Relación entre el riesgo de metástasis en el ganglio centinela y los receptores estrogénicos en pacientes pre y posmenopáusicas con cáncer de mama / Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women

Objetivo. Investigar la relación entre el estado pre o posmenopáusico de la paciente con carcinoma de mama (CM) y el riesgo de metástasis en el ganglio centinela (GC) y dentro de cada uno de esos grupos el riesgo según el estado de los receptores de estrógeno (RE). Método. Análisis de la base de datos de GC con 1.388 pacientes. Se estudiaron tres grupos de edad: A) posmenopáusicas ancianas, 200 pacientes, ≥70 años; B) posmenopáusicas más jóvenes, 89 pacientes, 55–69 años, y C) premenopáusicas, 85 pacientes, <55 años. En cada grupo se analizaron 2 subgrupos: tumores con RE positivos o negativos. Factores estudiados en cada grupo y subgrupo: pacientes con GC positivo, pacientes con ganglios no centinela (GNC) positivos, número de no detecciones quirúrgicas (NDQ) y pacientes no libres de enfermedad (NLE) tras 52 meses de seguimiento. Análisis estadístico: test de chi-cuadrado; significancia p<=0,05. Resultados. En las premenopáusicas el número de GC positivos es significativamente (p<0,025) mayor que en las posmenopáusicas y dentro de las premenopáusicas fundamentalmente en los tumores con RE negativos. El número de GNC positivos aumenta solo discretamente en las premenopáusicas y ocurre exclusivamente en tumores con RE negativos. El número de pacientes NLE es similar en los 3 grupos y en todos ellos es mucho más frecuente en pacientes con tumores con RE negativos. Conclusiones. El número de pacientes con GC positivo varía significativamente con el estado hormonal y no con la edad de la paciente, siendo más frecuentes en las premenopáusicas y fundamentalmente en tumores con RE negativos(AU)

Objective. The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. Methods. A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥70 years old; B, younger postmenopausal, 89 patients, 55–69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. Statistical analysis: chi-squared test, significance: P<=0.05. Results. SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. Conclusion. SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours(AU)

[Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women]. / Relación entre el riesgo de metástasis en el ganglio centinela y los receptores estrogénicos en pacientes pre y posmenopáusicas con cáncer de mama.

OBJECTIVE: The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. METHODS: A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥ 70 years old; B, younger postmenopausal, 89 patients, 55-69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. STATISTICAL ANALYSIS: chi-squared test, significance: P ≤ 0.05. RESULTS: SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. CONCLUSION: SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.

What are the preoperative factors that can determine the presence of metastases in other axillary nodes in breast cancer when the sentinel node is positive?

AIM: To determine whether preoperative factors, such as size of metastases in the sentinel lymph node (SLN), number of positive SLNs (1, >1), tumoral grade, lymphovascular invasion (LVI) and tumoral size can predict the presence of metastases in non-SLNs, when the SLN is positive. METHODS: The study population was 1 146 breast cancer patients. Lymphadenectomy was performed in 150. Three groups of patients were established depending on the size of the metastases in SLNs: group A: <2 mm; group B: 2 < or =GC < or =5 mm; group C: > 5 mm. Either the chi(2) test or Fisher's test was performed to compare categorical variables, and a multivariate conditional logistic regression model for data sets was performed to identify the deterministic factors of metastases presence. RESULTS: Ten percent of group A, 28% of group B and 52% of group C presented non-SLN metastases. Patients with >1 positive-SLN presented significantly more non-SLN metastases than those with only one positive-SLN; 56% of patients with LVI presented non-SLN metastases versus 26% of those without LVI. The tumoral grade and size did not seem to have any influence on the number of patients with non-SLN metastases. The number of positive-SLNs and size of metastases were statistically associated with the presence of metastases. CONCLUSIONS: In this study population, the probability of finding non-SLN metastases was statistically related to the size of the SLN metastases and the number of positive-SLNs.

Utilidad clínica de la corrección de atenuación con rayos X en los estudios SPECT de perfusión miocárdica / Clinical utility of attenuation correction with X-RAYS in myocardial perfusion SPECT studies

Objetivos. Comparar la tomogammagrafía (SPECT) de perfusión miocárdica con corrección de atenuaciónmediante rayos X con la evaluación conjunta delas imágenes no corregidas y los datos del gated en el manejo de la enfermedad arterial coronaria.Método. A 60 pacientes (p) se les realizó una SPECT deperfusión miocárdica esfuerzo/reposo-gated con correcciónde atenuación mediante una tomografía computarizada (TC)de baja resolución con una gammacámara híbrida y una cateterización cardíaca. Se evaluaron cualitativamente tres tipos de imágenes: esfuerzo/reposo no corregidas (NC), esfuerzo/ reposo no corregidas valoradas juntamente con el gated (NCG) y esfuerzo/reposo corregidas por atenuación y con correción de scatter (CA). Con el test de McNemar se analizaron las diferencias estadísticas en la exactitud diagnósticaentre cada tipo de imágenes; p < 0,05 se consideró estadísticamente significativa. Resultados. Catorce p no tenían lesiones significativas en las arterias coronarias (LNS), en los 46 p restantes se detectaron:29 lesiones en la descendente anterior, 26 en la coronaria derecha y 18 en la circunfleja. En el territorio de la coronaria derecha la exactitud diagnóstica fue significativamente mayor en lasimágenes CA que en las NC (p < 0,001) y que en las NCG(p < 0,01). En el grupo de LNS hubo diferencias significativas entre NC y CA (p < 0,02) y entre NCG y CA (p < 0,05). Conclusiones. La corrección de atenuación con rayos X en los estudios SPECT-gated de perfusión miocárdica mejora significativamente tanto la capacidad de los mismos para descartar la existencia de enfermedad coronaria, como la exactitud diagnóstica en el territorio de la coronaria derecha

Objective. We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. Methods. In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemar’s test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. Results. Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). Conclusions. Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated

[Clinical utility of attenuation correction with X-rays in myocardial perfusion SPECT studies]. / Utilidad clínica de la corrección de atenuación con rayos X en los estudios SPECT de perfusión miocárdica.

OBJECTIVE: We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. METHODS: In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemar's test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. RESULTS: Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). CONCLUSIONS: Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated.

[Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer]. / Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama.

OBJECTIVE: The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. MATERIAL AND METHODS: 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24 h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. RESULTS: No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (>90 %) and FNR (< or = 6 %) were found in both groups. CONCLUSIONS: The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group.

Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama / Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer

Objetivo. Analizar las detecciones radioisotópica y quirúrgica del ganglio centinela (GC) en el carcinoma no palpable de mama (CNPM) y comparar los resultados en este grupo con los del grupo de tumores palpables de mama (CPM). Material y métodos. Se estudian 199 pacientes. Se les realizó biopsia del GC y linfadenectomía axilar (LDNA). Se establecen dos grupos: CNPM y CPM. La cirugía tuvo lugar entre las 4-24 horas de la administración peritumoral de 111MBq de 99mTc-nanocoloide. La histopatología del GC fue mediante impronta peroperatoria y estudio diferido. Se analiza el porcentaje de detección gammagráfica y quirúrgica y la vía de drenaje del GC según la palpación del tumor y su localización en la mama; los verdaderos positivos (VP), verdaderos negativos (VN), falsos negativos (FN), la sensibilidad (S), el valor predictivo negativo (VPN), la tasa de falsos negativos (TFN) y la precisión global (PG) de la técnica. Resultados. No se observaron diferencias estadísticamente significativas (p > 0,05) ni en la detección gammagráfica y quirúrgica del GC, ni en la existencia de drenaje a mamaria interna (p = 0,211) entre ambos grupos. La prevalencia de metástasis axilar fue menor en el grupo CNPM (p = 0,019). La S, el VPN y la PG de la técnica fue similar en los dos grupos (> 90 %), así como la TFN (<= 6 %). Conclusiones. La fiabilidad de la técnica es similar en los dos grupos. El drenaje predominante es axilar. El drenaje a mamaria interna predominó en los tumores mediales y en CNPM. La prevalencia metastásica axilar es menor en el CNPM

Objective. The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. Material and methods. 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. Results. No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (> 90 %) and FNR (<= 6 %) were found in both groups. Conclusions. The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group

[Influence of tumor location in patients with breast cancer on the sentinel node detection]. / Influencia de la localización del cáncer de mama en la detección del ganglio centinela.

OBJECTIVE: To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lymphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosin, inmunohistochemistry CAM 19-2 and PCR. RESULTS: The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. CONCLUSIONS: Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage.

[Clinical utility of fused 67Ga SPECT/CT scan images in patients with lymphoma]. / Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma.

AIM: The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. MATERIAL AND METHOD: 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. RESULTS: 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. CONCLUSION: To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46% of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies.

Influencia de la localización del cáncer de mama en la detección del ganglio centinela / Influence of tumor location in patients with breast cancer on the sentinel node detection

Objetivo. Valorar la influencia del cuadrante de localización del cáncer de mama en la detección del ganglio centinela (GC) y en la visualización del drenaje a mamaria interna mediante técnicas radioisotópicas. Se estudiaron 376 pacientes con cáncer de mama; edad media: 57 años (rango 29-88). A todas se les inyectó peritumoralmente 37-74 MBq de 99mTc-nanocoloide, en 2 ml. El tumor se localizó en cuadrante superoexterno (CSE) en 189 pacientes, en inferoexterno (CIE) en 57, en superointerno en 57 (CSI), en 55 en inferointerno (CII) y en 18 en el central. Se obtuvieron imágenes gammagráficas en proyecciones anterior y lateral a las 2 horas postinyección del trazador. Se realizó marcaje cutáneo del GC para facilitar su localización quirúrgica. Se utilizó una sonda gammadetectora para la detección intraquirúrgica. Se realizó impronta del GC extirpado. El estudio histopatológico diferido se realizó mediante técnicas de hematoxilina-eosina, inmunohistoquimia (CAM 19-2) y PCR. Resultados. La detección gammagráfica y quirúrgica del GC fue respectivamente 90 % y 93 % en CSE, 91 % y 95 % en CIE, 93 % y 95 % en CSI, 87 % y 95 % en CII y 94 % y 83 % en el central. El drenaje linfático a mamaria interna fue de 6 % en CSE, 5 % en CIE, 12 % en CSI, 20 % en CII y ningún caso en el central. Conclusiones. Estos resultados sugieren que la detección tanto gammagráfica como quirúrgica del GC es independiente del cuadrante de localización del cáncer. Los tumores localizados en los cuadrantes internos muestran un mayor porcentaje de drenaje linfático a la cadena mamaria interna

Objetive. To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lynphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosine, inmunohistochemistry CAM 19-2 and PCR. Results. The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. Conclusions. Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage

Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma / Clinical utility of fused 67GA SPECT/CT scan images in patients with lymphoma

Objetivo. El objetivo de este trabajo es la valoración de la utilidad clínica de las imágenes de fusión SPECT 67Ga/TC en los pacientes afectos de procesos linfoproliferativos. Material y método. Se estudiaron 44 pacientes (22 hombres) con linfoma (22 enfermedad de Hodgkin, 22 linfoma no Hodgkin). Se realizaron 59 estudios con una gammacámara híbrida, adquiriéndose consecutivamente un rastreo de cuerpo entero, un SPECT y una tomografía computarizada (TC) de la zona/s afecta/s para su fusión con el SPECT. El estudio de fusión se centró en las siguientes áreas: 33 tóraco-cervical (T), 24 abdomen (A) y 2 cráneo-cervical (CC). Las imágenes fueron evaluadas por 2 médicos nucleares sin conocimiento de los datos del paciente, clasificando la aportación de la fusión de imágenes respecto al SPECT como: no cambia, mejora la localización o extensión de las lesiones y cambia la estadificación. Se confirmaron los resultados con la realización de una TC de alta resolución en el periodo de un mes. Resultados. En 32/59 estudios no se observaron cambios (20 T, 12 A), en 23/59 estudios cambió la localización o extensión de las lesiones (12 T, 9 A y 2 CC) y en 4/59 estudios (1 T y 3 A) el cambio de localización implicó un cambio de estadificación respecto al observado en el SPECT. Conclusión. La realización de estudios de fusión de imágenes SPECT 67Ga/TC en pacientes con linfoma permite mejorar la precisión diagnóstica en un 46 % de los casos, principalmente en los estudios abdominales, óseos y del área diafragmática

Aim. The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. Material and method. 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. Results. 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. Conclusion. To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46 % of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies

Subdermal re-injection: a method to increase surgical detection of the sentinel node in breast cancer without increasing the false-negative rate.

PURPOSE: The aim of this study was to evaluate in breast cancer whether subdermal (SB) re-injection improves surgical detection (SD) of the sentinel node (SN) in patients with negative lymphoscintigraphy on peritumoral (PT) injection, without increasing the false-negative (FN) rate. METHODS: Group I comprised 261 patients with invasive breast cancer >3 cm and clinically negative axilla treated with primary chemotherapy. Axillary lymphadenectomy was performed in all of these patients. Group IA comprised 201 patients with PT injection, while group IB comprised 60 patients with SB injection in the tumour quadrant. Group II comprised 652 patients with breast cancer <3 cm; in 73 of these patients with negative lymphoscintigraphy, SB re-injection was performed. For lymphoscintigraphy, 37-55 MBq (99m)Tc-albumin nanocolloid in 1 ml was used for PT injection, and 18 MBq in 0.2 ml for SB injection. Five-minute images were obtained 2 h p.i. for PT injection and 20-30 min p.i. for SB injection. SD was performed 4 or 24 h p.i. Lymphoscintigraphic (LD), surgical and internal mammary (IM) detection rates were calculated. In group I, FN, negative predictive value (NPV) and accuracy (A) were calculated. Statistical analysis was performed using the chi-square test. RESULTS: In percentages, results were as follows: Group IA: SD: 84.1, FN: 13.6, NPV: 88.9, A: 78.6, IM: 14.5*. Group IB: SD: 90, FN: 0, NPV: 100, A: 90, IM: 1.7* (*p<0.025). Group II: PT injection only: LD: 82.4, SD: 94; PT injection+SB re-injection: LD: 90, SD: 98.5. SD was 97.8** in patients with positive lymphoscintigraphy and 58.5** when lymphoscintigraphy was negative (**p<0.001). CONCLUSION: For correct staging, including extra-axillary drainage, peritumoural injection should first be performed. When the SN is not visualised, and only in those cases, SB re-injection should be performed, which increases the SD rate without increasing the FN rate.

[First diagnostic choice in patients with high clinical suspicion of pulmonary thromboembolism: helical CT or ventilation/perfusion pulmonary scintigraphy?]. / Primera elección diagnóstica en pacientes con alta sospecha clínica de tromboembolismo pulmonar: gammagrafía de ventilación/perfusión pulmonar o tomografía computarizada helicoidal?

AIM: Comparative analysis about helical CT (ThC) vs ventilation-perfusion pulmonary scintigraphy (V/P Sc) diagnosis effectiveness, as a first diagnosis technique in patients with high clinical suspicion of pulmonary thromboembolism (PT). MATERIALS AND METHODS: Prospective study of 30 patients with high clinical suspicion and high Dimer-D levels (> 250 microg/l). The diagnosis was defined as anticoagulant therapeutic prescription and posterior clinical evolution. V/P Sc were performed to each patient within the next 48 h (an average of 14.8 h) after TCh, without anticoagulant treatment. We classified the scintigrams according to the PIOPED criteria and hTC images as positive, negative and indeterminated. RESULTS: In sixteen patients final diagnosis was PT: in 9 both techniques were positive; in 5 scintigraphy was positive with normal hTC and in 1, hTC was normal with negative scintigraphy. The last case was an indeterminated hTC with negative scintigraphy. In fourteen patients, final diagnosis was non-PT: in 6 both techniques were negative; in 7 scintigraphy was negative with positive hTC and in 1, both results were indeterminated. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency were respectively 87.5, 100, 100, 87.5 and 93 % for V/P Sc and 62, 50, 58.8, 53.8 and 53 % for TCh. CONCLUSION: V/P Sc has better PT diagnosis reliability. It is recommended to do V/P Sc in all patients with high clinical suspicion of PT.

Primera elección diagnóstica en pacientes con alta sospecha clínica de tromboembolismo pulmonar: ¿gammagrafía de ventilación/ perfusión pulmonar o tomografía computarizada helicoidal? / First diagnosis choice in patients with high clinical suspicion of pulmonary thromboembolism: helical CT or ventilation/perfusion pulmonary scintigraphy?

Objetivo: Análisis comparativo de la eficacia de la tomografía computarizada helicoidal (TCh) frente a la gammagrafía de ventilación/perfusión (Gg V/P) como primera técnica diagnóstica en pacientes con alta sospecha clínica de enfermedad tromboembólica pulmonar (TEP). Material y método: Estudio prospectivo de 30 pacientes con alta sospecha clínica de TEP y valores de dímero-D elevados (> 250 mg/l). El diagnóstico se estableció según la prescripción de tratamiento anticoagulante y la evolución clínica posterior. Se practicó a cada paciente un estudio TCh con contraste y, posteriormente, una Gg V/P en un intervalo medio 14,8 horas (rango entre 1-48 horas), sin haber recibido tratamiento anticoagulante previo. La Gg V/P se clasificó según los criterios PIOPED, considerándose positivos los de alta probabilidad. La TCh se valoró como negativa, positiva o indeterminada. Resultados: En 16 pacientes se confirmó TEP: en 9 ambas técnicas fueron positivas, en 5 la Gg V/P fue positiva con TC normal; en 1 la TCh fue positiva con Gg V/P negativa y en el restante la TCh fue indeterminada y la Gg V/P negativa. En 14 pacientes se descartó TEP: en 6 ambas pruebas fueron negativas, en 7 la Gg V/P fue negativa con TCh positiva y en 1 el resultado de ambas pruebas fue indeterminado. La sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN) y eficacia fueron, respectivamente, del 87,5 %, el 100 %, el 100 %, el 87,5 % y el 93 %, para la Gg V/P y del 62 %, el 50 %, el 58,8 %, el 53,8 % y el 53 %, para la TCh. Conclusión: La Gg V/P muestra mayor fiabilidad que la TCh para el diagnóstico de TEP, considerándose necesaria en todos los pacientes con alta sospecha clínica

Aim: Comparative analysis about helical CT (ThC) vs ventilation-perfusion pulmonary scintigraphy (V/P Sc) diagnosis effectiveness, as a first diagnosis technique in patients with high clinical suspicion of pulmonary thromboembolism (PT). Materials and methods: Prospective study of 30 patients with high clinical suspicion and high Dimer-D levels (> 250 mg/l). The diagnosis was defined as anticoagulant therapeutic prescription and posterior clinical evolution. V/P Sc were performed to each patient within the next 48 h (an average of 14.8 h) after TCh, without anticoagulant treatment. We classified the scintigrams according to the PIOPED criteria and hTC images as positive, negative and indeterminated. Results: In sixteen patients final diagnosis was PT: in 9 both techniques were positive; in 5 scintigraphy was positive with normal hTC and in 1, hTC was normal with negative scintigraphy. The last case was an indeterminated hTC with negative scintigraphy. In fourteen patients, final diagnosis was non-PT: in 6 both techniques were negative; in 7 scintigraphy was negative with positive hTC and in 1, both results were indeterminated. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency were respectively 87.5, 100, 100, 87.5 and 93 % for V/P Sc and 62, 50, 58.8, 53.8 and 53 % for TCh. Conclusion: V/P Sc has better PT diagnosis reliability. It is recommended to do V/P Sc in all patients with high clinical suspicion of PT

Localización simultánea de neoplasias de mama no palpables y estudio del ganglio centinela (GC) mediante técnicas radioisotópicas / Simultaneous location of non-palpable breast neoplasms and sentinel node (SN) study by radioisotopic techniques

Objetivo: Obtener una correcta localización de lesiones no palpables de mama, con alta sospecha de malignidad y la detección del GC mediante técnicas radiosotópicas. Material y método: Se han estudiado 31 pacientes de edad comprendida entre 35 y 79 años, con lesiones no palpables de mama detectadas mediante mamografía y/o ecografía. Todas las pacientes fueron diagnosticadas de cáncer de mama y tratadas con quimioterapia primaria. A todas las pacientes se les practicó disección axilar total. 24 h antes de la intervención a todas ellas se les administró una dosis de 37 MBq (1 mCi) de macroagregados de albúmina (MAA) marcados con 99mTc, en el centro de la lesión, mediante guía ecográfica. Se practicaron imágenes gammagráficas en proyecciones anterior y lateral (en decúbito prono con mama colgante) para comprobar la correcta localización del radiofármaco. Seguidamente se les realizó estudio del GC mediante la administración subdérmica de una dosis de 18 MBq (0,5 mCi) de nanocoloide marcado con 99mTc. La localización del GC fue marcada en la piel con tinta indeleble. La localización intraquirúrgica de la lesión de la mama y del GC se realizó con ayuda de una sonda gammadetectora. La correcta colocación del radiofármaco intralesional, la existencia de bordes libres de enfermedad y el estudio histológico del GC fueron realizadas por el anatomopatólogo en el acto operatorio. El estudio histopatológico diferido se llevó a cabo con técnicas con hematoxilina-eosina e inmunohistoquimia. Resultados: En 29 de las 31 localizaciones de la lesión, había una buena colocación del radiotrazador (93,5 %), hubo 1 caso de contaminación del trayecto de la aguja y otro que no coincidía con la lesión, por mala colocación. La localización del GC fue del 96 % en axila y del 4 % en axila y mamaria interna. El GC se localizó en quirófano en 28/31 pacientes (90 %). Conclusión: La localización simultánea radioguiada de las lesiones ocultas de la mama y del ganglio centinela es un método sencillo, bien tolerado por las pacientes y que permite realizarse en un solo acto operatorio

[Simultaneous location of non-palpable breast neoplasms and sentinel node (SN) study by radioisotopic techniques]. / Localización simultánea de neoplasias de mama no palpables y estudio del ganglio centinela (GC) mediante técnicas radioisotópicas.

OBJECTIVE: To obtain correct location of non-palpable breast lesions, with high suspicion of malignancy and detection of SN by radiosotopic techniques. MATERIAL AND METHODS: Thirty-one patients whose ages ranged from 35 to 79 years, with non-palpable breast lesions detected by mammography and/or ultrasonography were studied. All the patients were diagnosed of breast cancer and treated with primary chemotherapy. All the patients underwent total axillary dissection. At 24 hours of the intervention, all patients received one dose of 37 MBq (1 mCi) of 99mTc labeled macroaggregated albumin (MAA) in the center of the lesion by ultrasonographic guide. Scintigraphic images were performed in anterior and lateral projections (in prone decubitus with hanging breast) to verify the correct location of the radiopharmaceutical. After, a study of the SN was performed by subdermal administration of an 18 MBq (0.5 mCi) dose of 99mTc labeled nanocolloid. The SN site was labeled on the skin with indelible ink. The intrasurgical site of the breast lesion and SN was performed using a gamma detector probe. Correct placement of the intralesional radiopharmaceutical, existence of disease free borders and histological study of SN were performed by the pathologist in the surgical act. The differed pathology study was performed with hematoxilin-eosin and immunohistochemistry. RESULT: In 29 of the 31 lesion sites, there was good placement of the radiotracer (93.5 %). There was 1 case of contamination of the needle pathway and another that did not coincide with the lesion, due to poor placement. Location of the SN was 96 % in the axilla and 4 % in axilla and internal mammary chain. The SN was located in surgery in 28/31 patients (90 %). CONCLUSION: Simultaneous radioguided location of the hidden breast lesions and sentinel node is a simple method, which is well tolerated by the patients and can be done in a single operation act.

[Sentinel lymph node (SN) detection in patients with breast cancer. Influence of tumor size and age of the patient]. / Localización del ganglio centinela en el carcinoma de mama. Influencia del tamaño tumoral y edad de la paciente.

OBJECTIVE: The objective of this study is to analyze the influence of tumor size and age of the patient in the detection of the SN in breast neoplasms. MATERIAL AND METHODS: A total of 190 patients affected of breast cancer with a mean age of 57 years (range from 28 to 87 years) were studied. According to age, the following were distinguished: under 40 years, 23 patients; between 40 and 60 years, 102 patients and over 60 years, 65 patients. The lesions were classified based on size (in mm) into: less than 10 in 27 patients, between 10 and 20 in 61 patients, between 20 and 30 in 64 patients, and greater than 30 in 38 patients. In all the cases, a scintigraphy was performed at 2 hr. post-injection of 3 mCi of 99mTc-nanocoloide, in the peritumoral area. After lymphoscintigraphy detection of the SN, cutaneous labeling was performed and it was detected surgically by a gamma detector probe. A complete lymphadenectomy was performed in all the patients. The histopathology was performed with hematoxylin-eosin and immunohistochemistry techniques and the state of the SN was compared with the remaining lymph nodes of the lymphadenectomy. RESULTS: The SN was located in 169 of the 190 cases (89%). In 164 cases, it was found in the axilla. The greatest percentage of those not detected was observed in tumors over 30 mm (32%) and patients older than 60 years (30%). No false negative were observed in tumors under 10 mm or in patients under 40 years, but the false negative rate increased with the patient's age and the tumor size. CONCLUSIONS: The patient's age and tumor size seem to influence SN detection rates. The FN rates seem to be superior in patients over 60 years. Patients under 40 years with tumors less than 10 mm are those who benefit most from this technique.

Localización del ganglio centinela en el carcinoma de mama. Influencia del tamaño tumoral y edad de la paciente / Sentinel lymph node (sn) detection in patients with breast cancer. Influence of tumor size and age of the patient

Objetivo: El objetivo de este estudio es analizar la influencia del tamaño del tumor y la edad de la paciente en la detección del GC en neoplasias de mama. Material y métodos: Se estudiaron 190 pacientes afectas de neoplasia de mama. Edad media de 57 años (rango comprendido entre 28 y 87 años). Según la edad distinguieron: menores de 40 años, 23 pacientes; entre 40 y 60 años, 102 pacientes y mayores de 60 años, 65 pacientes. Las lesiones se clasificaron en función del tamaño (en mm) en: menor de 10 en 27 pacientes, entre 10 y 20 en 61 pacientes, entre 20 y 30 en 64 pacientes, y superior a 30 en 38 pacientes. En todos los casos se practicó una gammagrafía a las 2 h post-inyección de 3 mCi de 99mTc-nanocoloide, en el área peritumoral. Tras la detección linfogammagráfica del GC se realizó un marcaje cutáneo, y mediante una sonda gammadetectora se detectó quirúrgicamente. En todas las pacientes se realizó linfadenectomia completa. La histopatología se realizó con técnicas de hematoxilina-eosina e inmunohistoquimia, y se comparó el estado del GC con el resto de ganglios de la linfadenectomía. Resultados: El GC se localizó en 169 de los 190 casos (89 por ciento). En 164 casos se localizó en axila. El mayor porcentaje de no detecciones se observó en tumores mayores de 30 mm (32 por ciento) y pacientes mayores de 60 años (30 por ciento). No se observaron falsos negativos en tumores de menos de 10 mm ni en pacientes menores de 40 años, pero la tasa de falsos negativos aumenta con la edad de la paciente y el tamaño del tumor. Conclusiones: La edad de las pacientes y el tamaño del tumor parece influir en las tasas de detección del GC. Las tasas de FN parecen ser superiores en las pacientes mayores a 60 años. Las pacientes menores de 40 años y con tumores de menos de 10 mm son las que más se benefician de esta técnica (AU)