RESUMO
AIMS: The gold standard for detection of Sentinel Lymph Nodes (SLN) is a combined radioisotope and blue dye breast injection, using a gamma probe (GP). A new, non-radioactive method was developed, using a tracer (Sienna+(®)) of superparamagnetic iron oxide (SPIO) nanoparticles and a manual magnetometer (SentiMag(®)) (SM). The IMAGINE study was designed to show the non-inferiority of SM compared to GP, for the detection of SLN in breast cancer patients with SLN biopsy indication. METHODS: From November 2013 to June 2014, 181 patients were recruited, and 321 nodes were excised and assessed ex-vivo. Readings from both SM and GP devices were recorded during transcutaneous, intraoperative, and ex-vivo detection attempts. RESULTS: At the patient level, ex-vivo detection rates (primary variable) with SM and GP were 97.8% and 98.3% (concordance rate 99.4%). Transcutaneous and intraoperative detection rates were 95.5% vs 97.2%, and 97.2% vs 97.8% for SM and GP respectively (concordance rates > 97%). At the node level, intraoperative and ex-vivo detection rates were 92.5% vs 89.3% and 91.0% vs 86.3% for SM and GP respectively. In all cases the non-inferiority of SM compared to SM was shown by ruling out a predefined non-inferiority margin of 5%. CONCLUSIONS: Our study showed the non-inferiority of SM as compared to GP. Moreover, the ex-vivo and intraoperative detection rates at the node level were slightly higher with SM.
Assuntos
Neoplasias da Mama/diagnóstico , Óxido Ferroso-Férrico , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/metabolismo , Neoplasias da Mama/secundário , Feminino , Óxido Ferroso-Férrico/farmacocinética , Humanos , Linfonodos/metabolismo , Metástase Linfática , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Fístula Pancreática/etiologia , Pseudocisto Pancreático/complicações , Doenças Pleurais/etiologia , Fístula do Sistema Respiratório/etiologia , Drenagem , Dispneia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/cirurgia , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Pancreatite Alcoólica/complicações , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/cirurgia , Derrame Pleural/etiologia , Pleurodese , Fístula do Sistema Respiratório/diagnóstico por imagem , Fístula do Sistema Respiratório/cirurgia , Ruptura Espontânea , Tomografia Computadorizada por Raios XAssuntos
Angiomiolipoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/patologia , Angiomiolipoma/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia Abdominal , Tomografia Computadorizada por Raios XRESUMO
We describe a case of hepatic carcinoid tumor that was diagnosed after right hepatectomy. The tumor was initially believed to be metastases from a rectal adenocarcinoma for which surgery had been performed seven years earlier. We highlight the localization of the tumor in the liver only, its large size and rapid growth, as well as the absence of carcinoid syndrome. Diagnostic studies of function and localization are presented. The absence of neoplasia in other locations suggested that this neoplasm was probably a primary hepatic carcinoid tumor. The association of carcinoid tumors with other neoplasms is well-known. However, because of our patient's history and the absence of symptoms, the preoperative diagnosis was incorrect. The definitive diagnosis was confirmed by pathological analysis, allowing specific studies of function and localization to be performed and therapeutic and follow-up measures to be adopted. Although surgery plays a crucial role in the treatment of these tumors, it should be performed in the context of the multidisciplinary management recommended for this disease.
Assuntos
Adenocarcinoma , Tumor Carcinoide/diagnóstico , Erros de Diagnóstico , Neoplasias Hepáticas/diagnóstico , Segunda Neoplasia Primária , Neoplasias Retais , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The incidence of gastric remnant carcinoma ranges between 1% and 9%. We report here our experience in a sanitary area in which, on account of different social and working reasons, the surgical indication for treatment of peptic disease was very common in previous decades. PATIENTS AND METHODS: An analysis was made of the 52 cases of patients operated over the last 12 years, which represents 7.13% of 729 gastric cancers operated over the same time period. RESULTS: In 67% of cases the carcinoma sat on a type-II stump, in 25% on a B-I type stump, and in the remaining 8% on stomachs with vagotomy and pyloroplasty. Seventy-five percent of patients had two characteristics: to be older than 60 years and to have undergone primary surgery at least 15 years before. Over half of patients were admitted on an emergency basis with no diagnosis and had received prolonged symptomatic therapies without previous examinations. The carcinoma involved the anastomotic mouth in 56% of cases and the histologic intestinal type predominated. Twenty-seven percent of patients had stages I and II, whereas almost half of patients had stage IV. Surgical resection was feasible in 42 cases (81%), with a surgical mortality rate of 21% for resections. The overall survival rate estimated at 5 years was 23%. CONCLUSIONS: The possibility of performing surgery with a curative aim is the main prognostic factor for the gastric remnant carcinoma. The endoscopic study of patients at risk allows for diagnosis in earlier stages and therefore and improvement in results.