Sentinel Lymph Node Biopsy in Prostate Cancer Patients: Results From an Injection Technique Targeting the Index Lesion in the Prostate Gland.

Objectives: To determine the accuracy of nodal staging in patients with prostate cancer (PCa) when 99 m Tc-nanocolloid radiotracer is injected into an index lesion (IL). Methods: This prospective study was conducted at our institution between June 2016 and October 2020. It included 64 patients with localized PCa with at least a 5% possibility for lymph node involvement in the Memorial Sloan Kettering Cancer Center nomogram, suitable for surgical treatment. All patients underwent magnetic resonance imaging (MRI) with IL and were pathologically confirmed. The day before surgery, transrectal ultrasound-guided injection (TRUS) of 99 m Tc-nanocolloid into the IL was performed. Surgical procedures included radical prostatectomy (RP), sentinel lymph node biopsy (SLNB), and extended pelvic lymphadenectomy (ePLND). Analysis was performed, including histopathological findings of RP, ePLND, and SLNB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative (FN), false positive (FP), diagnostic yield, and non-diagnostic rate were calculated. Results: A total of 1,316 lymph nodes were excised, including 1,102 from the ePLND (83.7%) and 214 (16.3%) sentinel lymph nodes (SLN). 26 SLN were dissected outside the ePLND template. The final pathology demonstrated 46 (3.5%) lymph node metastasis, 31 (67.4%) in the SLNB and 15 (32.6%) in the non-SLN ePLND. At the patient level, 18 (28.1%) patients had pN1. With a mean follow-up of 33.1 months, 4/19 (21.1%) pN1 patients had undetectable PSA, and 3/19 (15.8%) had a PSA < 0.1 ng/mL. Lymph node dissection included 20.6 lymph nodes per patient (IQR 15-24.2), with 3.3 SLNB nodes per patient (IQR 2-4.2). PPV and NPV were 100 and 97.8%, respectively. Sensitivity and specificity were 94.4 and 100%, respectively. FN was 5.5% and FP was 4.3%. Diagnostic yields were 95.3% and the non-diagnostic rate was 4.7%. Conclusion: Radiotracer injection into the prostate IL offers promising results for staging purposes in cases in which ePLND is considered. Negative SLNB is a predictor of negative ePLND. Patients with a limited burden of nodal metastasis have a significant chance of remaining free of biochemical recurrence at mid-term follow-up.

Sentinel Lymph Node Biopsy in Prostate Cancer Using the SENSEI® Drop-In Gamma Probe.

ABSTRACT: Minimally invasive surgery in the form of laparoscopic and robot-assisted procedures has been widely adopted in the field of prostate cancer. When performing minimally invasive radioguided surgery, conventional rigid laparoscopic gamma probes have limited maneuverability and control due to their form factor, which may hinder detection of radiotracer-avid lesions in anatomically challenging areas. A drop-in gamma probe has been developed to address these limitations. Our group report on the first clinical use of this probe (SENSEI®) as part of an ongoing prospective, international, multicenter clinical trial in primary prostate cancer patients undergoing 99mTc-nanocolloid sentinel lymph node biopsy.

Impacto clínico del PET/TC Ga68-DOTATOC en tumores de origen neuroendocrino. Experiencia preliminar / Clinical impact of Ga68-DOTATOC PET/CT on neuroendocrine tumors. A preliminary experience

El PET/TC Ga68-DOTATOC es una técnica de diagnóstico por la imagen, de reciente introducción en nuestro medio, para el diagnóstico y seguimiento de tumores neuroendocrinos. Estudio observacional prospectivo de 7 pacientes a quienes se les realizó un estudio PET/TC Ga68-DOTATOC. Los pacientes tenían sospecha de lesiones tumorales neuroendocrinas activas, en diagnóstico inicial o con posible recidiva y/o progresión de tumores ya conocidos. Los resultados de los estudios de imagen realizados previamente (RM, TC toracoabdominal, octreotida...) habían sido negativos o no concluyentes. Todos los PET Ga68-DOTATOC positivos fueron verdaderos positivos, confirmándose por anatomía patológica. No se obtuvieron resultados falsos positivos. Solo se obtuvo un falso negativo. PET/TC Ga68-DOTATOC es más sensible y específico en la detección de lesiones tumorales primarias neuroendocrinas, permite un estudio de extensión más completo y detecta recidivas en estadios más precoces, condicionando cambios en la estadificación y el tratamiento quirúrgico. Aporta información adicional sobre la sobreexpresión de receptores de somatostatina, esencial para la indicación de PRRT (terapia con péptidos marcados con radionúclidos) con Lu177-Dotatate

Ga-68-DOTATOC PET/CT is a recently introduced imaging technique for the diagnosis and follow-up of neuroendocrine tumors. A prospective observational study was conducted in seven patients who underwent a Ga-68-DOTATOC PET/CT study. They were suspected of active neuroendocrine tumor lesions, either on initial diagnosis or as a possible recurrence and/or progression of already known tumors. The results of prior imaging studies (MRI, thoracoabdominal CT scan, octreotide...), had been negative or inconclusive. All positive Ga-68-DOTATOC PETs were true positives, confirmed by pathological examination. There were no false positive results. Only one false negative result was found. Ga-68-DOTATOC PET/CC is more sensitive and specific for the detection of primary neuroendocrine tumor lesions, allows for a more complete extension study, and detects recurrences in earlier stages, conditioning changes in staging and surgical treatment. It provides additional information on somatostatin receptor overexpression, which is essential for the indication of PRRT (peptide receptor radionuclide therapy) with Lu177 dotatate

Clinical impact of Ga68-DOTATOC PET/CT on neuroendocrine tumors. A preliminary experience. / Impacto clínico del PET/TC Ga68-DOTATOC en tumores de origen neuroendocrino. Experiencia preliminar.

Ga-68-DOTATOC PET/CT is a recently introduced imaging technique for the diagnosis and follow-up of neuroendocrine tumors. A prospective observational study was conducted in seven patients who underwent a Ga-68-DOTATOC PET/CT study. They were suspected of active neuroendocrine tumor lesions, either on initial diagnosis or as a possible recurrence and/or progression of already known tumors. The results of prior imaging studies (MRI, thoracoabdominal CT scan, octreotide...), had been negative or inconclusive. All positive Ga-68-DOTATOC PETs were true positives, confirmed by pathological examination. There were no false positive results. Only one false negative result was found. Ga-68-DOTATOC PET/CC is more sensitive and specific for the detection of primary neuroendocrine tumor lesions, allows for a more complete extension study, and detects recurrences in earlier stages, conditioning changes in staging and surgical treatment. It provides additional information on somatostatin receptor overexpression, which is essential for the indication of PRRT (peptide receptor radionuclide therapy) with Lu177 dotatate.

FDG PET-CT SUVmax and IASLC/ATS/ERS histologic classification: a new profile of lung adenocarcinoma with prognostic value.

Quantitative analysis of glucose consumption measured by maximum standardized uptake value (SUVmax) in lung adenocarcinoma (LA) remains in discussion and metabolic information provided by FDG-PET is not included in cancer staging. The first aim of this work was to evaluate the correlation between SUVmax and different histologic subtypes of LA. The second aim was to establish the correlation between SUVmax and TNM, genetic mutations and prognostic. Glucose consumption of primary tumor was quantified using SUVmax in 112 patients with histologically-confirmed LA. Specimens were classified according to the IASLC/ATS/ERS into in situ -AIS-, minimally invasive -MIA-, invasive (lepidic, papillary, acinar, solid and micropapillary) and invasive mucinous adenocarcinoma. Tumors were grouped according to three histological grades; low-grade: AIS, MIA, intermediate-grade: lepidic, acinar, papillary and high-grade: micropapillary, solid and mucinous. Comparisons between SUVmax and histologic subtypes were performed with Kruskal-Wallis followed by a Dunn's test. Overall (OS) and disease-free survival (DFS) were calculated. SUVmax was histologically-dependent (P<0.001): AIS 0.5±0.1, MIA 1.1±0.9 lepidic 3.3±3.1, acinar 8.6±6.7, papillary 3.9±5.1, micropapillary 4.9±3.4, solid 10.4±5.4 and invasive mucinous 2.7±1.2. SUVmax was associated with TNM stage in stage IA and IB. SUVmax was significantly lower in patients with K-RAS and EGFR mutation. Low SUVmax was associated with low-grade histology and with a higher OS and DSF compared to high SUVmax (intermediate and high-grade histology). SUVmax on FDG-PET is a powerful information in the presurgical evaluation of LA patients. It provides prognostic data and should be considered in the staging algorithm of patients with LA.

Vasculitis aórtica en un paciente con lupus eritematoso sistémico / Aortic vasculitis in a patient with systemic lupus erythematosus

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Incidental focal uptake in colorectal location on oncologic FDG PET and PET/CT studies: Histopathological findings and clinical significances / Captación focal incidental de 18F-FDG en colon en los estudios PET y PET/TAC: Hallazgos histopatológicos y significado clínico

Purpose: Unexpected focal colonic or rectal radiotracer activity is an usual finding in patients subjected to a PET study. The aim of this work has been to evaluate the clinical significance of this finding in the prediction of an existing colorectal malignancy. Material and methods: During the last three years, all patients studied with 18F-FDG PET/CT and PET for oncologic work-up purposes were prospectively surveyed for focal colorectal radiotracer activity. Colonoscopy was performed in all patients with this incidental finding in order to exclude colonic malignancy. CEA level, maximum standardized uptake value (SUVmax), CT findings, colonoscopy findings and histopathological results were prospectively analyzed in all patients. Results: A total of 2290 patients were evaluated, 158 of whom were studied with PET and the remainder with a hybrid PET/CT. Focal FDG colorectal activity was incidentally detected in 27 patients with no previous history of colorectal cancer. Colorectal adenocarcinoma was diagnosed in seven (25.9%) patients. A pre-cancerous lesion was found in eleven patients (40.7%). Eight patients (29.6%) had no macroscopic lesions. One patient was diagnosed with a benign lesion. Any focal activity found in the colon by 18F-FDG PET/CT examination predicts a probability greater than 50% of an underlying malignant or premalignant lesion in the histopathological analysis (logistic regression, p = 0.01), independently of the calculated SUVmax. Conclusion: According to the results of the present study, we recommend the performance of a colonoscopy and biopsy of any suspicious lesions, in all patients with unexpected focal FDG activity found in colon or rectum during a 18F-FDG PET/CT examination (AU)

Objetivo: La actividad focal incidental de FDG en colon o recto es un hallazgo usual en pacientes sometidos a una PET. El objetivo de este trabajo es evaluar el significado clínico que tiene este hallazgo en la predicción de la existencia de una lesión colorectal maligna. Material y métodos: Durante los últimos tres años todos los pacientes estudiados mediante PET/CT con 18F con fines oncológicos fueron valorados de forma prospectiva en busca de actividad focal colónica o rectal. Se realizó colonoscopia a todos los pacientes con este hallazgo, para excluir enfermedad maligna. Tanto los hallazgos de la colonoscopia, como los niveles de CEA, SUVmáx, hallazgos TAC y los resultados histopatológicos fueron prospectivamente analizados en todos ellos. Resultados: Un total de 2290 pacientes fueron evaluados, 158 de ellos fueron estudiados con PET y el resto con un equipo híbrido PET/TAC. En 27 de ellos se halló actividad focal de FDG sospechosa en colon o recto. En siete (25,9%) pacientes se diagnóstico adenocarcinoma colorectal. En 11 pacientes (40,7%) se halló una lesión precancerosa. Ocho pacientes (29,6%) no presentaron ninguna lesión macroscópicamente apreciable en la colonoscopia. Un paciente fue diagnosticado de una lesión benigna. Cualquier actividad focal de FDG predice una probabilidad mayor del 50% de corresponder a una lesión premaligna o maligna en el análisis histopatológico (regresión logística, p=0,01), independientemente del SUVmáx. Conclusión: De acuerdo con los resultados del presente estudio recomendamos la realización de una colonoscopia y biopsia de cualquier lesión sospechosa en todos los pacientes en los que se observe actividad focal de FDG en colon o recto en los estudios PET/TAC (AU)

p53 expression in breast cancer predicts tumors with low probability of non-sentinel nodes infiltration.

AIM: Several predictive tools of non-sentinel lymph nodes neoplastic involvement when a positive sentinel lymph node is found have been described. However, molecular factors have been rarely evaluated to build these tools. The aim of this study was to establish which factors predicted non-sentinel lymph nodes infiltration in our setting, including some molecular factors. MATERIAL AND METHODS: We carried out a retrospective review of 161 patients with breast cancer and a positive sentinel lymph node who had undergone axillary lymph node dissection, none of whom had received neoadjuvant treatment. Features evaluated as predictive factors for non-sentinel node positivity were: menopausal status, tumor size, histological subtype, histological grade, lymphovascular invasion, extracapsular invasion, Ki67 index, hormonal receptors, CerbB2 and p53 expression, size of sentinel lymph node metastases and number of sentinel lymph nodes affected. RESULTS: Tumor size (P = 0.001), size of sentinel lymph node metastases (P = 0.001), lobular invasive carcinoma (P = 0.05) and lymphovascular invasion (P = 0.006) were significantly associated with non-sentinel lymph node positivity. Tumor p53 positive expression was strongly associated with non-sentinel lymph node negativity (P = 0.000). In multivariate analysis, all these factors but tumor size maintained their significance. The discrimination power of the model calculated by the area under the receiver-operator curve was 0.811 (95% confidence interval, 0.741-0.880). CONCLUSION: p53 expression in breast cancer was highly predictive of non-sentinel lymph node negativity in our study. New studies should evaluate if it would be useful to add p53 expression to other existing predictive tools.

Incidental focal uptake in colorectal location on oncologic ¹8FDG PET and PET/CT studies: histopathological findings and clinical significances.

PURPOSE: Unexpected focal colonic or rectal radiotracer activity is an usual finding in patients subjected to a PET study. The aim of this work has been to evaluate the clinical significance of this finding in the prediction of an existing colorectal malignancy. MATERIAL AND METHODS: During the last three years, all patients studied with (18)F-FDG PET/CT and PET for oncologic work-up purposes were prospectively surveyed for focal colorectal radiotracer activity. Colonoscopy was performed in all patients with this incidental finding in order to exclude colonic malignancy. CEA level, maximum standardized uptake value (SUVmax), CT findings, colonoscopy findings and histopathological results were prospectively analyzed in all patients. RESULTS: A total of 2290 patients were evaluated, 158 of whom were studied with PET and the remainder with a hybrid PET/CT. Focal FDG colorectal activity was incidentally detected in 27 patients with no previous history of colorectal cancer. Colorectal adenocarcinoma was diagnosed in seven (25.9%) patients. A pre-cancerous lesion was found in eleven patients (40.7%). Eight patients (29.6%) had no macroscopic lesions. One patient was diagnosed with a benign lesion. Any focal activity found in the colon by (18)F-FDG PET/CT examination predicts a probability greater than 50% of an underlying malignant or premalignant lesion in the histopathological analysis (logistic regression, p=0.01), independently of the calculated SUVmax. CONCLUSION: According to the results of the present study, we recommend the performance of a colonoscopy and biopsy of any suspicious lesions, in all patients with unexpected focal FDG activity found in colon or rectum during a (18)F-FDG PET/CT examination.

¿Qué hubiera pasado si hubiésemos aplicado el Z0011 en nuestro medio? Revisión de los ganglios centinela realizados en los últimos 2 años en nuestro centro / What would happen if we applied the Z0011 study criteria? A review of the sentinel node dissections performed in our centre over the last 2 years

Objetivo: Revisar la casuística de nuestro centro para determinar en cuantas pacientes hubiéramos dejado enfermedad residual en la axila si hubiéramos aplicado los criterios del estudio Z0011. Material y métodos: Estudio retrospectivo de los ganglios centinelas (GC) realizados en carcinomas infiltrantes de nuestra Unidad de Patología Mamaria entre junio de 2008 y diciembre de 2010. Se revisaron todos los GC y las linfadenectomías axilares realizadas si 2 o menos GC eran positivos. Resultados: De 194 GC realizados, 33 resultaron positivos en 2 o menos ganglios centinelas (12,3%). La linfadenectomía axilar fue positiva en 13 casos (39,3%). Esto se produjo de forma más frecuente en las pacientes con ≤ 50 años (el 53,84 frente al 30%); en los tumores T2 en comparación con los T1 (el 53,84 frente al 30%); en los que tenían un grado histológico III comparados con los que mostraban grado I y II (el 38,46 frente al 33,33%); en aquéllos con receptores hormonales positivos en comparación con los que tenían receptores hormonales negativos (el 41,9 frente al 0%), y cuando el Ki67 era ≤ 20% en comparación con un Ki67 > a 20% (el 50 frente al 18,18%). Ninguna de estas diferencias fue estadísticamente significativa. Conclusión: Si hubiéramos aplicado los criterios del Z0011, un 39,3% de pacientes hubiera tenido enfermedad residual. Esto parece producirse con más frecuencia en pacientes de 50 o menos años, con tumoraciones de más de 2 cm, alto grado histológico, receptores hormonales positivos y Ki67 bajo. Sin embargo, el número bajo de casos de nuestra casuística no nos permite establecer unas conclusiones definitivas (AU)

Objective: To review the series of our centre in order to determine how many patients would have had residual disease in the axilla if we had applied the criteria of the Z0011 study. Material and methods: Retrospective study of sentinel lymph nodes performed in T1 and T2 breast infiltrating carcinomas in our Breast Pathology Unit between June 2008 and December 2010. We reviewed all the sentinel nodes (SN) and axillary lymph node dissections (ALND) performed when 2 or less SN were positive. Results: Of 194 sentinel nodes reviewed, 33 were positive in two nodes or less (12.3%). ALND was positive in 13 cases of 33 (39.3%). Positive ALND occurred more frequently in patients ≤ 50 years old than in > 50 years old patients (53.84% vs. 30%), in T2 compared toT1 tumours (30% vs. 53.84%), in grade III versus grade I and II tumours (38.46 vs. 33.33%), in hormone receptor-positive than in receptor-negative tumours (41.9 vs. 0%) and in Ki67 ≤ 20% compared to Ki67 > 20% tumours (50% vs. 18.18%). None of these differences were statistically significant. Conclusion: If we had applied the criteria of the Z0011 study, 39.3% of patients would have had residual disease. This seems to occur more frequently in patients 50 years or younger, with tumours larger than 2 cm, with high histological grade tumours, with positive hormone receptor and low Ki67. However, the low number of cases in our series does not allow definitive conclusions to be made (AU)

Assessment of rhabdoid brain tumor by F-18 FDG PET, C-11 methionine PET and MRI.

A 28-year-old man with headache, nausea, and decreased vision had a left parieto-occipital tumor demonstrated by MRI. Postradical resection and histology showed a solid mass containing rhabdoid cells, 10% positive for Ki-67. After completing chemotherapy and radiotherapy treatment, follow-up MRI revealed possible tumoral recurrence. Cerebral F-18 FDG PET revealed no pathologic uptake, and C-11 methionine PET showed a pathologic low uptake. These findings suggested recurrence of a mild-grade aggressiveness tumor, which was confirmed by a second neurosurgical resection.