A systematic review about the role of preoperative 18F-FDG PET/CT for prognosis and risk stratification in patients with endometrial cancer.

OBJECTIVE: To analyse the available literature on the prognostic value of preoperative 18F-FDG PET/CT metabolic parameters and their usefulness in risk stratification in patients with endometrial cancer (EC). MATERIAL AND METHODS: Pubmed searches used "(endometr* OR uter*) AND (PET OR FDG)" as keywords from January-2000 to June-2020. References in included articles were checked for possible publications not included in the first search. Studies evaluating the prognostic value of preoperative 18F-FDG PET/CT and its role for risk stratification in patients with EC were included. Non-original articles (reviews, editorials, letters, legal cases, interviews, case reports, etc.) were not included. RESULTS: Twenty-six studies (1918 patients) were selected according to the inclusion criteria in this review. Thirteen studies (939 patients) related to the prognostic role of preoperative 18F-FDG PET/CT and 14 studies (1036 patients) related to its role in risk stratification were included. Parameters such as SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumour were analysed. CONCLUSIONS: Preoperative SUVmax is useful for non-invasive diagnosis and for deciding the appropriate therapeutic strategy, as it could be used as an independent prognostic marker for recurrence and survival in EC. In addition, both preoperative VTM and GTL could be independent prognostic factors for predicting recurrence and survival, but there is still insufficient scientific evidence. The usefulness of SUVmax for risk stratification is limited (there is insufficient literature that 18F-FDG PET/CT can replace surgical staging), although VTM and GTL are more accurate and have a valuable role in risk stratification of EC. However, larger multicentre studies with adequate follow-up time are needed to confirm these findings.

Failure of scintigraphy lymphatic mapping in endometrial cancer. Causes and solutions.

AIM: To evaluate the effect of technical problems and patient characteristics on sentinel lymph node (SLN) scintigraphic detection and mapping success in early stages of endometrial cancer (EC). METHODS: Patients with clinical early stage EC (IA-IB) underwent SLN mapping using technetium-99m-nanocolloid, between September 2011 and February 2020 were included. There were excluded cases with technical problems, 92 patients were included for the analysis of the diagnostic performance and the relation of mapping failure (pelvic unilateral or not detected SLN) with patient (age, body mass index, previous pelvic disease or surgery) and disease characteristics (histology, grade, myometrial invasion, lymphovascular space infiltration, tumor size, and lymphatic infiltration risk). RESULTS: The overall detection rate was 79%. Lymph node metastases were diagnosed in 7 patients. Age (P = .01), depth of myometrial invasion ≥50% (P = .04) and high risk of lymphatic infiltration (P = .02) were positively associated with mapping failure. In multivariate analysis, age was significantly associated with mapping failure [odds ratio = 1.63, 95%CI: 1.06-2.50; P = .027]. CONCLUSIONS: Age, depth of myometrial invasion and high risk of lymphatic infiltration were the factors associated with higher mapping failure. An individualized injection technique, optimizing the methodology, could minimize the detection failures.

Correlation between ferromagnetic and isotopic tracers for sentinel lymph node detection in cutaneous melanoma: IMINEM study.

BACKGROUND: The usefulness of sentinel lymph node biopsy (SLNB) in staging cutaneous melanoma has been proven. Therefore, different tracers have been used to identify the sentinel lymph nodes (SLNs). The use of isotopic tracers together with radioactivity detectors allowed a much more precise and direct approach to the SLNs. However, not all centres have access to a Nuclear Medicine department hindering sentinel lymph node detection (SLND) and consequently, other markers such as ferromagnetic tracers have been evaluated looking for the same advantages and effectiveness as isotopic tracers. Ferromagnetic tracers have proven their usefulness in other cancer entities such as breast, prostate and thyroid cancer. The objective was to assess the detection and concordance rates between isotopic and ferromagnetic techniques for SLNB in cutaneous melanoma. METHOD: Isotopic SLNB technique and ferromagnetic tracer were compared for cutaneous melanoma in a non-inferiority multicentre prospective study carried out in six Spanish hospitals. RESULTS: A total of 60 patients were recruited and 133 lymph nodes removed. The detection rate was slightly higher with ferromagnetic tracer in head-neck and trunk melanomas, and with isotopic tracer in limbs. The patients' and nodes' concordance rates between both techniques for ex vivo samples were 95% and 86% for head-neck and trunk tumours and 97% and 93% for limbs tumours, respectively. The concordance rates for involved nodes were 100% and 88.2% for patients and nodes, respectively. CONCLUSION: The intraoperative detection and biopsy of SLN in cutaneous melanoma using a ferromagnetic was a reliable alternative method to the isotopic technique in cutaneous melanomas.

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer.

AIM: Based on the response criteria of the 2015 American Thyroid Associations guidelines, our objectives were to -determine the response rate when using a low dose of -131-I GBq in patients with low-risk differentiated thyroid cancer (LRDTC) and the influence of clinical and analytical variables on the prediction of complete response. METHODS: We performed a multicentre and longitudinal study, including patients who were operated for LRDTC and who underwent radioiodine remnant ablation with a low-dose of 131-I. All patients were assessed at 6-12 months, and their status was classified as complete (excellent response) or incomplete response (structural incomplete, biochemical incomplete or indeterminate response). Various factors including age, gender, histology, tumour focality and size, stage, time from surgery to treatment, type of thyroid-stimulating hormone (TSH) stimulation, preablation serum thyroglobulin (pTg), antiTg antibodies (pAntiTgAb) and TSH (pTSH) levels were also analysed in order to predict the complete response rate. RESULTS: Of 108 patients, 79.6$ achieved complete response and the remaining showed incomplete response (2.9, 5.5 and 12$ due to biochemical incomplete, structural incomplete and indeterminate response respectively). Six patients received a new dose of 131-I. Tumour size and pAntiTgAb were the only factors related to therapeutic response (p = 0.03 and p < 0.01, respectively). However, pAntiTgAb was the only independent factor related to complete -response. Patients with complete response showed lower pTg than those with incomplete response (5.1 ± 12.9 vs. 11.2 ± 25 ng/mL) although without statistical significance (p = 0.14). There was no significant difference in the response rate depending on the thyrotropin stimulation methods. CONCLUSIONS: A low dose of 131-I was sufficient for reaching a complete response at 6-12 months of follow-up in the majority of patients with LRDTC. Tumour size and pAntiTgAb variables were related to therapeutic response.

Usefulness of CA125 and its kinetic parameters and positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose ([18F] FDG) in the detection of recurrent ovarian cancer / Utilidad del CA125 y sus parámetros cinéticos y de la tomografía por emisión de positrones/tomografía computarizada (PET/TC) con fluorodesoxiglucosa ([18F]FDG) en la detección de la recidiva del cáncer de ovario

Background and objective: To assess the usefulness of cancer antigen 125 (CA125) serum levels and kinetic values, velocity (CA125vel) and doubling time (CA125dt), as well as fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT), in the detection of ovarian cancer recurrence. To assess the optimal cut-off for CA125, CA125vel and CA125dt to detect relapse with [18F]FDG-PET/CT. Material and methods: A retrospective analysis was performed of 59 [18F]FDG-PET/CT (48 patients) for suspected recurrence of ovarian cancer. Receiver operating characteristic (ROC) curves were plotted and area-under-the curve (AUC) statistics were computed for CA125, CA125vel and CA125dt. The results obtained in the group with normal and high (>35U/ml) CA125 levels were compared. Results: Forty-four cases of recurrence were diagnosed (7 had CA125 ≤35U/ml), whereas 15 showed no disease. All of them were correctly catalogued by PET/CT. In ROC analysis, the discriminatory power of CA125 was relatively high (AUC 0.835) and the optimal cut-off point to reflect active disease was 23.9U/ml. The ROC analyses for the CA125vel and CA125dt showed an AUC of 0.849 and 0.728, respectively, with an optimal cut-off point of 1.96U/ml/month and 0.76 months, respectively. In patients with normal CA125 and recurrence of ovarian cancer, the CA125vel was significantly higher than in patients without recurrence (p=0.029). Conclusion: [18F]FDG-PET/CT is more accurate than CA125 parameters in the detection of ovarian cancer recurrence. CA125 serum levels are essential; nevertheless, CA125 kinetic values must be considered to detect relapse. Particularly in patients with CA125 within normal values, in which a higher CA125vel is indicative of recurrence

