ABSTRACT
Objective To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and Methods In the period from June 2011 to May 2012, seven computed tomography-guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results In all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible. .
Objetivo Descrever a técnica de biópsia percutânea de tumores pancreáticos guiada por tomografia computadorizada com pneumodissecção. Materiais e Métodos No período de junho de 2011 a maio de 2012, foram realizadas sete biópsias percutâneas de tumores pancreáticos guiadas por tomografia computadorizada utilizando a manobra de pneumodissecção em nossa instituição. Todas as biópsias foram realizadas utilizando pistola de disparo automático e sistema coaxial, com agulhas Tru-core. As amostras colhidas foram submetidas a avaliação histológica. Resultados Para todos os casos, não havia um acesso direto seguro pela tomografia computadorizada para atingir o tumor pancreático sem atravessar órgãos e estruturas importantes. A injeção de ar foi capaz de deslocar as estruturas adjacentes e criar uma nova rota de acesso, permitindo um trajeto seguro da agulha coaxial até a lesão, e a biópsia foi realizada com sucesso em todos os casos. Todas as biópsias forneceram material suficiente para análise histológica. Conclusão Esta técnica é segura, barata e tecnicamente fácil, podendo auxiliar na realização de biópsias percutâneas de tumores pancreáticos guiadas por tomografia computadorizada de casos selecionados em que não existe acesso direto à lesão. .
ABSTRACT
Introdução: O tratamento dos carcinomas epidermoides de cabeça e pescoço é altamente complexo. Em geral, pacientes com tumores iniciais são tratados por cirurgia ou radioterapia, enquanto aqueles com tumores avançados recebem terapias combinadas, composto por cirurgia, radioterapia e quimioterapia, sendo que um fator primordial no tratamento dos tumores de cabeça e pescoço é a avaliação da resposta terapêutica. Tradicionalmente, a resposta terapêutica é avaliada por parâmetros morfológicos, como as dimensões das lesões, através de critérios de avaliação de resposta terapêutica, sendo que os mais usados são o RECIST e WHO. Nos últimos anos têm sido desenvolvidos métodos funcionais de avaliação por imagem de tumores, dentre os quais se destacam o 18FDG-PET-CT e a ressonância magnética com sequências ponderadas em difusão. O 18FDG-PET-CT é capaz de fornecer informações relacionadas ao metabolismo da glicose nos diversos órgãos e tecidos. As sequências ponderadas em difusão exploram o princípio do movimento randômico das moléculas de água nos tecidos do corpo humano. A movimentação das moléculas de água é mais restrita em tecidos com elevada celularidade, tais como alguns tecidos tumorais Há ainda carência de estudos na literatura sobre a avaliação de resposta terapêutica com difusão e são escassos os estudos na literatura comparando ambos os métodos. Objetivo Primário: Comparar a variação do Coeficiente Aparente de Difusão obtido por Ressonância Magnética antes e após o tratamento nas lesões primárias e metástases cervicais de pacientes portadores de carcinoma epidermóide de cabeça e pescoço submetidos a tratamento com quimioterapia e/ou radioterapia, bem como as variações nas dimensões e no valor de SUV calculado no 18FDG-PET-CT. Objetivos Secundários: Avaliar os valores de ADC em tecidos neoplásicos e normais, definindo ponto de corte para distinção destes, calculando sensibilidade, especificidade e acurácia; Comparar as variações dos valores do ADC...
Introduction: Head and Neck squamous cell carcinoma (HNSCC) treatment is a complex topic. Patients with initial tumors are usually treated by surgery or radiotherapy, while those with advanced tumors receiving combination therapy, consisting of surgery, radiation and chemotherapy, and a key factor is the evaluation of therapeutic response. Traditionally, the therapeutic response is assessed by morphological parameters such as the size of the lesions, and the most widely used is the RECIST criteria. In recent years functional methods have been developed, such as 18FDG-PET-CT and diffusion-weighted MRI. 18FDG-PET-CT is able to provide information related to glucose metabolism in various organs and tissues. The diffusion-weighted sequences exploiting the water molecules random motion principle in body tissues. Water molecules movement is more restricted in high cellularity tissues, such neoplastic tissues. There are few studies about diffusion MRI therapeutic response comparing this method with 18FDG-PET-CT. Methods: Were included 23 patients (75 lesions) with stage III and IV HNSCC, non-metastatic, with indication for neoadjuvant chemotherapy followed by radiotherapy or chemoradiotherapy or curative chemotherapy and concomitant radiotherapy. Images (18FDG-PET-CT and Diffusion) were performed before and after treatment and calculated ADC and SUV values and size of lesions. Patients were classified according to conventional response evaluation criteria (RECIST and WHO), PET-CT response criteria, and these values were compared with the ADC values. Primary Objective: To compare the Apparent Diffusion Coefficient (ADC) variation before and after treatment in primary lesions and cervical metastases HNSCC treated with chemotherapy and / or radiatiotherapy, as well as dimensions and SUV in 18FDG-PET-CT variations. Secondary Objectives: To evaluate ADC values in normal and neoplastic tissues, defining a cutoff value for distinguishing these by calculating sensitivity...
Subject(s)
Humans , Male , Female , Middle Aged , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/epidemiology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Positron-Emission TomographyABSTRACT
OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity.