Diagnóstico y cirugía radioguiada de nódulos pulmonares / Diagnosis and radio-guided surgery of lung nodules

La detección de nódulos pulmonares se ha incrementado en las últimas décadas debido a la introducción de los programas de cribado del cáncer de pulmón y al aumento de las exploraciones rutinarias de tomografía computarizada en los pacientes con neoplasias. La biopsia percutánea de estos nódulos no siempre permite caracterizarlos, por lo que en ocasiones es necesaria la biopsia quirúrgica, que a menudo requiere de localización prequirúrgica. La resección radioguiada de lesiones ocultas (ROLL) descrita para las lesiones mamarias se aplicó por primera vez en la resección de nódulos pulmonares en el año 2000, siendo en la actualidad una alternativa a otras técnicas de localización prequirúrgica como la resección guiada por arpón. La técnica aporta elevada tasa de detección con mínima morbimortalidad, potenciando el trabajo multidisciplinar entre los especialistas en Medicina Nuclear y los especialistas de radiodiagnóstico y cirugía torácica. En este trabajo, se describen las diferentes técnicas de localización prequirúrgica disponibles, los procesos metodológicos de la técnica ROLL y los resultados acumulados en 20 años de experiencia

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience

Diagnosis and radio-guided surgery of lung nodules. / Diagnóstico y cirugía radioguiada de nódulos pulmonares.

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience.

Utilidad de la gammagrafía con hematíes desnaturalizados por calor marcados con 99mTc en el diagnóstico de una esplenosis intramuscular / Usefulness of 99mTc labelled heat-denatured red blood cell scintigraphy in the diagnosis of intramuscular splenosi

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Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular / One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection

Introducción: Resulta difícil determinar la infección osteoarticular y diferenciar entre inflamación e infección mediante procedimientos de laboratorio e imagen (TC, RM, US). La gammagrafía con leucocitos marcados (GLM) constituye la prueba de medicina nuclear de elección, pero su duración es de dos días, y a veces es difícil diferenciar entre tejido blando e infección, por lo que se produce una variabilidad interobservador que hace disminuir su especificidad. Objetivo: Demostrar la utilidad del protocolo de un día de GLM con corrección por decaimiento del tiempo de adquisición para diagnosticar la infección osteoarticular y reducir la variabilidad interobservador. También se evaluó la función de SPECT/TC en GLM en la localización del foco de infección. Métodos: Se estudiaron prospectivamente 110 pacientes con sospecha de infección osteoarticular. Se obtuvieron imágenes planares con corrección por decaimiento del tiempo de adquisición a 30min, 4h, 8h y 24h. Las imágenes planares de GLM se agruparon en dos protocolos: Protocolo de un día: los expertos evaluaron imágenes de 30min, 4h y 8h. Protocolo de dos días: los expertos evaluaron imágenes de 30min, 4h y 24h. Ambos protocolos fueron clasificados como: Negativos: ausencia de migración leucocitaria. Positivos: persistencia o incremento de la captación con el tiempo. Inflamación aséptica: disminución de la captación con el tiempo. La SPECT/TC se realizó en 72 pacientes. Se calculó el índice kappa para evaluar la variabilidad interobservador. Resultados: Se confirmó infección en 34 casos. Los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión diagnóstica fueron del 97,1, del 97,4, del 94,3, del 98,7 y del 97,3% para el protocolo de un día, y del 94,1, del 97,4, del 94,1, del 97,4 y del 96,4 para el protocolo de dos días, respectivamente. SPECT/TC contribuyó al diagnóstico en 45 de 50 pacientes con GLM planar positiva. Índice kappa: 0,8 para el protocolo de un día y 0,79 para el protocolo de dos días. Conclusión: El protocolo de un día de GLM con corrección por decaimiento del tiempo de adquisición y SPECT/TC permite el diagnóstico precoz y preciso de la infección osteoarticular

Introduction: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. Objective: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. Methods: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: Negative: absence of leukocyte migration. Positive: uptake persisted or increased over time. Aseptic inflammation: uptake decreased over time. SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. Results: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. Conclusion: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection

Hipoglucemia causada por insulinoma. Revisión de una serie de casos atendidos en un hospital terciario / Hypoglycemia caused by insulinoma. A review of a case series treated at a tertiary hospital

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One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection. / Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular.

INTRODUCTION: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. OBJECTIVE: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. METHODS: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. RESULTS: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. CONCLUSION: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

[Field realities: surgical activities in an isolated medical station]. / Les réalités de terrain: activité chirurgicale d'un poste médical isole.

The authors, general practitioners graduate at the Tropical Medicine Institute (Le Pharo-Marseille-France), report on their surgical activities for 22 months in the isolated medical post of Kaedi (Mauritania). They put emphasis on the necessity of a multidisciplinary teaching and training before any posting in this type of hospital, not important enough to receive specialized practitioners.