Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results.

OBJECTIVES: Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM). SECONDARY OBJECTIVE: To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique. MATERIAL AND METHODS: Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of 99mTc-nanocolloids of albumin/99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical + SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4-5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior-posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10 mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM. RESULTS: Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8. True positive (TP: detection margin affected) with freehandSPECT: 5 margins, with RxM: 6. True negative (TN: consider free margin when healthy) with freehandSPECT: 213 margins; with RxM: 196. Negative predictive value (NPV: probability of negative margin on unaffected part) with freehandSPECT: 95.9%, with RxM: 96.07%. Specificity with freehandSPECT: 96.8%, with RxM: 97%. The concordance of surgical bed margins between freehandSPECT and RxM: 94.5%. Between freehandSPECT and AP: 93.1%. Between RxM and PA: 93.5%, being all statistically significant (p-value <0.000), so we can affirm that both techniques are related or dependent on the reference technique, the PA. Degree of correlation between SPECT-portable and low PA (Kappa index: 0.34, 95% CI [0.22-0.47], and between RxM and moderate PA (Kappa index: 0.42, 95% CI [0.29-0.56], p-value <0.001. Comparison of the successes and failures of both techniques (SPECT-portable and RxM) and PA: Distribution χ2: 0.023 with degree of freedom 1, with value <0.05, so we can affirm that both techniques are similar, since there are no significant statistical differences. Median total OR time: 60.25 min (30-145). Mean freehandSPECT OR time: 5 scans = 10 min. CONCLUSIONS: There are no statistically significant differences in the probability to rule out affective margins that require a second surgery between both techniques (SPECT-portable and RxM) so, the technique performed with SPECT-Portable is a useful and effective procedure, which requires specific training with an optimized and multidisciplinary protocol. The time spent with SPECT-portable is feasible for daily practice.

Homeopathic mistletoe adverse reaction mimics nodal involvement in 18F-FDG PET/CT performed for evaluation of response to chemotherapy in lymphoma.

Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with 18F-FDG PET/CT for evaluation of response after chemotherapy, who was self-administering mistletoe as a homeopathic medicine product. The careful review of the images of the entire scan and patient collaboration in anamnesis were crucial to avoid a false positive result. A review of the published scientific data on the effects of mistletoe is also presented.

Implementación del uso del SPECT portátil para valoración de márgenes quirúrgicos en cáncer de mama con indicación de ROLL. Primeros resultados / Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results

Objetivo principal: comparar la efectividad para la comprobación de márgenes quirúrgicos entre SPECT portátil y la mamografía de la pieza (RxM). Objetivo secundario: estandarizar un protocolo preintraquirúrgico mediante SPECT portátil y evaluar el tiempo requerido en el uso de esta técnica. Material y métodos Estudio longitudinal prospectivo con 36 pacientes (39 lesiones) diagnosticadas de cáncer de mama con criterios para realización SNOLL/ROLL. Se realiza en estudio prequirúrgico de la lesión tumoral, tras la administración ecoguiada de [99mTc]Tc-nanocoloides de albúmina/[99mTc]Tc-macroagregados de albúmina, en la lesión tumoral. Mediante SPECT portátil se obtienen imágenes híbridas (óptico + SPECT) e imágenes de navegación en 3D con sonda gamma. En quirófano se obtienen 4-5 imágenes con SPECT portátil, I) sobre piel para localización tumoral II) tras exposición de lecho para guía de resección, III) del lecho tras exéresis, IV y V) a la pieza quirúrgica. Se decide ampliación o no de márgenes considerando tres criterios: a) actividad residual (cps) en bordes de resección del lecho; b) análisis visual de la captación en la pieza; c) una distancia mínima de 10mm de los bordes de la pieza hasta el centro de mayor captación, más el radio de la lesión. En este estudio se valora la concordancia de: la medición de la profundidad entre ecografía y SPECT portátil en el estudio prequirúrgico; los márgenes quirúrgicos entre SPECT portátil vs. RxM, teniendo de técnica de referencia anatomía patológica (AP); del tiempo quirúrgico empleado con SPECT portátil (AU)

Objectives Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM). Secondary objective: To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique. Material and method Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of 99mTc-nanocolloids of albumin/99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical+SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4–5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior–posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM. Results Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8 (AU)

Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal / Hydrothorax secondary to peritoneal dialysis detected by peritoneal scintigraphy

No disponible

Homeopathic mistletoe adverse reaction mimics nodal involvement in 18F-FDG PET/CT performed for evaluation of response to chemotherapy in lymphoma / Reacción adversa a muérdago homeopático que imita infiltración ganglionar en 18F-FDG PET/TC realizada para valorar la respuesta a quimioterapia en linfoma

Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with 18F-FDG PET/CT for evaluation of response after chemotherapy, who was self-administering mistletoe as a homeopathic medicine product. The careful review of the images of the entire scan and patient collaboration in anamnesis were crucial to avoid a false positive result. A review of the published scientific data on the effects of mistletoe is also presented (AU)

Algunas personas usan terapias alternativas. Presentamos el caso de una paciente con enfermedad de Hodgkin a la que se realiza una 18F-FDG PET/TC para evaluar la respuesta tras quimioterapia, en paciente que se autoadministraba muérdago como tratamiento homeopático. La cuidadosa evaluación de todas las imágenes de la prueba y la colaboración de la paciente durante la anamnesis fueron cruciales para evitar un resultado falso positivo. Además, se revisan los datos publicados sobre los efectos del muérdago (AU)

Trans-scaphoid perilunate dislocation in a child. A case report.

An acute trans-scaphoid perilunate dislocation in a 10-year-old boy is reported. Closed reduction was successful and normal strength and mobility resulted 9 weeks after injury. The mechanism of production and the reason for the rarity of this injury is discussed.

Triplane distal tibial epiphyseal fracture.

The uncommon type IV Salter-Harris distal tibial epiphyseal so-called triplane fractures has been described as a three-fragment fracture by several authors, but other descriptions based on roentgenograms alone include the injury among two-fragment fractures. We report here on one case with three fragments and five with two fragments. Good results have been obtained by closed methods, but there is more than 2 mm of joint incongruity after reduction, open reduction and internal fixation are indicated. Premature closure of the epiphyseal plate resulted but it was not an important consideration because the epiphyses were nearly closed in all of our patients.

Fracture-separation of the lower humeral epiphysis in young children.

Five fracture-separations of the lower humeral epiphysis, type II according to the Salter-Harris classification, are presented. The fracture line generally passes through the cartilaginous epiphysis, which does not show up in roentgenograms, and sometimes included a laterally based metaphyseal wedge. This injury is often misdiagnosed as it is mistaken for other injuries of the elbow, especially fracture of the lateral humeral condyle. The concomitant displacement of the radius and ulna in relations to the capitellar ossification center is the key to the diagnosis of fracture-separation of the lower humeral epiphysis. Good results are obtained with treatment by closed methods if this lesion is correctly diagnosed.

Cirugía radioguiada de las lesiones no palpables de mama (ROLL): ¿cómo lo hacemos? / No disponible

El objetivo de este trabajo es describir la técnica ROLL tal como nosotros la venimos aplicando, aprendida durante estancias realizadas en el Instituto Europeo de Oncología de Milán. S e describen los aspectos más importantes que tenemos en cuenta en las distintas fases: diagnóstica, pre-quirúrgica, quirúrgica y de cuidados postoperatorios. El procedimiento ROLL es una técnica multidisciplinar sencilla y reproducible que permite conseguir resultados óptimos y una tasa baja de reintervenciones, así como un buen resultado estético cuando se adquiere la suficiente experiencia(AU)

The aim of this paper is to describe the ROLL technique as we perform after having it learned during stays at the European Institute of Oncology in Milan. We describe the most important aspects that we consider in the different phases such as diagnostic, pre-surgical, surgical and postoperative care. The ROLL procedure is a multidisciplinary technique, simple and reproducible, that allows optimum results with a low rate of reintervention and a good cosmetic result when sufficient experience is gained(AU)