Diagnostic efficiency of sestamibi gammagraphy and Doppler sonography in the preoperative assessment of breast lesions.

INTRODUCTION: It would be desirable to have preoperative methods that allow an adequate selection of patients with breast lesions to rule out breast cancer. The aim of the present study is to evaluate the efficiency of preoperative Sestamibi gammagraphy and Doppler sonography regarding the differential diagnosis of malignancy in breast lesions. MATERIAL AND METHODS: A prospective observational study was conducted on 88 consecutive patients with breast lesions. All the patients underwent preoperative Doppler sonography with an echo-enhancing agent and Sestamibi gammagraphy. All the patients had histopathological study of the surgical specimen to compare with the result of the preoperative techniques. These comparisons were done both for the overall series and separately for palpable and non-palpable lesions. RESULTS: In the overall series results, both tests separately and the two combined, are related significantly to the malignant histological diagnosis (p < 0.001). In palpable lesions, there is a considerable increase in sensitivity, and especially in specificity, attaining 100%, with the combination of both tests. In non-palpable lesions, a relationship was only found between the results of the Sestamibi gammagraphy and the malignant histological diagnosis (93.3%; p < 0.05). CONCLUSIONS: Sestamibi gammagraphy and Doppler sonography are two efficient exploratory techniques in the preoperative assessment of malignancy in breast lesions, especially for palpable lesions, and this efficiency is greater when they are combined.

Diagnostic efficiency of Sestamibi gammagraphy and Doppler sonography in the preoperative assessment of breast lesions

No disponible

Introduction. It would be desirable to have preoperativemethods that allow an adequate selection ofpatients with breast lesions to rule out breast cancer.The aim of the present study is to evaluate theefficiency of preoperative Sestamibi gammagraphyand Doppler sonography regarding the differentialdiagnosis of malignancy in breast lesions.Material and methods. A prospective observationalstudy was conducted on 88 consecutive patientswith breast lesions. All the patients underwent preoperativeDoppler sonography with an echo-enhancingagent and Sestamibi gammagraphy. All thepatients had histopathological study of the surgicalspecimen to compare with the result of the preoperativetechniques. These comparations were doneboth for the overall series and separately for palpableand non-palpable lesions.Results. In the overall series results, both tests separatelyand the two combined, are related significantlyto the malignant histological diagnosis (p <0.001). In palpable lesions, there is a considerableincrease in sensitivity, and especially in specificity,attaining 100%, with the combination of both tests.In non-palpable lesions, a relationship was onlyfound between the results of the Sestamibi gammagraphyand the malignant histological diagnosis(93.3%; p < 0.05).Conclusions. Sestamibi gammagraphy and Dopplersonography are two efficient exploratory techniquesin the preoperative assessment of malignancy inbreast lesions, especially for palpable lesions, andthis efficiency is greater when they are combined

Estudio multivariable de los factores de riesgo para desarrollar complicaciones en la cirugía del bocio multinodular / Multivariate study of risk fators for developing complications after multinodular goiter surgery

Introducción. El bocio multinodular (BM) supone un alto volumen de pacientes en los servicios de cirugía endocrina. Sin embargo, los factores de riesgo de morbilidad tras la cirugía no han sido investigados sistemáticamente. El objetivo es analizar, mediante un análisis estadístico multivariable, los resultados quirúrgicos, en cuanto a morbimortalidad, para poder determinar los factores de riesgo de la cirugía del BM. Pacientes y método. Se han revisado retrospectivamente 672 BM intervenidos. Las variables analizadas fueron la edad, el sexo, la cirugía previa, el tiempo de evolución, la sintomatología, el componente intratorácico, la gradación cervical del bocio, la duración de la cirugía, la experiencia del cirujano, la técnica quirúrgica, la identificación de estructuras, el carcinoma tiroideo asociado y el peso de la pieza tiroidea. Se aplicaron el test de la ÷2 y el de la t de Student, así como un análisis de regresión logística. Resultados. El índice de morbilidad fue del 22% (n = 147), la mayoría correspondiente a hipoparatiroidismos y lesiones recurrenciales transitorias. Los factores de riesgo para desarrollar estas complicaciones fueron la presencia de sintomatología (p = 0,0131), el hipertiroidismo (p = 0,0333), la sintomatologíacompresiva (p = 0,0158), la gradación clínica del bocio (p = 0,0482), la técnica quirúrgica realizada (p < 0,00001) y el peso del tiroides (p = 0,0302); como factores de riesgo independiente persistieron la técnica quirúrgica, el hipertiroidismo y la gradación del bocio. El índice de complicaciones definitivas fue del 2,2% (n = 15), que corresponden a 6 hipoparatiroidismos (0,9%) y 10 lesiones recurrenciales (1,5%). El factor de riesgo para su desarrollo es el hipertiroidismo (p = 0,0037; riesgo relativo [RR] = 2,8). Conclusiones. El principal factor de riesgo independiente para el desarrollo de complicaciones en la cirugía del BM es el hipertiroidismo (AU)

Introduction. Multinodular goiter (MG) accounts for a large volume of procedures performed in endocrine surgery departments. However, risk factors for postoperative complications have not been systematically investigated. The aim of the present study was to evaluate surgical outcomes in terms of morbidity and mortality through multivariate statistical analysis with a view to determining risk factors in MG surgery. Patients and method. A total of 672 patients who underwent surgery for MG were retrospectively reviewed. The variables analyzed were age, sex, prior surgery, disease duration, symptomatology, intrathoracic component, the surgeon’s experience, surgical technique, identification of structures, associated thyroid carcinoma and thyroid specimen weight. The chi-squared test, Student’s t-test and logistic regression analysis were performed. Results. Morbidity was 22% (n = 147) and mostly corresponded to hypoparathyroidisms and transitory recurrent lesions. Risk factors for developing these complications were symptomatic disease (p = 0.0131), hyperthyroidism (p = 0.0333), compressive symptoms (p = 0.0158), clinical grade of the goiter (p = 0.0482), surgical technique (p < 0.00001) and thyroid weight (p = 0.0302). Independent risk factors were surgical technique, hyperthyroidism and goiter grade. The definitive complication rate was 2.2% (n = 15), corresponding to six hypoparathyroidisms (0.9%) and 10 recurrent lesions (1.5%). The risk factor for their development was hyperthyroidism (p = 0.0037; RR = 2.8). Conclusions. The main independent risk factor for complications after MG surgery is hyperthyroidism (AU)

[Multivariate study of risk factors for developing complications after multinodular goiter surgery]. / Estudio multivariable de los factores de riesgo para desarrollar complicaciones en la cirugía del bocio multinodular.

INTRODUCTION: Multinodular goiter (MG) accounts for a large volume of procedures performed in endocrine surgery departments. However, risk factors for postoperative complications have not been systematically investigated. The aim of the present study was to evaluate surgical outcomes in terms of morbidity and mortality through multivariate statistical analysis with a view to determining risk factors in MG surgery. PATIENTS AND METHOD: A total of 672 patients who underwent surgery for MG were retrospectively reviewed. The variables analyzed were age, sex, prior surgery, disease duration, symptomatology, intrathoracic component, the surgeons experience, surgical technique, identification of structures, associated thyroid carcinoma and thyroid specimen weight. The chi-squared test, Students t-test and logistic regression analysis were performed. RESULTS: Morbidity was 22% (n = 147) and mostly corresponded to hypoparathyroidisms and transitory recurrent lesions. Risk factors for developing these complications were symptomatic disease (p = 0.0131), hyperthyroidism (p = 0.0333), compressive symptoms (p = 0.0158), clinical grade of the goiter (p = 0.0482), surgical technique (p < 0.00001) and thyroid weight (p = 0.0302). Independent risk factors were surgical technique, hyperthyroidism and goiter grade. The definitive complication rate was 2.2% (n = 15), corresponding to six hypoparathyroidisms (0.9%) and 10 recurrent lesions (1.5%). The risk factor for their development was hyperthyroidism (p = 0.0037; RR = 2.8). CONCLUSIONS: The main independent risk factor for complications after MG surgery is hyperthyroidism.

Effect on oximetry of dyes used for sentinel lymph node biopsy.

