Preoperative nodal staging of non-small cell lung cancer using 99mTc-sestamibi spect/ct imaging

OBJECTIVES: The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. METHODS: Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99mTc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. RESULTS: Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99mTc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6 percent, 95.5 percent, 85.7 percent, and 61.8 percent, respectively. The same values for the mediastinum were 14.3 percent, 97.1 percent, 50 percent, and 84.6 percent, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4 percent and 57.1 percent, specificity values of 95.5 percent and 91.2 percent, positive predictive values of 90 percent and 57.1 percent and negative predictive values of 67.7 percent and 91.2 percent, respectively. CONCLUSION: Single-photon emission computed tomography/computed tomography with 99mTc-sestamibi showed very low sensitivity and accuracy for the nodal staging of patients with non-small cell lung cancer, despite its high level of specificity. In addition, the performance of single-photon emission computed tomography/computed tomography added no relevant information compared to computed tomography that would justify its use in the routine preoperative staging of non-small cell lung carcinoma.

Histerectomias: estudo retrospectivo de 554 casos / Hysterectomies: a retrospective study of 554 cases

Objetivo: A histerectomia é uma operação muito realizada, entretanto há poucos trabalhos na literatura nacional sobre suas indicações, técnica e complicações. O objetivo deste trabalho é avaliar estes procedimentos realizados na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. Método: Estudo retrospectivo de 470 histerectomias abdominais e 84 vaginais foi conduzido analisando as indicações, tempo de cirurgia e internação, tipo de incisão e morbidez. Resultados: As principaisindicações foram o mioma uterino e o prolapso uterino para as histerectomias abdominais e vaginais, respectivamente.As complicações intra-operatórias aconteceram em 3,4% e as pós- operatórias em 2,4% do total de casos. Nenhuma diferença estatística foi encontrada no número de complicações em relação ao tipo de incisão (vertical ou transversal). O tempo de cirurgia e o de hospitalização foram estatisticamente maiores nas incisões verticais. A hemorragia foi a mais freqüente complicação intra-operatória e a infecção da incisão operatória foi a mais freqüente no pós-operatório. Conclusões: A histerectomia é um procedimento de baixo risco, no entanto, a realização de revisões sobre indicações e complicações, e a pesquisa de melhores técnicas cirúrgicas são necessárias para torná-la cada vez mais segura.

Objective: Hysterectomy is a frequently performed surgery, but national literature gives limited informationregarding indications, technique and complications. The aim of this study is to evaluate our results with this operation performed by the Discipline of Gynecology and Obstetrics of the Faculty of Medicine of “Triângulo Mineiro”. Methods: A retrospective study of 470 abdominal and 84 vaginal hysterectomies was conducted in which the indications, operation time, abdominal approach, hospitalization time, and morbidity were analyzed. Results: Uterine myoma and uterine prolapse were the most frequent indications for abdominal and vaginal hysterectomies, respectively. Intra-operative (3.4%) and postoperative (2.4%) complications occurred in abdominal hysterectomies, with no significant statistical difference in theincidence of complications related to the type of incision (transverse or vertical). Operative time and hospital stay were significantly increased with the vertical incision. Hemorrhage was the major intraoperative complication and wound infection in postoperative complications. Conclusions: We concluded that hysterectomy is a low risk procedure although improvements in surgical technique and continued research are needed for a even safer procedure.