innovadores y fascinantes que ha emergido en el campo de la oncología en los últimos años es la biopsia selectiva del ganglio centinela.ObjetivoValorar la aportación que las imágenes de SPECT (single photon emission computed tomography ‘tomografía computarizada por emisión de fotón simple’) y tomografía axial computarizada (TAC) (SPECT-TAC) han realizado a la localización del ganglio centinela en pacientes con melanoma.Material y métodosEntre marzo de 2007 y octubre de 2008, 18 pacientes diagnosticados de melanoma fueron estudiados mediante gammagrafía dinámica, estudio planar y SPECT-TAC en el Servicio de Medicina Nuclear del Hospital Clínico San Carlos. Se trataba de 10 mujeres y 8 varones con una edad comprendida entre los 14 y los 83 años, con una edad media de 57 años (57±20,1).ResultadosEl ganglio centinela fue localizado mediante las técnicas convencionales (estudio dinámico e imágenes planares) en 16 de los 18 pacientes incluidos en el estudio, alcanzando una tasa de detección del 88,8%. El estudio SPECT-TAC logró localizar el ganglio centinela en los 18 pacientes alcanzando una tasa de detección del 100%. Además, aportó información relevante en 6 de los 18 pacientes (33%).ConclusionesLa SPECT-TAC aporta información clínicamente relevante en la localización del ganglio centinela en pacientes con melanoma. Esta aportación resulta de mayor trascendencia en pacientes con melanoma de cabeza y cuello, y en pacientes con melanoma localizado en el tronco(AU)

IntroductionThe prognosis of patients with cutaneous melanoma is greatly influenced by the presence of lymph node metastases. One of the most innovative and fascinating concepts to emerge in the field of oncology in recent years is the use of sentinel lymph node biopsy (SLNB).AimThe aim of this study was to determine what SPECT-CT images contribute to the search for sentinel nodes in patients with melanoma.MethodsFrom March 2007 to October 2008, 18 patients were examined for sentinel nodes using dynamic scintigraphy, planar images, and SPECT-CT in the Nuclear Medicine Department of San Carlos University Hospital. The group contained 10 women and 8 men, age range 14–83 years, mean age 57 years (57±20.1).ResultsThe sentinel node was located by conventional imaging techniques (dynamic scintigraphy and planar images) in 16 of 18 patients (88.88%). SPECT-CT identified the sentinel node in 18 of 18 patients (100%) and detected clinically relevant findings in 6 of 18 patients (33.33%)ConclusionsSPECT-CT imaging contributed clinically relevant information on sentinel nodes of melanoma, which is particularly important in patients with melanoma of the trunk or head and neck(AU)