Implementación del uso del SPECT portátil para valoración de márgenes quirúrgicos en cáncer de mama con indicación de ROLL. Primeros resultados / Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results

Objetivo principal: comparar la efectividad para la comprobación de márgenes quirúrgicos entre SPECT portátil y la mamografía de la pieza (RxM). Objetivo secundario: estandarizar un protocolo preintraquirúrgico mediante SPECT portátil y evaluar el tiempo requerido en el uso de esta técnica. Material y métodos Estudio longitudinal prospectivo con 36 pacientes (39 lesiones) diagnosticadas de cáncer de mama con criterios para realización SNOLL/ROLL. Se realiza en estudio prequirúrgico de la lesión tumoral, tras la administración ecoguiada de [99mTc]Tc-nanocoloides de albúmina/[99mTc]Tc-macroagregados de albúmina, en la lesión tumoral. Mediante SPECT portátil se obtienen imágenes híbridas (óptico + SPECT) e imágenes de navegación en 3D con sonda gamma. En quirófano se obtienen 4-5 imágenes con SPECT portátil, I) sobre piel para localización tumoral II) tras exposición de lecho para guía de resección, III) del lecho tras exéresis, IV y V) a la pieza quirúrgica. Se decide ampliación o no de márgenes considerando tres criterios: a) actividad residual (cps) en bordes de resección del lecho; b) análisis visual de la captación en la pieza; c) una distancia mínima de 10mm de los bordes de la pieza hasta el centro de mayor captación, más el radio de la lesión. En este estudio se valora la concordancia de: la medición de la profundidad entre ecografía y SPECT portátil en el estudio prequirúrgico; los márgenes quirúrgicos entre SPECT portátil vs. RxM, teniendo de técnica de referencia anatomía patológica (AP); del tiempo quirúrgico empleado con SPECT portátil (AU)

Objectives Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM). Secondary objective: To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique. Material and method Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of 99mTc-nanocolloids of albumin/99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical+SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4–5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior–posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM. Results Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8 (AU)

Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results.

OBJECTIVES: Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM). SECONDARY OBJECTIVE: To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique. MATERIAL AND METHODS: Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of 99mTc-nanocolloids of albumin/99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical + SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4-5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior-posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10 mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM. RESULTS: Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8. True positive (TP: detection margin affected) with freehandSPECT: 5 margins, with RxM: 6. True negative (TN: consider free margin when healthy) with freehandSPECT: 213 margins; with RxM: 196. Negative predictive value (NPV: probability of negative margin on unaffected part) with freehandSPECT: 95.9%, with RxM: 96.07%. Specificity with freehandSPECT: 96.8%, with RxM: 97%. The concordance of surgical bed margins between freehandSPECT and RxM: 94.5%. Between freehandSPECT and AP: 93.1%. Between RxM and PA: 93.5%, being all statistically significant (p-value <0.000), so we can affirm that both techniques are related or dependent on the reference technique, the PA. Degree of correlation between SPECT-portable and low PA (Kappa index: 0.34, 95% CI [0.22-0.47], and between RxM and moderate PA (Kappa index: 0.42, 95% CI [0.29-0.56], p-value <0.001. Comparison of the successes and failures of both techniques (SPECT-portable and RxM) and PA: Distribution χ2: 0.023 with degree of freedom 1, with value <0.05, so we can affirm that both techniques are similar, since there are no significant statistical differences. Median total OR time: 60.25 min (30-145). Mean freehandSPECT OR time: 5 scans = 10 min. CONCLUSIONS: There are no statistically significant differences in the probability to rule out affective margins that require a second surgery between both techniques (SPECT-portable and RxM) so, the technique performed with SPECT-Portable is a useful and effective procedure, which requires specific training with an optimized and multidisciplinary protocol. The time spent with SPECT-portable is feasible for daily practice.

Biphasic response of complement to heparin: fluid-phase generation of neoantigens in human serum and in a reconstituted alternative pathway amplification cycle.

We describe a study of the effects of heparin on complement activation through the use of assays for fragment C4d, fragment Bb, and the S-C5b-9 complex (S-MAC). In sera from healthy volunteers, virtually no change was observed in C4d either as a function of time or of heparin concentration, whereas changes in Bb and S-MAC were biphasic. This observation was explored in greater detail in the heparin concentration range 0.001-5.0 u/ml (5 x 10(-3) to 25 micrograms/ml). For both Bb and S-MAC, a significant (P < 0.05) increase in production was noted in the heparin concentration range, 0.01-0.5 u/ml (5 x 10(-2) to 2.5 micrograms/ml). At higher heparin concentrations, Bb and S-MAC production decreased markedly (P < 0.05). We reconstituted the alternative pathway amplification cycle (C3, factor B, and factor D) and studied Bb generation. With reactants at concentrations one tenth those of normal serum, we observed a maximum generation of 13.2 micrograms/ml Bb. Control and heparin at 5 x 10(-4) micrograms/ml generated Bb concentrations of 6.8 and 6.1 micrograms/ml, respectively, for a 2-min incubation; at 5 x 10(-3) micrograms/ml heparin, Bb was increased to 9.8 micrograms/ml. Using isoelectric focusing to study anionic pI shifts in heparin-bound factors B and D, it was found that factor B bound heparin only at the highest heparin concentration studied, i.e., 50 micrograms/ml; factor D, however, bound heparin at a much lower concentration (0.05 micrograms/ml). We conclude that, at low concentrations, heparin activates complement due to potentiation of the alternative pathway amplification cycle in the fluid phase.

[The prone position as an indicator of deviated motor development during the first year of life]. / La posición prona como indicador de un desarrollo motor desviado en el primer año de la vida.

The adequate control and alignment of a baby in the prone position during the first year of life is a basic necessary milestone for a normal, neuromotor development. In this study the prone position was registered in 246 babies with a previous pediatric evaluation, three options could be made: normal retarded or altered. The Milani Comparetti neuromotor evaluation was also realized for each baby at the same time with the same classification options. Both results were compared. A sensitivity and specificity = 1.0 were found for the prone position registered. This test is fast and simple, so it is recommended at a first attention level in high risk population for neuromotor disability.

[Canavan's disease: apropos of a case]. / Enfermedad de Canavan: a propósito de un caso.

One case of spongy degeneration of CNS in infancy is presented. Main clinical features were, complete failure of motor and mental development, sudden hypotonia and hyperreflexia, blindness and optic atrophy. Computed tomography demonstrated a decrease in white matter density of cerebral hemispheres. Histopathological studies confirmed clinical diagnosis of Canavan's disease and indicated presence of abnormal mitochondria in accordance with those reported in the literature.