Surface-guided radiation therapy for breast cancer: more precise positioning

Introduction Hypofractionated radiation therapy for breast cancer requires highly precise delivery through the use of image-guided radiotherapy (IGRT). Surface-guided radiation therapy (SGRT) is being increasingly used for patient positioning in breast radiotherapy. We aimed to assess the role of SGRT for verification of breast radiotherapy and the tumour bed. Materials and method Prospective study of 252 patients with early stage breast cancer. A total of 1170 determinations of daily positioning were performed. Breast surface positioning was determined with SGRT (AlignRT) and correlated with the surgical clips in the tumour bed, verified by IGRT (ExacTrac). Results SGRT improved surface matching by a mean of 5.3 points compared to conventional skin markers (98.0 vs. 92.7), a statistically significant difference (p < 0.01, Wilcoxon Test). For surface matching values > 95%, ≥ 3 clips coincided in 99.7% of the determinations and all markers coincided in 92.5%. For surface matching rates > 90%, the location of ≥ 3 clips coincided in 99.55% of determinations. Conclusions SGRT improves patient positioning accuracy compared to skin markers. Optimal breast SGRT can accurately verify the localisation of the tumour bed, ensuring matching with ≥ 3 surgical clips. SGRT can eliminate unwanted radiation from IGRT verification systems (AU)

Surface-guided radiation therapy for breast cancer: more precise positioning.

INTRODUCTION: Hypofractionated radiation therapy for breast cancer requires highly precise delivery through the use of image-guided radiotherapy (IGRT). Surface-guided radiation therapy (SGRT) is being increasingly used for patient positioning in breast radiotherapy. We aimed to assess the role of SGRT for verification of breast radiotherapy and the tumour bed. MATERIALS AND METHODS: Prospective study of 252 patients with early stage breast cancer. A total of 1170 determinations of daily positioning were performed. Breast surface positioning was determined with SGRT (AlignRT) and correlated with the surgical clips in the tumour bed, verified by IGRT (ExacTrac). RESULTS: SGRT improved surface matching by a mean of 5.3 points compared to conventional skin markers (98.0 vs. 92.7), a statistically significant difference (p < 0.01, Wilcoxon Test). For surface matching values > 95%, ≥ 3 clips coincided in 99.7% of the determinations and all markers coincided in 92.5%. For surface matching rates > 90%, the location of ≥ 3 clips coincided in 99.55% of determinations. CONCLUSIONS: SGRT improves patient positioning accuracy compared to skin markers. Optimal breast SGRT can accurately verify the localisation of the tumour bed, ensuring matching with ≥ 3 surgical clips. SGRT can eliminate unwanted radiation from IGRT verification systems.

Topography of the sentinel node according to the affected lobe in lung cancer

Purpose. The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. Patients and methods. 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. Results. While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. Conclusion. The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL (AU)

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Topography of the sentinel node according to the affected lobe in lung cancer.

PURPOSE: The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. PATIENTS AND METHODS: 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. RESULTS: While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. CONCLUSION: The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL.

Superparamagnetic iron oxide as a tracer for sentinel node biopsy in breast cancer: A comparative non-inferiority study.

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.

Tumor bed segmentation: first step for partial breast irradiation

INTRODUCTION: In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS: On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS: Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS: The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe (AU)

Phase II trial with letrozole to maximum response as primary systemic therapy in postmenopausal patients with ER/PgR[+] operable breast cancer

PURPOSE: Letrozole is superior to tamoxifen in terms of response and breast preservation rates as primary systemic therapy (PST) in postmenopausal women with ER-positive early breast cancer. However, the optimum duration of endocrine PST remains uncertain. METHODS: A phase 2 multicentre, open-label trial was conducted to evaluate the efficacy of letrozole over a preoperative period of 4 months to 1 year. Seventy postmenopausal patients (over 65 years) were recruited in four centers. The primary endpoint was to establish the optimal duration of treatment defined as the time required to attain the maximum response by clinical palpation. RESULTS: The median age of the group was 79 years (66-91) and the median tumour size 35 mm (range 25-100 mm). No severe adverse events were reported. Fifty-six patients were evaluable for the primary objective. A total of 43 patients (76.8%) achieved an objective response; 29 (51.8%) being partial and 14 (25.0%) complete. The median time to objective response was 3.9 months (95% CI, 3.3-4.5) and the median time to maximum response was 4.2 months (95% CI, 4.0-4.5), although 20 (37.1%) patients achieved the maximal response within 6-12 months. CONCLUSIONS: Letrozole shows a high activity and excellent tolerability as neoadjuvant therapy in elderly patients with endocrine-dependent breast cancer. Four to six months of letrozole as PST is an optimum duration with modest benefits thereafter (AU)

Estudio del ganglio centinela en cáncer de mama mediante la utilización de la técnica combinada (radiotrazadores y colorantes): ¿qué aporta la combinación de ambos? / No disponible

Objetivo: Ha sido la valoración estadística del empleo de la técnica isotópica, con los factores que pueden influir en la visualización linfogammagráfica del ganglio centinela (GC) y el empleo de colorantes en combinación con marcadores isotópicos, las ventajas que pueden aportar y los inconvenientes. Pacientes y métodos: En la fase de validación de la técnica del GC fueron intervenidas 256 pacientes con diagnóstico de cáncer de mama. En 42 casos se empleó solo el radiotrazador, mientras que en 214 se utilizó además el colorante azul de isosulfán. Resultados: Los parámetros que influyeron de forma independiente en la captación isotópica han sido: la edad de la paciente y la invasión metastásica del GC con rotura capsular, mientras que los parámetros independientes para la tinción con colorante han sido la ubicación del tumor en la mama y la técnica diagnóstica empleada. Conclusión: La utilización del colorante complementa al radiotrazador para la búsqueda del GC ya que mejora la tasa de detección en las pacientes con tumores localizados en cuadrante externos de la mama y en los casos en que existe afectación ganglionar con rotura capsular(AU)

Aim: The statistical assessment of the use of radiotracer technique and which factors may influence the lymphogammagraphic detection, and the use of dyes in combination with isotopic tracers, the potential advantages and disadvantages. Patients and methods: In the validation phase of the sentinel lymph node (SLN) biopsy 256 breast cancer patients were included. In 42 cases only the radiotracer was used, while in 214 patients isosulfhan blue dye was also used. Results: The parameters that independently influenced the isotopic uptake were patient age and SLN metastatic invasion with capsular invasion, while the independent parameters for the dye stain has been the location of the tumor and diagnostic technique used. Conclusion: The use of blue dyes complements the radiotracer for the pursuit of SLN since it improves the detection rate in patients with tumors in the outer quadrants of the breast and in the cases where there is lymph node involvement with capsular invasion(AU)

Sternal resection and reconstruction after malignant tumours.

AIM: We present our experience of the resection of sternal tumours (both primary and metastatic), followed by reconstruction of soft-tissue and skeletal defects with a mesh and musculocutaneous flap. METHODS: Eleven patients were included in this study, all of which underwent sternal tumour resection and immediate chest wall repair. Reconstruction was accomplished with prosthetic material (polytetrafluoroethylene [PTFE]), a sandwich of polypropylene (Marlex-methylmethacrylate or titanium/polypropylene) and a pedicled musculocutaneous flap (pectoralis major, latissimus dorsi or rectus abdominis). Sternal tumours may arise from both primary (chondrosarcoma and neurofibrosarcoma) and secondary (local recurrence of breast carcinoma and metastatic disease from other organs) disease. RESULTS: Extubation did not result in paradoxical respiration in any of the patients in the study. The post-operative mortality rate was seen to be zero. One patient with a PTFE prosthesis had chest failure requiring immediate intubation and posterior prosthesis replacement. One mesh was removed two months after surgery. There was local recurrence in one patient and five patients died from distal metastases. The final patient is still alive with metastases at the time of presenting our results. CONCLUSIONS: Wide resection of sternal tumours provides good local control. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects.

Sternal resection and reconstruction after malignant tumours

AIM: We present our experience of the resection of sternal tumours (both primary and metastatic), followed by reconstruction of soft-tissue and skeletal defects with a mesh and musculocutaneous flap. METHODS: Eleven patients were included in this study, all of which underwent sternal tumour resection and immediate chest wall repair. Reconstruction was accomplished with prosthetic material (polytetrafluoroethylene [PTFE]), a sandwich of polypropylene (Marlex-methylmethacrylate or titanium/polypropylene) and a pedicled musculocutaneous flap (pectoralis major, latissimus dorsi or rectus abdominis). Sternal tumours may arise from both primary (chondrosarcoma and neurofibrosarcoma) and secondary (local recurrence of breast carcinoma and metastatic disease from other organs) disease. RESULTS: Extubation did not result in paradoxical respiration in any of the patients in the study. The post-operative mortality rate was seen to be zero. One patient with a PTFE prosthesis had chest failure requiring immediate intubation and posterior prosthesis replacement. One mesh was removed two months after surgery. There was local recurrence in one patient and five patients died from distal metastases. The final patient is still alive with metastases at the time of presenting our results. CONCLUSIONS: Wide resection of sternal tumours provides good local control. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects (AU)

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Protocol for the implantation of a venous access device (Port-A-Cath System). The complications and solutions found in 560 cases

INTRODUCTION: The cannulation of suitable peripheral veins may be a very painful experience. Implantable venous access systems have to some degree relieved this problem and help to provide an improvement in terms of quality of life. MATERIAL AND METHODS: We have evaluated 560 patients during a follow up period of two years. A low overall complication percentage of 7.32% was seen when using the venous access device. RESULTS: Complications and treatments were: pneumothorax; portal rotation or infection; catheter infection; embolism and migration; extravasation; partial or total obstruction of the device; rupture of the catheter or the membrane. CONCLUSIONS: There is no other system that allows repeated venous access on such a long term basis. Placing the devices completely under the skin allows the patient to conduct a normal life style, and its maintenance does not need any special care, with the exception of the monthly heparinised serum infusion. The preferred option is to insert the catheter through the cephalic vein in the delto pectoral groove (AU)

Tumor de mama de origen parasitario / Tumour of the breast from parasite origin

Paciente de 18 años de edad, natural de Guinea, que acudea la consulta presentando una gran tumoración en la mama izquierdaque ocupa los dos cuadrantes externos. Se realizanmamografías, ecografía y resonancia magnética, mostrandoun gran granuloma de 12 centímetros, sin observar calcificacionesy localizando una larva adulta en el interior del mismo.Se practica una punción aspiración con aguja fina (PAAF)de la tumoración, observando filarias del tipo Loa Loa. Trasrecibir tratamiento con Dietilcarbamazina e Ivermectin es intervenidarealizando una tumorectomía amplia, quedando lapaciente asintomática

An eighteen years old patient, from Guinea, who comes toour clinic with a large tumour in the left breast that includesthe two external quadrants. A mammography, an ecographand a magnetic nuclear resonance are made showing a largegranuloma of 12 centimetres, without calcifications andwatching the adult larva on the inside of granuloma.A PAAF is practised on the tumour, watching the parasite(Loa Loa filaria). After receiving treatment with Dietilcarbamazinaand Ivermectin, the patient undergoes a large lumpectomy,the patient is now asymptomatic

Linfadenectomía selectiva del ganlio centinela en cáncer de mama: resultados de la fase de validación / Sentinel lymph node biopsy in breast cancer: validation study results

Introducción: la biopsia selectiva del ganglio centinela (GC) permite averiguar la estadificación ganglionar en el cáncer de mama mediante una cirugía mínimamente invasiva. El objetivo de este estudio ha sido valorar si un GC libre de metástasis es un factor pronóstico de axila sin enfermedad y detectar GC localizados fuera del drenaje habitual. Material y métodos: se han incluido 190 pacientes desde diciembre de 1998 hasta agosto de 2001 diagnosticadas de cáncer de mama, con un tamaño tumoral inferior a 5 cm. y sin adenopatías palpables. A las pacientes se las sometió a un tratamiento quirúrgico para exéresis del tumor, detección y exéresis del GC junto a una linfadenectomía axilar en los casos de tumores infiltrantes. Resultados: se realizó cirugía conservadora en un 69,5 por ciento, mastectomía radical modificada en un 28,9 por ciento, mastectomía tipo Halsted en un 0,5 por ciento, mastectomía simple en un 0,5 por ciento y mastectomía simple junto a colocación de expansor en un 0,5 por ciento. La técnica empleada para la localización del GC fue la combinada en un 84,7 por ciento y únicamente la isotópica en un 15,3 por ciento, localizándose el ganglio en un 93,68 por ciento de los casos. Tras el estudio rutinario del GC mediante la técnica con hematoxilina-eosina estaban afectos el 28,94 por ciento de los ganglios. El resto de GC negativos se estudiaron mediante la técnica de cortes seriados e inmunohistoquimia. Se positivizaron al alza un 16,26 por ciento con los cortes seriados y un 8,94 por ciento más con la inmunohistoquimia que no se habían evidenciado con los cortes seriados. La tasa de falsos negativos fue de 5,43 por ciento. Conclusiones: la técnica de biopsia del ganglio centinela es una técnica de aplicación terapéutica con buenos resultados y mínimas complicaciones, que evita la linfadenectomía axilar en un porcentaje elevado de pacientes (AU)

[Experimental study of the immunomodulator effect of pentoxifylline in bacterial translocation produced by lipid-free parenteral nutrition]. / Estudio experimental sobe la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos.

