Controversy over sentinel lymph node detection in endometrial cancer.

In the last decade, the procedure of sentinel lymph node biopsy has been introduced in low-risk endometrial cancer, being optional in intermediate- and high-risk cancer. However, until the last year, there was no consensus regarding the group of patients to whom to apply it, the best tracer to use or the site of injection. In this paper, we present in a multidisciplinary view the most controversial issues about the sentinel lymph node procedure in endometrial cancer, emphasizing the pros and cons of the different tracers available: radiotracers, hybrid tracers and indocyanine green.

Interventional nuclear medicine's contribution to molecularly targeted precision surgery.

The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from "maximum tolerable treatments to minimum effective treatments" and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say. A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient.

Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions. / Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables.

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.

Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida / nterventional nuclear medicine's contribution to molecularly targeted precision surgery

El abordaje quirúrgico de las distintas enfermedades, no solo oncológicas, ha evolucionado. Como ha sido acuñado de forma muy gráfica por el grupo de Veronesi, estamos pasando de los «tratamientos máximos tolerables a los mínimos eficaces» y este recorrido no puede ser llevado a cabo de otra forma que mediante un planteamiento de trabajo multidisciplinar y multimodalidad. Obligatoriamente multidisciplinar porque es necesaria la colaboración entre cirujanos, oncólogos, radiólogos, médicos nucleares, patólogos y todo aquel relacionado con el seguimiento de los pacientes, y obligatoriamente multimodalidad porque nos debemos encaminar hacia una cirugía de precisión a la medida de cada paciente en la que, por parte de la Medicina Nuclear, tiene mucho que decir la imagen híbrida (SPECT/TC y PET/TC), los trazadores bimodales, el empleo de nuevos aliados como la ecografía o nuestra propia adaptación a la cirugía robótica. Todo un amplio abanico de posibilidades construido a partir de un sólido cimiento como es la gammagrafía preoperatoria, que posibilita la identificación de los tejidos diana y cuyo conocimiento previo a la intervención permite plantear el abordaje quirúrgico necesario para cada paciente (AU)

The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from “maximum tolerable treatments to minimum effective treatments” and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient (AU)

[Usefulness of bone scintigraphy for staging in a case of histiocytosis of the temporal bone]. / La gammagrafía ósea demuestra ser útil para el diagnóstico de extensión en un caso de histiocitosis X del hueso temporal.

We present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRI.

[Usefulness of pilocarpine in the prevention of xerostomia in patients with head and neck cancer treated with radiotherapy. Assessment with gammagraphy and salivary flow]. / Utilidad de la pilocarpina como profiláctico de xerostomía en pacientes con cáncer de cabeza y cuello tratados con radioterapia. Valoración mediante gammagrafía y flujo salivar.

AIM: To assess the utility of salivary gland scintigraphy and salivary flow to quantify salivary function and to evaluate the usefulness of pilocarpine in the treatment of radiation-induced xerestomia in head and neck cancer patients. METHOD: Thirty two patients with head and neck tumor treated with radiotherapy (RDT) were studied. Patients were classified into two groups: pilocarpine group (P), that received prophylactic pilocarpine before RDT and during the first year after treatment. No pilocarpine group (NP) that received RDT without pilocarpine. Salivary gland scintigraphy and salivary flow were performed before RDT and during one year after treatment. Parotid and submaxillary uptake and excretion were calculated. Salivary flow after stimulation during five minutes was also obtained. RESULTS: Uptake and excretion in both salivary glands decreased after RDT. There were no statistical differences comparing P and NP groups (p < 0.001). However, in group P a trend to recovery was observed in parotid uptake values at 12 months after treatment, but it was not statistically significant. In both groups the salivary flow decreased after RDT and a good correlation (r = 0.8) between salivary flow and submaxillary excretion and parotid excretion was found. CONCLUSIONS: Salivary gland scintigraphy and salivary flow could be useful to evaluate salivary gland function in patients with head and neck irradiated tumors. Although better results on the salivary uptake at 12 months were noted, pilocarpine did not significantly improve salivary gland function.

Controversias en la técnica de detección del ganglio centinela en cáncer de endometrio / Controversy over sentinel lymph node detection in endometrial cancer

En la última década se ha introducido la biopsia selectiva del ganglio centinela en cáncer de endometrio de bajo riesgo, siendo opcional en el de riesgo intermedio y alto. Sin embargo, hasta hace un año no se existía consenso respecto al grupo de población indicado, el trazador de elección o el lugar de administración del trazador. En este trabajo, presentamos de forma multidisciplinar los aspectos más controvertidos sobre la técnica de detección del ganglio centinela en cáncer de endometrio, con mayor énfasis en las ventajas y desventajas de los tipos de trazadores disponibles: radiotrazadores, trazadores híbridos y verde de indocianina (AU)

In the last decade, the procedure of sentinel lymph node biopsy has been introduced in low-risk endometrial cancer, being optional in intermediate- and high-risk cancer. However, until the last year, there was no consensus regarding the group of patients to whom to apply it, the best tracer to use or the site of injection. In this paper, we present in a multidisciplinary view the most controversial issues about the sentinel lymph node procedure in endometrial cancer, emphasizing the pros and cons of the different tracers available: radiotracers, hybrid tracers and indocyanine green (AU)

Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables / Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions

La presente revisión tiene como objetivo brindar una visión actualizada en diferentes campos de la cirugía radioguiada. En lo que se refiere a la biopsia del ganglio centinela en el carcinoma escamoso oral, se exponen los resultados del debate interactivo llevado a cabo en el reciente Congreso de nuestra especialidad sobre los aspectos más relevantes del Consenso de Londres. En los tumores ginecológicos, cáncer de endometrio y cérvix, se detallan las particularidades del drenaje, las indicaciones establecidas según las guías actuales y se presentan nuevos escenarios para el médico nuclear, como pueden ser la cirugía robótica y los trazadores híbridos. Por otra parte, la notable expansión de las indicaciones de la cirugía radioguiada de lesiones no palpables, ampliamente utilizada en patología mamaria, hace conveniente la puesta al día en dos procedimientos que han demostrado resultados satisfactorios, como son el nódulo pulmonar solitario y el osteoma osteoide

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma

La gammagrafía ósea demuestra ser útil para el diagnóstico de extensión en un caso de histiocitosis X del hueso temporal / Usefulness of bone scintigraphy for staging in a case of histiocytosis od the temporal bone

Exponemos el caso de un varón de 43 años diagnosticado de diabetes insípida e hipogonadismo hipogonadotropo, que en la RM craneal de control se objetivó una lesión extraaxial temporal derecha, motivo por el que fue ingresado. Se realizó una gammagrafía ósea que describió un aumento de captación de Tc99m-HMDP en región temporal derecha con extensión esfenoidal, coincidente con la RM. Además, en región temporal izquierda se observó una hipercaptación de menor intensidad y tamaño. Se realizó biopsia sobre úlceras bucales de nueva aparición en mucosa yugal que mostró células de Langerhans, estableciéndose el diagnóstico de histiocitosis X. Al cabo de 6 meses se realizó una nueva RM que demostró progresión de la enfermedad, con afectación temporal bilateral. Los hallazgos de la gammagrafía ósea, dieron lugar en este caso a un diagnóstico de extensión de la enfermedad más preciso que la RM

We present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of Histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRIWe present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of Histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRI