Concordance between freehand SPECT and conventional scintigraphy for sentinel lymph node detection in breast cancer.

INTRODUCTION: Freehand SPECT can be a useful imaging technique for preoperative planning of sentinel lymph node biopsy (SLNB) as it allows localization of the sentinel node by 3D and real-time tomographic imaging and determines its depth after a few minutes of scanning. The aim of the study was to evaluate the correlation between the number of detected SNs between freehand SPECT images and lymphoscintigraphy (LS). MATERIALS AND METHODS: 100 patients with a diagnosis of invasive breast cancer and no clinical evidence of lymph node involvement prospectively underwent SLNB. The preoperative study included freehand SPECT imaging at 15min after injection and LS imaging at 25 and 60-90min after injection (early and late). The observed agreement was analyzed and a concordance study was performed between the number of SNs detected with freehand SPECT and LS. RESULTS: The observed agreement in the detection of SNs between freehand SPECT and early LS was 72%; between freehand SPECT and late LS was 85%; and between early and late LS was 87%. In the concordance study, there was moderate concordance between freehand SPECT and early LS (kappa coefficient: 0.42); moderate-high concordance between freehand SPECT and late LS (kappa coefficient: 0.60); and moderate-high concordance between early and late LS (kappa coefficient: 0.70), with no significant differences between them (p-value=0.16). CONCLUSION: Freehand SPECT showed a moderate-high concordance with conventional imaging studies and could be a valid alternative for the presurgical study of SLNB in breast cancer.

[Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism]. / Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario.

Primary hyperparathyroidism diagnosis and radioguided surgery by (99m)Tc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful.

[Determination of dose calibrator setting of the capintec CRC-35R for samarium-153]. / Determinación del factor de calibración para el samario-153 en el activímetro de dosis CRC-35R.

OBJECTIVE: The aim of this work is to determine the calibration factor for Sm-153 and evaluate the influence of the geometry in the activity measurements in order to administer accurately the activity to the patient. METHODS: The calibration factor for Sm-153 was determinated using the Sm-153 sources commonly used in clinical practice and the calibrator response in a known calibration setting. The geometry correction factor for the vial and the plastic syringe was calculated using the real activity indicated by the manufacturer and the activity measured in the vial and in the plastic syringe. RESULTS: The calibration factor obtained is 239 +/- 4 and the correction factor which takes in consideration the geometry is 0,87 +/- 0,07. The activity measured in the syringe is eighteen percent higher to activity measured in the vial. CONCLUSION: This method allows to measure accurately the activity of Sm-153 in vial and syringe applying this geometry correction factor to determine accurately the activity administered to the patient.

[Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results]. / Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares.

This study aims to evaluate the contribution of the 99mTc-HMPAO labelled leukocyte in the prognostic assessment of patients with acute pancreatitis. We have compared the usual methods of prognostic evaluation (computed tomography CT and the Ranson clinical score scale) with the scintigraphic findings in 23 consecutive patients with a clinical diagnosis of mild or severe acute pancreatitis. All 6 patients with severe pancreatitis showed an uptake which was mostly mild. 9/17 patients with mild pancreatitis showed uptake, which also frequently had a low intensity. When the severity index of CT was compared with the leukocyte results, the only patient with a high severity index showed a grade 3 uptake. However, in over 50% of the patients with a low severity index, uptake, generally having a low intensity, was found. When the uptake degree was compared with the Ranson score level, we observed a predominance of mild uptake in both patients with mild and severe pancreatitis. Considering these results, we believe that the lack of uptake in the leukocyte study in a patient with acute pancreatitis can be interpreted as a good prognosis sign. The significance of the finding of uptake in the pancreatic area is uncertain and studies should be performed in larger sized samples.

[Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism]. / Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario.

OBJECTIVES: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIAL AND METHODS: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. RESULTS: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. CONCLUSIONS: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.

[Treatment protocols and follow-up of differentiated thyroid carcinoma: results of a questionnaire sent to the Spanish Metabolic Therapy Units]. / Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides: resultados de un cuestionario enviado a las Unidades de Terapia Metabólica españolas.

OBJECTIVE: To know the treatment and follow-up protocols of differentiated thyroid carcinoma patients in Spanish Metabolic Therapy Units, the clinical variability between them and the adaptation to the consensus guidelines. MATERIALS AND METHODS: Analysis of the results obtained from the questionnaire submitted by E-mail to the Spanish Society of Nuclear Medicine (SEMNIM) members on the treatment and follow-up of differentiated thyroid carcinoma patients. A descriptive study was made of the qualitative variables (frequency, percentage) and quantitative variables (mean, standard deviation). RESULTS: Twenty Radiometabolic Therapy Units responded to the questionnaire. In spite of the varied origin of the patients, the Units receive sufficient clinical information and have specialized surgeons. There is variability in the surgical protocols and indication for ablation in patients with intermediate and low risk of recurrence. The Units agree on the use of (131)I doses for ablation and therapy, but show great variability regarding the preparation protocols (previous (131)I-whole body scan or other imaging techniques, (131)I-whole body scan dose, diet and radioiodine contrast prohibition, total dose per patient). Nuclear Medicine physicians perceive radioiodine adverse effects and prevention methods are used. The post-ablation follow-up protocol differs between Units. CONCLUSIONS: Treatment and follow-up protocols of differentiated thyroid carcinoma patients in the Spanish Radiometabolic Therapy Units show variability in aspects such as surgery and ablation indications, patient preparation for radioiodine therapy and follow-up. Our clinical practice differs in several aspects from the recent consensus guideline recommendations.

Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides: resultados de un cuestionario enviado a las Unidades de Terapia Metabólica españolas / Treatment protocols and follow-up of differentiated thyroid carcinoma: results of a questionnaire sent to the Spanish Metabolic Therapy Units

Objetivos. Conocer los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides en las Unidades de Terapia Metabólica españolas, la variabilidad de los mismos y la adaptación a las guías de consenso. Material y métodos. Análisis de los resultados de un cuestionario remitido por e-mail a los miembros de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM) sobre tratamiento y seguimiento del carcinoma diferenciado de tiroides. Estudio descriptivo, de variables cualitativas (frecuencias, porcentajes) y cuantitativas (media, desviación típica). Resultados. Veinte Unidades de Terapia respondieron la encuesta. Aunque hay dispersión en la procedencia de los pacientes, las Unidades reciben suficiente información y cuentan con cirujanos especializados. Hay variabilidad en los protocolos quirúrgicos e indicación de ablación en pacientes de riesgo bajo e intermedio. Hay acuerdo en las dosis de 131I administradas en ablación y tratamiento, pero una gran variabilidad en el protocolo de preparación (rastreo y dosis, otras técnicas de imagen, dieta y prohibición de contrastes yodados, dosis total por paciente). Se perciben las complicaciones del radioyodo y se utilizan sistemas de prevención. El seguimiento de los pacientes postablación es muy variado. Conclusiones. Los protocolos de tratamiento y seguimiento del carcinoma diferenciado de tiroides en las Unidades de Terapia Metabólica con 131I españolas muestran variabilidad en aspectos como el tipo de cirugía e indicación de la ablación, la preparación de los pacientes para el tratamiento con radioyodo, y el seguimiento, existiendo muchos aspectos en los que nos separamos de lo recomendado en las recientes guías de consenso(AU)

Objective. To know the treatment and follow-up protocols of differentiated thyroid carcinoma patients in Spanish Metabolic Therapy Units, the clinical variability between them and the adaptation to the consensus guidelines. Materials and methods. Analysis of the results obtained from the questionnaire submitted by E-mail to the Spanish Society of Nuclear Medicine (SEMNIM) members on the treatment and follow-up of differentiated thyroid carcinoma patients. A descriptive study was made of the qualitative variables (frequency, percentage) and quantitative variables (mean, standard deviation). Results. Twenty Radiometabolic Therapy Units responded to the questionnaire. In spite of the varied origin of the patients, the Units receive sufficient clinical information and have specialized surgeons. There is variability in the surgical protocols and indication for ablation in patients with intermediate and low risk of recurrence. The Units agree on the use of 131I doses for ablation and therapy, but show great variability regarding the preparation protocols (previous 131I-whole body scan or other imaging techniques, 131I-whole body scan dose, diet and radioiodine contrast prohibition, total dose per patient). Nuclear Medicine physicians perceive radioiodine adverse effects and prevention methods are used. The post-ablation follow-up protocol differs between Units. Conclusions. Treatment and follow-up protocols of differentiated thyroid carcinoma patients in the Spanish Radiometabolic Therapy Units show variability in aspects such as surgery and ablation indications, patient preparation for radioiodine therapy and follow-up. Our clinical practice differs in several aspects from the recent consensus guideline recommendations(AU)

Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario / Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism

En los últimos años se ha generalizado el uso de la gammagrafía paratiroidea con 99mTc-MIBI para el diagnóstico preoperatorio e intraoperatorio del hiperparatiroidismo primario. La aparición de un nuevo modelo de minigammacámara portátil (MGP) abre nuevas perspectivas en el campo de la detección intraoperatoria. Presentamos un estudio preliminar de tres pacientes con hiperparatiroidismo primario en el que se demuestra la utilidad del empleo de la MGP

Primary hyperparathyroidism diagnosis and radioguided surgery by 99mTc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful (AU)

Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario / Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism

Objetivo: Determinar la rentabilidad diagnóstica de las diferentes técnicas de localización de las glándulas paratiroides. Material y Métodos: Se realiza un estudio prospectivo sobre 71 pacientes diagnosticados de hiperparatiroidismo primario e intervenidos quirúrgicamente. Evaluamos la validez diagnóstica de la ecografía de alta resolución, gammagrafía de sustracción Talio/Tecnecio y gammagrafía sestamibi en doble fase. Resultados: La sensibilidad (S) y especificidad (E) de la utilización conjunta de la gammagrafía de sustracción Talio/Tecnecio y la ecografía en los adenomas fue de 72,27 por ciento y 89,22 por ciento, respectivamente. La combinación de la gammagrafía sestamibi seguida de la ecografía mejoró discretamente los parámetros evaluados, en particular la especificidad (93,67 por ciento) y el valor predictivo positivo (80,39 por ciento). En nuestra serie la rentabilidad diagnóstica ha sido inferior en las hiperplasias. Conclusión: La utilización conjunta de la gammagrafía seguida de la ecografía de alta resolución, realizadas por un operador experimentado, son la mejor estrategia diagnóstica a seguir para la localización preoperatoria de las glándulas paratiroides patológicas (AU)

OBJECTIVES: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIAL AND METHODS: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. RESULTS: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. CONCLUSIONS: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary (AU)

Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares / Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results

El propósito de este trabajo es analizar la aportación del estudio con leucocitos marcados con 99mTcHMPAO en la valoración pronóstica de los enfermos con pancreatitis aguda. Para ello, hemos comparado los métodos habituales de evaluación pronóstica, la tomografía computarizada (TC) y la escala clínica de Ranson con los hallazgos gammagráficos en 23 pacientes consecutivos, con diagnóstico de pancreatitis aguda leve o severa. Todos los pacientes con diagnóstico de pancreatitis severa (6 pacientes), presentaron captación y esta fue mayoritariamente poco intensa. 9 de los pacientes con diagnóstico de pancreatitis leve (17 pacientes) mostraron captación, también predominantemente poco intensa. Al comparar el índice de severidad de la TC con los resultados de los leucocitos, el único paciente con índice de severidad alto mostró captación de grado 3. Sin embargo, en más de la mitad de los pacientes con índice de severidad bajo se encontró captación, generalmente poco intensa. Al comparar el grado de captación con el nivel de gravedad según la clasificación de Ranson, se observó un predominio de la captación leve tanto en los pacientes con pancreatitis leve como en los pacientes con pancreatitis severa. Antes estos resultados, pensamos que la ausencia de captación en el estudio con leucocitos en pacientes con pancreatitis aguda, puede interpretarse como signo de buen pronóstico. El hallazgo de captación en área pancreática tiene un significado incierto y es necesario el estudio con muestras de mayor tamaño. (AU)