INTRODUCTION: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-alpha, which seems to be linked to the progress of these conditions towards multiple organ failures. MATERIAL AND METHOD: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-alpha. The data obtained were subsequently analyzed statistically. RESULTS: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-alpha, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. CONCLUSIONS: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-alpha.

Estudio experimental sobre la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos / Experimental study on the immune modulation influence of pentoxiphylline on bacterial translocation produced by lipid-free parenteral nutrition

Introducción: La translocación bacteriana (TB) provoca sepsis de origen intestinal y a pesar de los avances actuales existe una elevada morbimortalidad por sepsis por esta causa. Hemos querido investigar si una sustancia inmunomoduladora como es la pentoxifilina (PX), podía disminuir o inhibir la TB. Hemos elegido la PX por tener acciones inmunomoduladoras y por inhibir la síntesis y la actuación del TNF-alfa, que parece tener relación con el avance hasta el fallo multiorgánico en estos cuadros. Material y método: Se realiza un estudio experimental con 4 grupos de 20 ratas Wistar a las que se les ha sometido a una nutrición parenteral sin lípidos (NP) durante 7 días. Al grupo A: NP; grupo B: NP + 50mg/kg de PX; grupo C: NP + 100mg/kg y grupo D: NP + 134m/kg. Al 7º día se extrae de forma estéril la cadena ganglionar mesentérica, hígado, sangre e intestino, estas muestras se procesan para realizar el estudio microbiológico cuantitativo y cualitativo, estudio histológico de la mucosa intestinal y cuantificación del TNF-alfa. A los datos obtenidos se les aplica un estudio estadístico. Resultados: En el estudio microbiológico cuantitativo se observó que el en el ganglio linfático, hígado y sangre crecieron más colonias en los animales que pertenecían al grupo A con diferencias estadísticamente significativas. El germen que con más frecuencia se identificó fue E. coli. En el estudio del TNF-alfa, el mayor valor medio lo obtuvo el grupo A, con diferencias estadísticamente significativas. En el estudio histológico se observó que el grupo con más atrofia era el grupo A. Conclusiones: Nuestro modelo experimental es válido como modelo de TB, en el grupo A sin PX se produjeron 16 TB y en los grupos con PX se disminuye el número de TB y las cifras de TNF-alfa en suero (AU)

Introduction: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-α, which seems to be linked to the progress of these conditions towards multiple organ failures. Material and method: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-α. The data obtained were subsequently analyzed statistically. Results: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-α, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. Conclusions: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-α (AU)

Valor de la mamografía isotópica en el diagnóstico del cáncer de mama / Value of scintimammography in the diagnosis of breast cancer

Introducción. La mamografía es la técnica diagnóstica más utilizada en el cáncer de mama, pero en ocasiones debe complementarse con otras exploraciones para intentar llegar a un diagnóstico correcto. Objetivo. Valorar la utilidad del estudio isotópico con 99mTcsestamibi en el diagnóstico del cáncer de mama. Material y métodos. Se han estudiado 120 pacientes con sospecha clínica y/o radiológica de patología maligna. Se administraron 20 mCi (740 MBq) de 99mTc-sestamibi i.v. en el brazo contralateral a la lesión, obteniendo imágenes a los 10 min en proyecciones anteroposterior y lateral en decúbito prono (mama péndula).Resultados. El 74 por ciento de las lesiones fueron histológicamente malignas. Los resultados fueron para el tumor: sensibilidad 90 por ciento, especificidad 83 por ciento, valor predictivo positivo 94 por ciento, valor predictivo negativo 74 por ciento, precisión 88 por ciento, prevalencia de enfermedad maligna 74 por ciento; para la afectación ganglionar: sensibilidad 41 por ciento, especificidad 99 por ciento, valor predictivo positivo 93 por ciento, valor predictivo negativo 81 por ciento, precisión 82,5 por ciento, prevalencia de afectación metastásica ganglionar 32 por ciento. En las 45 lesiones no palpables estudiadas se obtuvieron los siguientes resultados: sensibilidad 61 por ciento, especificidad 100 por ciento, valor predictivo positivo 100 por ciento, valor predictivo negativo 61 por ciento, precisión 69 por ciento y prevalencia 80 por ciento. En 11 pacientes existía sospecha de recidiva local tras tratamiento conservador. La sensibilidad fue del 50 por ciento, la especificidad del 89 por ciento, el valor predictivo positivo del 50 por ciento y el valor predictivo negativo del 89 por ciento.Se valoraron como parámetros que pudieran incidir en la captación isotópica: el tamaño del tumor, el tipo histológico y el grado de carff-Bloom-Richardson. Conclusiones. El estudio isotópico con 99mTc-sestamibi es una técnica complementaria válida en el diagnóstico del cáncer de mama, especialmente en los casos en los que la clínica y la radiología no son concluyentes (AU)