HYPOTHESIS: There are differences between readings of peripheral blood oxygen saturation when the effect on saturation values of methylene blue is compared with that of isosulfan blue when used in sentinel lymph node biopsy in patients with breast cancer. DESIGN: Prospective randomized study. SETTING: University tertiary care center. PATIENTS: Thirty-two women undergoing surgery for breast cancer using sentinel lymph node biopsy. INTERVENTIONS: Sentinel lymph node biopsy using methylene blue (16 patients) and isosulfan blue (16 patients); there was also a control group of 6 surgical patients in whom dyes were not used. MAIN OUTCOME MEASURES: Peripheral saturation of blood using pulse oximetry, oxygen saturation by blood-gas analysis, partial oxygen pressure by blood-gas analysis, and plasma dye levels, recorded before dye injection and 15, 30, and 60 minutes afterward. RESULTS: The 2 dyes interfered with the peripheral saturation reading, but only isosulfan blue showed significant differences. The differences in blood-gas analysis values between the 2 groups and with regard to the controls were not significant. CONCLUSIONS: Methylene blue interferes less than isosulfan blue in the peripheral saturation reading. Desaturation is factitious in both cases, and does not correspond to alterations in blood-gas analysis values.

Cáncer epidermoide de mama en el varón. ¿Primario o secundario? / Squamous cell cancer of the breast in the male. Primary or secondary?

El cáncer epidermoide de mama es una enfermedad poco frecuente y representa el 0,06-1,1 por ciento de las neoplasias malignas de mama; raramente aparece en varones. Puede ser un tumor primario, cuyo origen es controvertido (absceso, quiste, etc.), o secundario a un tumor epidermoide de otra localización (pulmonar, laringe, esófago, vejiga y cérvix), por lo que es importante realizar endoscopia, tomografía axial computarizada toracoabdominal y exploración ginecológica en las mujeres, con el fin de diagnosticar posibles lesiones primarias. Su tratamiento no difiere del resto de tumores de mama, aunque suele presentar un curso rápido y agresivo, con tasas de recurrencia de alrededor del 25 por ciento (AU)

Quiste paratiroideo / Parathoyroid cyst

No disponible

Descripción de un instrumento para la biopsia mamaria (ABIMA®) / Description of an instrument for breast biopsy (ABIMA®)

Introducción. Las biopsias de las tumoraciones palpables de mama y especialmente de las lesiones no palpables que se realizan mediante guía con arpón pueden ser técnicamente tediosas por la dificultad en el manejo, tanto de la tumoración en las primeras, como del arpón en las segundas. Objetivo. Presentar un nuevo instrumento quirúrgico (ABIMA®: Aparato para la Biopsia de Mama con Arpón), diseñado por nuestro grupo y dirigido a facilitar la realización de la biopsia de lesiones mamarias, útil tanto en lesiones palpables como en no palpables. Pacientes y método. Hasta noviembre de 2003 se ha realizado la biopsia de 33 lesiones en 31 pacientes (7 palpables y 26 no palpables) utilizando el ABIMA®. Resultados. Se han realizado resecciones adecuadas, con márgenes oncológicamente correctos, en 19 de las 21 lesiones malignas (una precisó ampliación y otra, al ser un carcinoma in situ multicéntrico, mastectomía). Sólo se registró un hematoma postoperatorio en una paciente anticoagulada. El resultado estético fue muy bueno. Conclusiones. El ABIMA® es un instrumento útil en la biopsia de lesiones mamarias, especialmente en el caso de las lesiones no palpables que precisan biopsia guiada por arpón. Además, permite la obtención de márgenes oncológicos adecuados en la mayoría de las lesiones de este tipo que resultan ser malignas, evitando la reintervención para ampliarlos (AU)

Estudio comparativo entre el azul de isosulfán y el azul de metileno para la identificación del ganglio centinela en el cáncer de mama / Isosulfan blue compared with methylene blue in localizing sentinel lymph nodes in breast cancer

