Biopsia selectiva de ganglio centinela en pacientes con cáncer de endometrio. Inicio de la técnica en el Hospital Universitario Virgen Macarena / Sentinel lymph node biopsy in patients with endometrial cancer. Beginning of using the technique in the Virgen Macarena University Hospital

Antecedentes: La biopsia selectiva de ganglio centinela (BSGC) en el cáncer de endometrio se encuentra aún en periodo de estudio para validar su implantación protocolizada y evitar así la linfadenectomía pélvica y aortocava. Objetivo: Mostrar nuestros resultados durante el proceso de validación de la técnica y así colaborar para su implantación en otros centros. Método: Estudio observacional descriptivo prospectivo de pacientes intervenidas de cáncer endometrial en las que se realizó BSGC vía laparoscópica desde julio de 2016 a diciembre de 2019. Resultados: Los ganglios centinela (GC) en todas las pacientes fueron negativos para metástasis. Hubo una concordancia del 100% entre los resultados anatomopatológicos de los GC y de las posteriores linfadenectomías de validación. En ningún caso se objetivaron complicaciones operatorias durante la realización de la BSGC. Conclusión: La BSGC en pacientes en estadios iniciales de carcinoma endometrial es una técnica en fase de validación pero cuyos resultados son prometedores, pudiéndose llevar a cabo una cirugía menos invasiva de forma segura, evitando la comorbilidad asociada a la linfadenectomía.(AU)

Background: Sentinel lymph node biopsy (SLNB) in endometrial cancer is still being assessed in order to validate its standardised protocol to avoid pelvic and aortocaval lymphadenectomy. Objective: To present the results of the technique during the validation process, and work towards its implementation in other centres. Method: A prospective descriptive observational study of endometrial cancer patients who underwent laparoscopic SLNB from July 2016 to December 2019. Results: Sentinel lymph nodes (SLN) in all patients were negative for metastasis. There was a 100% agreement between the histopathology results of the SLN and the subsequent validation of lymphadenectomies. No surgical complications were observed in any of the cases during the performing of the SLNB. Conclusion: SLNB in patients in early stages of endometrial carcinoma is a technique in the validation phase, but the results of which are promising. This means that less invasive surgery can be carried out safely, avoiding comorbidity associated with lymphadenectomy.(AU)

Tumor de Brenner benigno asociado a tumor mucinoso borderline de ovario en paciente postmenopáusica / Benign Brenner tumour associated with a borderline mucinous tumour of the ovary in a post-menopausal patient

El tumor de Brenner es una neoplasia ovárica infrecuente de origen incierto, generalmente asintomática. Su diagnóstico es complejo, sin presentar patrones ecográficos específicos. Se ha asociado a tumores mucinosos con distinto potencial de malignidad, pudiendo encontrar componentes malignos o borderline que determinarán el tratamiento. Para su diagnóstico diferencial es esencial la realización de un estudio inmunohistoquímico, para objetivar el origen clonal del tumor de Brenner y de la estirpe mucinosa. Presentamos el caso de una mujer diagnosticada intraoperatoriamente de un tumor de Brenner asociado a un tumor mucinoso borderline de ovario, en el estudio definitivo posterior.(AU)

Brenner tumour is an uncommon neoplasm of the ovary of uncertain origin and often asymptomatic. Diagnostic is complex, without specific ultrasound patterns. It has been associated with mucinous tumours with different potential for malignancy, and it is possible to find malignant or borderline components that determine the treatment. For its differential diagnosis immunohistochemical study is essential, which shows, according to various studies, a clonal origin of Brenner and mucinous tumour. This is a case report of a Brenner tumour associated with a mucinous tumour, which in a definitive study showed to be associated with a borderline ovarian tumour component.(AU)

Falso positivo en rastreo con 131I por quiste de Naboth / False-positive 131I uptake secondary to nabothian cyst

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Biopsia selectiva del ganglio centinela en cáncer de cérvix: experiencia en fase de validación / Selective biopsy of the sentinel node in cancer of cervix: Experience in validation phase

Antecedentes y objetivo: La biopsia selectiva del ganglio centinela (BSGC) surgió para disminuir la morbilidad asociada a la linfadenectomía pélvica en estadios iniciales del cáncer cervical (CC), conservando la información pronóstica obtenida de ella. El objetivo es determinar la validez diagnóstica de la BSGC en CC en estadios iniciales (IA1 con infiltración linfovascular [ILV] +, IA2, IB1 y IIA1), evitando así linfadenectomías innecesarias en muchos de los casos. Material y método: Desde enero del 2012 hasta abril del 2017, 23 pacientes con estadios iniciales de CC fueron incluidas en un estudio transversal de evaluación de la eficacia de la BSGC usando la técnica mixta de inyección cervical de 99mTc-nanocoloide de albúmina y azul de metileno, empleando linfogammagrafía planar combinada con imagen multimodalidad SPECT/TC y posterior extirpación del GC mediante laparoscopia. Resultados: La tasa de detección de la BSGC con técnica mixta fue del 95,6%, siendo el valor predictivo negativo (VPN) del 95,4% y la sensibilidad (S) del 100% en caso de drenaje bilateral. La media de GC extirpados fue de 3 (rango 1-5). La tasa de detección bilateral en la laparoscopia fue del 85,3%. La concordancia entre SPECT/TC y laparoscopia para el número y bilateralidad del GC mediante el coeficiente de Pearson fue r = 0,73 y r = 0,83, respectivamente; p = 0,01. Solo encontramos un GC con resultado diferido de micrometástasis y se detectó un falso negativo. Conclusiones: La BSGC en CC mediante técnica mixta tiene una elevada tasa de detección y de drenaje bilateral, pero aún la S es baja si incluimos casos de drenaje unilateral. Un mayor número de casos y el desarrollo de la ultraestadificación intraoperatoria podrían aumentar la S de la técnica y reducir el número de falsos negativos

Background and objective: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. Material and method: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. Results: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. Conclusions: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives

Selective biopsy of the sentinel node in cancer of cervix: Experience in validation phase. / Biopsia selectiva del ganglio centinela en cáncer de cérvix: experiencia en fase de validación.

BACKGROUND AND OBJECTIVE: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases. MATERIAL AND METHOD: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99mTc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy. RESULTS: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected. CONCLUSIONS: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives.