Biopsia del ganglio centinela y quimioterapia neoadyuvante en pacientes con cáncer de mama: nuestra experiencia / Sentinel lymph node biopsy and neoadjuvant chemotherapy in breast cancer patients: our experience

Objetivo. Revisar nuestra experiencia en la biopsia selectiva del ganglio centinela (BGC) en pacientes con cáncer de mama operable tratadas con quimioterapia neoadyuvante (QTN). Material y métodos. Estudio prospectivo, enero de 2008/diciembre de 2014, 235 BGC en pacientes con cáncer de mama infiltrante T1-3/N0-1, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se estableció por exploración física, ecografía axilar y punción de ganglios sospechosos. El día antes de la cirugía se inyectaron periareolarmente 74-111 MBq de 99mTc-nanocoloide de albúmina. Al finalizar el tratamiento se realizó BGC y linfadenectomía axilar. El GC se analizó por cortes de congelación, hematoxilina-eosina, inmunohistoquímica o one-step nucleic acid amplification. Se determinaron tasa de identificación (Id.GC) y falsos negativos (FN). Resultados. Grupo I BGC pre-QTN pacientes cN0 de inicio: n = 73, Id.GC 97,2% (IC 95% 90,5-99,2). Grupo II 2.a BGC pos-QTN pacientes pN1(gc) de inicio: n = 31, Id.GC 61,3% (IC 95% 43,8-76,3), FN 18,2% (IC 95% 5,1-47,7). Grupo III BGC pos-QTN pacientes cN0 de inicio: n = 54, Id.GC 96,3% (IC 95% 87,5-99,0), FN 9,5% (IC 95% 2,7-28,9). Grupo IV BGC pos-QTN pacientes cN1 de inicio, ycN0 posneoadyuvancia: n = 77, Id.GC 83,1% (IC 95% 73,2-89,8), FN 8,3% (IC 95% 2,9-21,8). Conclusiones. La identificación de la BGC pre-QTN es excelente. En pacientes pN1(gc) al diagnóstico, una 2.a BGC pos-QTN no es válida para su aplicación clínica. La BGC pos-QTN puede realizarse con fiabilidad en pacientes cN0 y cN1 de inicio, con axila clínicamente negativa al finalizar la neoadyuvancia (ycN0), y linfadenectomía axilar si el resultado del GC es positivo o no se identifica en la cirugía, en el ámbito de un equipo multidisciplinar con experiencia (AU)

Aim. To analyze our experience of sentinel lymph node biopsy (SLNB) in patients with operable breast cancer treated with neoadjuvant chemotherapy (NAC). Material and methods. A prospective study was conducted between January 2008 and December 2014 in 235 SLNB in patients with infiltrating breast carcinoma T1-3/N0-1 treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination and ultrasound, with guided core needle biopsy of any suspicious lymph nodes. The day before surgery, 74-111 MBq of 99mTc-albumin nanocolloid was injected periareolar. Following NAC, patients underwent SLNB and axillary lymph node dissection. SLN were examined with hematoxylin-eosin staining and immunohistochemical analysis or one-step nucleic acid amplification. The identification rate (IR) and false-negative rate (FNR) were determined. Results. Group I SLNB pre-NAC in patients cN0 at diagnosis: n = 73, IR 97.2% (95%CI: 90.5-99.2). Group II 2nd SLNB pos-NAC in patients pN1(sn) at diagnosis: n = 31, IR 61.3% (95%CI: 43.8-76.3), FNR 18.2% (95%CI: 5.1-47.7). Group III SLNB pos-NAC in patients cN0 at diagnosis: n = 54, IR 96.3% (95%CI: 87.5-99.0), FNR 9.5% (95%CI: 2.7-28.9). Group IV SLNB pos-NAC in patients cN1 at diagnosis and ycN0 post-treatment: n = 77, IR 83.1% (95%CI: 73.2-89.8), FNR 8.3% (95%CI: 2.9-21.8). Conclusions. The detection rate for SLNB prior to NAC is excellent. A second SLNB after NAC in women with a positive SLN at diagnosis is not useful. SLNB after NAC is feasible in cN0 and cN1 patients at diagnosis, clinically axillary node-negative after therapy (ycN0), with subsequent axillary lymph node dissection if the SLNB is positive or not identified during surgery, when performed by an experienced multidisciplinary team (AU)

Validation of the leukocyte labeling procedure with a new kit for the preparation of technetium-99m exametazime injection.

The labeling of leukocytes with technetium-99m (Tc)-HMPAO is a frequent procedure in our laboratory, which was first validated before initiation of clinical studies with the commercial kit of Tc-D,L-hexamethylpropylene amine oxime (Tc-D,L-HMPAO), available from 1988. Recently, a new kit of exametazime has been introduced, with a similar composition and clinical indications, but with some technical improvements. Validation of the labeling procedure with this new kit is proposed, including a comparison between both commercial kits. Requirements for validation were achieved successfully and a comparative study showed no statistically significant differences; nevertheless, labeling of leukocytes may be expected routinely with the new kit on account of its longer shelf-life and lower cost.

Positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose in the evaluation of postoperative endometrial cancer patients

Objective To evaluate the usefulness of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET) in the follow-up of endometrial cancer patients with suspicion of recurrence due to elevated serum tumour markers and suggestive conventional imaging findings. Material and methods A retrospective review was conducted of 17 FDG-PET studies performed in 11 patients with a previous diagnosis of endometrial cancer (6 patients underwent 2 studies) between April 2002 and October 2005. Mean age of patients was 63.4 yrs (range, 52-69 yrs), and mean time since diagnosis was 56 months (range, 11 months - 12 yrs). Initially, 7 patients were in stage I, 3 in stage III, and 1 in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid and 3 non-endometrioid cancers. Results FDG-PET showed infradiaphragmatic uptake in three patients and disseminated disease in seven; findings were negative in one patient. Computed tomography (CT, n=7) or magnetic resonance (MRI, n=7) images revealed infradiaphragmatic lesions in five patients and visceral lesions in two. All patients showed elevated serum tumour markers (CA125, n=9; CA19.9, n=2; CA15.3, n=2). FDG-PET results modified the information provided by conventional imaging techniques in seven patients and provided no additional information in the remaining four. There was histological confirmation of lesions in two patients. Nine patients were clinically followed up, including imaging studies (mean follow-up, 8.7 months; range, 3-20 months).