[Locating the sentinel node in breast cancer by gamma probe and staining agent. Preliminary study]. / Localización del ganglio centinela en el cáncer de mama mediante sonda gammadetectora y colorante. Estudio preliminar.

OBJECTIVE: The sentinel node biopsy appears to offer an alternative to routine axillary lymph node dissection for staging patients with breast cancer. Various techniques have been studied for identifying the sentinel node, using vital blue or radioactive colloid. This study aimed to evaluate our preliminary results with these techniques. MATERIAL AND METHODS: In this work carried out in the Valencian Institute of Oncology, 21 women with T1- T2 breast cancer with an average age of 52 years (range: 42-73) underwent the sentinel node biopsy, which was immediately followed by standard axillary dissection. Both blue dye and radioisotope were used to identify the sentinel node. The radioactive axillary of sentinel node was localized by the gamma probe. RESULTS: The sentinel node was successfully identified by lymph node scintigraphy in 100%. It was localized by blue dye in 33% and by combination of blue dye and isotope in 95%. Of the 21 patients in this study in whom sentinel nodes were identified, 7 (35%) were histologically positive; in 6 cases, the sentinel was the only site of the metastases (86%). The histology of the sentinel node accurately predicted axillary node status in 95% of cases. CONCLUSIONS: The sentinel node biopsy technique is a promising and feasible procedure in patients with clinically T1-T2 N0M0 breast cancer, providing valuable axillary staging information.

[Lympho-gammagraphy and study of sentinel node in cutaneous melanoma]. / Linfogammagrafía y estudio del ganglio centinela en el melanoma cutáneo.

OBJECTIVE: To evaluate the role of selective sentinel lymph node dissection to reduce the number of unnecessary lymphadenectomies in patients with intermediate risk of melanoma and without clinical evidence of regional node and distant metastases. MATERIAL AND METHOD: We studied 65 patients with stage I and II melanoma. Only vital blue dye mapping was carried out in nine patients and combined lymphatic mapping with both blue dye and lymphoscintigraphy was used in the remaining 56 patients. RESULTS: The sentinel node was identified in 63 of 65 patients (97%). Only eighth patients (12%) were found to have metastatic melanoma cells in their sentinel node. CONCLUSIONS: Our findings confirm that the intraoperative lymphatic mapping of the sentinel node using both blue dye and radiodetection is an appropriate and simple technique for selecting patients who are more likely to benefit from lymph node dissection.

Linfogammagrafía y estudio del ganglio centinela en el melanoma cutáneo / Lymphogammagraphy and study of sentinel node in cutaneous melanoma

Objetivo: Valorar el papel de la disección selectiva del ganglio centinela para reducir el número de linfadenectomías innecesarias en pacientes con melanoma de riesgo intermedio y sin evidencia clínica de adenopatías regionales ni metástasis a distancia. Material y método: Hemos estudiado 65 pacientes con Melanoma estadios I y II. Se usó solo la técnica del azul vital en nueve pacientes; en los restantes 56 se combinó en la detección linfática, el azul vital y la linfogammagrafía. Resultados: El ganglio centinela fue identificado en 63 de 65 pacientes (97 por ciento). Solamente en ocho enfermos (12 por ciento) se encontró afectación metastásica por M.M. en el ganglio centinela. Conclusiones: Nuestros hallazgos confirman que la detección linfática intraoperatoria del ganglio centinela, usando el colorante azul y la radiodetección, es una técnica apropiada y sencilla para seleccionar los pacientes que más se beneficiaran de la disección del ganglio linfático (AU)