Introducción. Aunque el azul de isosulfán es el colorante más utilizado en la realización de la biopsia selectiva del ganglio centinela en el cáncer de mama, su limitación comercial en nuestro medio ha llevado a un uso creciente de otros colorantes, especialmente el azul de metileno. En este trabajo comparamos la utilidad del azul de metileno y el azul de isosulfán en la localización del ganglio centinela en pacientes con cáncer de mama. Método. Se ha estudiado de forma prospectiva y aleatorizada a 89 pacientes en las que se realizaron 91 marcajes con 94 biopsias del ganglio centinela. En todos se usó un marcador isotópico peritumoral y colorante periareolar: en 45 azul de metileno y en 46 azul de isosulfán. Se registraron la detección o no de ganglio centinela, la concordancia del resultado con el isótopo, la producción de efectos adversos, el número de ganglios detectados y su localización (axilar o mamaria interna), y se compararon los 2 grupos. Resultados. Sólo en un caso no se encontró el ganglio centinela (1,06 por ciento). No hemos encontrado diferencias significativas en el número medio de ganglios por drenaje ni en la proporción de drenajes extraaxilares. La tasa de concordancia con el isótopo fue del 100 por ciento en ambos grupos. En ninguna de las pacientes intervenidas se detectaron reacciones adversas atribuibles al uso del colorante. Conclusiones. El azul de metileno es una alternativa al azul de isosulfán en la técnica de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama (AU)

Breast cancer metastasis alters acetylcholinesterase activity and the composition of enzyme forms in axillary lymph nodes.

Because of the probable involvement of cholinesterases (ChEs) in tumorigenesis, this research was addressed to ascertaining whether breast cancer metastasis alters the content of acetylcholinesterase (AChE) and/or butyrylcholinesterase (BuChE) in axillary lymph nodes (LN). ChE activity was assayed in nine normal (NLN) and seven metastasis-bearing nodes (MLN) from women. AChE and BuChE forms were characterised by sedimentation analyses, hydrophobic chromatography and western blotting. The origin of ChEs in LN was studied by lectin interaction. AChE activity dropped from 21.6 mU/mg (nmol of the substrate hydrolysed per minute and per milligram protein) in NLN to 3.8 mU/mg in MLN (p < 0.001), while BuChE activity (3.6 mU/mg) was little affected. NLN contained globular amphiphilic AChE dimers (G2A, 35%), monomers (G1A, 30%), hydrophilic tetramers (G4H, 8%), and asymmetric species (A4, 23%, and A8, 4%); MLN displayed only G2A (65%) and G1A (35%) AChE forms. NLN and MLN contained G4H (79%), G4A (7%), and G1H (14%) BuChE components. Neither the binding of ChE forms with lectins and antibodies nor the subunit size were altered by metastasis. The higher level of AChE in NLN than in brain and the specific pattern of AChE forms in NLN support its role in immunity. The different profile of AChE forms in NLN and MLN may be useful for diagnosis.

Cholinesterase activity and acetylcholinesterase glycosylation are altered in human breast cancer.

Increasing evidence supports the involvement of cholinesterases in tumorigenesis. Several tumour cells show ChE activity, while the acetyl- (AChE) and butyrylcholinesterase (BuChE) genes are amplified in leukemias, ovarian carcinoma and other cancers. ChE activity was measured in 31 samples of tumoral breast (TB) and 20 of normal breast (NB). Despite the wide variations observed, BuChE predominated over AChE both in TB and NB. The mean AChE activity in NB was 1.61 nmol of the substrate hydrolysed per minute and per miligram protein (mU/mg), which rose to 3.09 mU/mg in TB (p = 0.041). The BuChE activity dropped from 5.24 mU/mg in NB to 3.39 mU/mg in TB (p = 0.002). Glycolipid-linked AChE dimers and monomers and hydrophilic BuChE tetramers and monomers were identified in NB and TB, and their proportions were unmodified by the neoplasia. The amount of AChE forms reacting with wheat germ agglutinin (WGA) decreased in TB while that of BuChE species was unaffected, demonstrating that the glycosylation of AChE was altered in TB. The binding of AChE and BuChE with antibodies was unaffected by the neoplasia. The difference in lectin reactivity between erythrocyte and breast AChE, the lack of AChE in blood plasma, and the finding of monomeric BuChE in breast but not in plasma suggest that breast epithelial cells produce AChE for membrane attachment and hydrophilic BuChE for secretion. Several reasons are provided to explain the altered expression of ChEs in breast cancer.