Fundamento y objetivo: Valorar en la recidiva del cáncer de ovario la utilidad del CA125 y sus parámetros cinéticos, velocidad (CA125vel) y tiempo de duplicación (CA125td), y de la tomografía por emisión de positrones/tomografía computarizada (PET/TC) con fluorodesoxiglucosa ([18F]FDG). Determinar el valour óptimo del CA125, CA125vel y CA125td para detectar recidiva con [18F]FDG-PET/TC. Material y métodos: Análisis retrospectivo de 59 estudios [18F]FDG-PET/TC en 48 pacientes con sospecha de recidiva de cáncer de ovario platino-sensible. Realizamos un análisis ROC (Receiver operating characteristic) y el área bajo la curva (AUC) para el CA125, CA125vel, CA125td. Comparamos los resultados entre los grupos con CA125 dentro de la normalidad y CA125 patológico (>35U/ml). Resultados: Fueron diagnosticados de recidiva 44 casos (7 con CA125 ≤35U/ml), mientras que 15 no mostraron recurrencia. Todos ellos fueron correctamente catalogados mediante la PET/TC. La curva ROC demostró una capacidad discriminatoria del CA125 relativamente alta (AUC 0.835), con un valour óptimo de referencia de 23.9U/ml. El análisis ROC para la CA125vel y el CA125td mostró un AUC de 0.849 y 0.728, con un valour de referencia de 1.96U/ml/mes y 0.76 meses, respectivamente. En las pacientes con CA125 en límites normales la CA125vel fue significativamente mayor en las pacientes con recidiva que en aquellas sin enfermedad (p=0.029). Conclusión: La [18F]FDG-PET/TC es más exacta que los parámetros de CA125 en la detección de recurrencia de cáncer de ovario. Los niveles séricos de CA125 resultan esenciales, no obstante, los parámetros cinéticos deben ser tenidos en cuenta en la detección de la recidiva

Usefulness of CA125 and its kinetic parameters and positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose ([18F] FDG) in the detection of recurrent ovarian cancer.

BACKGROUND AND OBJECTIVE: To assess the usefulness of cancer antigen 125 (CA125) serum levels and kinetic values, velocity (CA125vel) and doubling time (CA125dt), as well as fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT), in the detection of ovarian cancer recurrence. To assess the optimal cut-off for CA125, CA125vel and CA125dt to detect relapse with [18F]FDG-PET/CT. MATERIAL AND METHODS: A retrospective analysis was performed of 59 [18F]FDG-PET/CT (48 patients) for suspected recurrence of ovarian cancer. Receiver operating characteristic (ROC) curves were plotted and area-under-the curve (AUC) statistics were computed for CA125, CA125vel and CA125dt. The results obtained in the group with normal and high (>35U/ml) CA125 levels were compared. RESULTS: Forty-four cases of recurrence were diagnosed (7 had CA125 ≤35U/ml), whereas 15 showed no disease. All of them were correctly catalogued by PET/CT. In ROC analysis, the discriminatory power of CA125 was relatively high (AUC 0.835) and the optimal cut-off point to reflect active disease was 23.9U/ml. The ROC analyses for the CA125vel and CA125dt showed an AUC of 0.849 and 0.728, respectively, with an optimal cut-off point of 1.96U/ml/month and 0.76 months, respectively. In patients with normal CA125 and recurrence of ovarian cancer, the CA125vel was significantly higher than in patients without recurrence (p=0.029). CONCLUSION: [18F]FDG-PET/CT is more accurate than CA125 parameters in the detection of ovarian cancer recurrence. CA125 serum levels are essential; nevertheless, CA125 kinetic values must be considered to detect relapse. Particularly in patients with CA125 within normal values, in which a higher CA125vel is indicative of recurrence.

Impact of radioguided occult lesion localization on the correct excision of malignant breast lesions: effect of histology and tumor size.

AIM: To evaluate the impact of radioguided occult lesion localization (ROLL) in the correct location and excision of malignant breast lesions, and analyze if these results are affected by the histology and tumor size. MATERIALS AND METHODS: A total of 105 patients with occult breast lesions were studied. The mean age was 55 years. An intralesional dose of 18.5 MBq of 99mTc-labeled macroaggregated human albumin (AMA) was administered using stereotaxic mammography or ultrasound. Surgical resection was carried out with the help of a gammadetector probe. In the histological study, disease-free margin was defined by a distance between the tumor lesion and the surgical margin of more than 1 mm. The possible influence of tumor histology and lesion diameter with respect to free/affected margins was analyzed. RESULTS: Correct radiotracer placement was achieved in 100/105 of the cases (95.2%). In the remaining 5 cases (4.8%), radiotracer placement was incorrect, with 2 of them being malignant lesions that were found by macroscopic inspection, and the other 3 having benign pathology. Among the malignant lesions (44 cases), correct placement of the radiotracer was achieved in 42 cases (95.5%). Of these 42 malignant lesions, in which the ROLL was correctly performed, free surgical margins were obtained in 24 cases (57.1%), while the other 18 (42.9%) had infiltrated surgical margins. The most common histological type among the malignant lesions was invasive ductal carcinoma (71.4%). The histological types with an increased frequency of infiltration of surgical margins were invasive and microinvasive cancer (94.4%). All the affected margins were in lesions greater than 10 mm, and the highest incidence was in those between 20 and 30 mm (55.5%). CONCLUSION: In our experience, the advantages of the ROLL technique are a precise localization of malignant breast lesions (95.5%) and an increased probability of a complete excision with free margins in more than one half of them. Nevertheless, special consideration should be taken when dealing with invasive and microinvasive cancers and in those exceeding 10 mm because of their higher incidence of infiltrated margins.

Androgenesis in recalcitrant solanaceous crops.

Tomato, eggplant, and pepper are three solanaceous crops of outstanding importance worldwide. For hybrid seed production in these species, a fast and cheap method to obtain pure (homozygous) lines is a priority. Traditionally, pure lines are produced by classical inbreeding and selection techniques, which are time consuming (several years) and costly. Alternatively, it has become possible to accelerate the production of homozygous lines through a biotechnological approach: the induction of androgenesis to generate doubled haploid (homozygous) plants. This biotechnological in vitro tool reduces the process to only one generation, which implies important time and costs savings. These facts make androgenic doubled haploids the choice in a number of important crops where the methodology is well set up. Unfortunately, recalcitrant solanaceous crops such as tomato, eggplant, and pepper are still far from an efficient and reliable technology to be applied on a routine basis to different genotypes in breeding programs. In eggplant and pepper, only anther cultures are known to work relatively well. Unfortunately, a more efficient and promising technique, the culture of isolated microspores, is not sufficiently developed yet. In tomato, none of these methods is available nowadays. However, recent advances in the knowledge of embryo development are filling the gaps and opening new ways to achieve the final goal of an efficient protocol in these three recalcitrant species. In this review, we outline the state of the art on androgenic induction in tomato, eggplant, and pepper, and postulate new experimental ways in order to overcome current limitations.

Manifestaciones radiológicas del Síndrome de Lemierre: a propósito de un caso / Radiological features of Lemierre's syndrome: a case report

El síndrome de Lemierre es una sepsis por anaerobios secundaria a una infección faringoamigdalina que se complica con una tromboflebitis supurada de la vena yugular ipsilateral y embolismos sépticos. Las pruebas de imagen son importantes para la confirmación del diagnóstico. En la radiografía de tórax pueden observarse lesiones nodulares periféricas cavitadas, mal definidas. La tomografía computarizada (TC) es útil para confirmar dichas lesiones pulmonares, que son sugerentes de émbolos sépticos. La ecografía-Doppler cervical es fundamental para demostrar la trombosis de la vena yugular interna. Presentamos un paciente con clínica y hallazgos radiológicos característicos de Síndrome de Lemierre (AU)