One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection. / Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular.

INTRODUCTION: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. OBJECTIVE: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. METHODS: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. RESULTS: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. CONCLUSION: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

[Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: is there a change in the reliability of the technique according to time from surgery?]. / Biopsia selectiva del ganglio centinela en pacientes con cáncer de mama y biopsia escisional previa: ¿cambia la fiabilidad de la técnica según el tiempo transcurrido desde la cirugía?

AIM: To assess the influence of time on the reliability of sentinel lymph node biopsy (SLNB) in breast cancer patients with previous excisional biopsy (EB), analyzing both the sentinel lymph node detection and the lymph node recurrence rate. MATERIAL AND METHODS: Thirty-six patients with cT1/T2 N0 breast cancer and previous EB of the lesion underwent a lymphoscintigraphy after subdermal periareolar administration of radiocolloid, the day before SLNB. Patients were classified into two groups, one including 12 patients with up to 29 days elapsed between EB and SLNB (group A), and another with the remaining 24 in which time between both procedures was of 30 days or more (group B). Scintigraphic and surgical detection of the sentinel lymph node, histological status of the sentinel lymph node and of the axillary lymph node dissection, if performed, and lymphatic recurrences during follow-up, were analyzed. RESULTS: Sentinel lymph node visualization at the lymphoscintigraphy and surgical detection were 100% in both groups. Histologically, three patients showed macrometastasis in the sentinel lymph node, one from group A and two from group B. None of the patients, not even those with malignancy of the sentinel lymph node, relapsed after a medium follow-up of 49.5 months (24-75). CONCLUSION: Time elapsed between EB and SLNB does not influence the reliability of this latter technique as long as a superficial injection of the radiopharmaceutical is performed, proving a very high detection rate of the sentinel lymph node without evidence of lymphatic relapse during follow-up.

[Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women]. / Relación entre el riesgo de metástasis en el ganglio centinela y los receptores estrogénicos en pacientes pre y posmenopáusicas con cáncer de mama.

OBJECTIVE: The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. METHODS: A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥ 70 years old; B, younger postmenopausal, 89 patients, 55-69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. STATISTICAL ANALYSIS: chi-squared test, significance: P ≤ 0.05. RESULTS: SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. CONCLUSION: SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.

What are the preoperative factors that can determine the presence of metastases in other axillary nodes in breast cancer when the sentinel node is positive?

AIM: To determine whether preoperative factors, such as size of metastases in the sentinel lymph node (SLN), number of positive SLNs (1, >1), tumoral grade, lymphovascular invasion (LVI) and tumoral size can predict the presence of metastases in non-SLNs, when the SLN is positive. METHODS: The study population was 1 146 breast cancer patients. Lymphadenectomy was performed in 150. Three groups of patients were established depending on the size of the metastases in SLNs: group A: <2 mm; group B: 2 < or =GC < or =5 mm; group C: > 5 mm. Either the chi(2) test or Fisher's test was performed to compare categorical variables, and a multivariate conditional logistic regression model for data sets was performed to identify the deterministic factors of metastases presence. RESULTS: Ten percent of group A, 28% of group B and 52% of group C presented non-SLN metastases. Patients with >1 positive-SLN presented significantly more non-SLN metastases than those with only one positive-SLN; 56% of patients with LVI presented non-SLN metastases versus 26% of those without LVI. The tumoral grade and size did not seem to have any influence on the number of patients with non-SLN metastases. The number of positive-SLNs and size of metastases were statistically associated with the presence of metastases. CONCLUSIONS: In this study population, the probability of finding non-SLN metastases was statistically related to the size of the SLN metastases and the number of positive-SLNs.

Metástasis de carcinoma renal de células claras en la musculatura esquelética / No disponible

No disponible

[Clinical utility of attenuation correction with X-rays in myocardial perfusion SPECT studies]. / Utilidad clínica de la corrección de atenuación con rayos X en los estudios SPECT de perfusión miocárdica.

OBJECTIVE: We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. METHODS: In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemar's test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. RESULTS: Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). CONCLUSIONS: Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated.

[Influence of tumor location in patients with breast cancer on the sentinel node detection]. / Influencia de la localización del cáncer de mama en la detección del ganglio centinela.

OBJECTIVE: To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lymphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosin, inmunohistochemistry CAM 19-2 and PCR. RESULTS: The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. CONCLUSIONS: Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage.

[Clinical utility of fused 67Ga SPECT/CT scan images in patients with lymphoma]. / Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma.

AIM: The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. MATERIAL AND METHOD: 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. RESULTS: 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. CONCLUSION: To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46% of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies.

Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma / Clinical utility of fused 67GA SPECT/CT scan images in patients with lymphoma

Objetivo. El objetivo de este trabajo es la valoración de la utilidad clínica de las imágenes de fusión SPECT 67Ga/TC en los pacientes afectos de procesos linfoproliferativos. Material y método. Se estudiaron 44 pacientes (22 hombres) con linfoma (22 enfermedad de Hodgkin, 22 linfoma no Hodgkin). Se realizaron 59 estudios con una gammacámara híbrida, adquiriéndose consecutivamente un rastreo de cuerpo entero, un SPECT y una tomografía computarizada (TC) de la zona/s afecta/s para su fusión con el SPECT. El estudio de fusión se centró en las siguientes áreas: 33 tóraco-cervical (T), 24 abdomen (A) y 2 cráneo-cervical (CC). Las imágenes fueron evaluadas por 2 médicos nucleares sin conocimiento de los datos del paciente, clasificando la aportación de la fusión de imágenes respecto al SPECT como: no cambia, mejora la localización o extensión de las lesiones y cambia la estadificación. Se confirmaron los resultados con la realización de una TC de alta resolución en el periodo de un mes. Resultados. En 32/59 estudios no se observaron cambios (20 T, 12 A), en 23/59 estudios cambió la localización o extensión de las lesiones (12 T, 9 A y 2 CC) y en 4/59 estudios (1 T y 3 A) el cambio de localización implicó un cambio de estadificación respecto al observado en el SPECT. Conclusión. La realización de estudios de fusión de imágenes SPECT 67Ga/TC en pacientes con linfoma permite mejorar la precisión diagnóstica en un 46 % de los casos, principalmente en los estudios abdominales, óseos y del área diafragmática

Aim. The aim of this work is to show the clinical utility of the fused SPECT 67Ga/CT images in patients with lymphoma. Material and method. 44 patients (22 male) with lymphoma have been studied. 22 with Hodgkin's disease and 22 with non Hodgkin lymphoma. 59 studies were performed (33 thorax-cervical [T], 24 abdomen [A] and 2 skull-cervical area [SC]) with an hybrid gammacamera Millenium VG. We acquire consecutively a whole body scan, a SPECT and a CT, for its fusion with the SPECT, of the affects areas. The images were evaluated by two experts blinded, who classify the contribution of the fusion of images respect to the SPECT like: non changes, it improves the location or changes the extension of the injuries and it changes the staging. Final lesion location was confirmed by a high resolution CT performed within one month. Results. 32/59 studies did not change the location or extension of the injuries (20T, 12A), 23/59 studies changed the location or extension of the injuries (12T, 9A and 2 SC) and on 4/59 the change of location induced a change of staging respect to showed by the SPECT. Conclusion. To make fused SPECT 67Ga/CT images in patients with lymphoma allows improving the diagnostic precision in a 46 % of the cases, mainly in the abdominal, bone and of the diaphragmatic area studies

Subdermal re-injection: a method to increase surgical detection of the sentinel node in breast cancer without increasing the false-negative rate.

PURPOSE: The aim of this study was to evaluate in breast cancer whether subdermal (SB) re-injection improves surgical detection (SD) of the sentinel node (SN) in patients with negative lymphoscintigraphy on peritumoral (PT) injection, without increasing the false-negative (FN) rate. METHODS: Group I comprised 261 patients with invasive breast cancer >3 cm and clinically negative axilla treated with primary chemotherapy. Axillary lymphadenectomy was performed in all of these patients. Group IA comprised 201 patients with PT injection, while group IB comprised 60 patients with SB injection in the tumour quadrant. Group II comprised 652 patients with breast cancer <3 cm; in 73 of these patients with negative lymphoscintigraphy, SB re-injection was performed. For lymphoscintigraphy, 37-55 MBq (99m)Tc-albumin nanocolloid in 1 ml was used for PT injection, and 18 MBq in 0.2 ml for SB injection. Five-minute images were obtained 2 h p.i. for PT injection and 20-30 min p.i. for SB injection. SD was performed 4 or 24 h p.i. Lymphoscintigraphic (LD), surgical and internal mammary (IM) detection rates were calculated. In group I, FN, negative predictive value (NPV) and accuracy (A) were calculated. Statistical analysis was performed using the chi-square test. RESULTS: In percentages, results were as follows: Group IA: SD: 84.1, FN: 13.6, NPV: 88.9, A: 78.6, IM: 14.5*. Group IB: SD: 90, FN: 0, NPV: 100, A: 90, IM: 1.7* (*p<0.025). Group II: PT injection only: LD: 82.4, SD: 94; PT injection+SB re-injection: LD: 90, SD: 98.5. SD was 97.8** in patients with positive lymphoscintigraphy and 58.5** when lymphoscintigraphy was negative (**p<0.001). CONCLUSION: For correct staging, including extra-axillary drainage, peritumoural injection should first be performed. When the SN is not visualised, and only in those cases, SB re-injection should be performed, which increases the SD rate without increasing the FN rate.

Localización simultánea de neoplasias de mama no palpables y estudio del ganglio centinela (GC) mediante técnicas radioisotópicas / Simultaneous location of non-palpable breast neoplasms and sentinel node (SN) study by radioisotopic techniques

Objetivo: Obtener una correcta localización de lesiones no palpables de mama, con alta sospecha de malignidad y la detección del GC mediante técnicas radiosotópicas. Material y método: Se han estudiado 31 pacientes de edad comprendida entre 35 y 79 años, con lesiones no palpables de mama detectadas mediante mamografía y/o ecografía. Todas las pacientes fueron diagnosticadas de cáncer de mama y tratadas con quimioterapia primaria. A todas las pacientes se les practicó disección axilar total. 24 h antes de la intervención a todas ellas se les administró una dosis de 37 MBq (1 mCi) de macroagregados de albúmina (MAA) marcados con 99mTc, en el centro de la lesión, mediante guía ecográfica. Se practicaron imágenes gammagráficas en proyecciones anterior y lateral (en decúbito prono con mama colgante) para comprobar la correcta localización del radiofármaco. Seguidamente se les realizó estudio del GC mediante la administración subdérmica de una dosis de 18 MBq (0,5 mCi) de nanocoloide marcado con 99mTc. La localización del GC fue marcada en la piel con tinta indeleble. La localización intraquirúrgica de la lesión de la mama y del GC se realizó con ayuda de una sonda gammadetectora. La correcta colocación del radiofármaco intralesional, la existencia de bordes libres de enfermedad y el estudio histológico del GC fueron realizadas por el anatomopatólogo en el acto operatorio. El estudio histopatológico diferido se llevó a cabo con técnicas con hematoxilina-eosina e inmunohistoquimia. Resultados: En 29 de las 31 localizaciones de la lesión, había una buena colocación del radiotrazador (93,5 %), hubo 1 caso de contaminación del trayecto de la aguja y otro que no coincidía con la lesión, por mala colocación. La localización del GC fue del 96 % en axila y del 4 % en axila y mamaria interna. El GC se localizó en quirófano en 28/31 pacientes (90 %). Conclusión: La localización simultánea radioguiada de las lesiones ocultas de la mama y del ganglio centinela es un método sencillo, bien tolerado por las pacientes y que permite realizarse en un solo acto operatorio

[Simultaneous location of non-palpable breast neoplasms and sentinel node (SN) study by radioisotopic techniques]. / Localización simultánea de neoplasias de mama no palpables y estudio del ganglio centinela (GC) mediante técnicas radioisotópicas.

OBJECTIVE: To obtain correct location of non-palpable breast lesions, with high suspicion of malignancy and detection of SN by radiosotopic techniques. MATERIAL AND METHODS: Thirty-one patients whose ages ranged from 35 to 79 years, with non-palpable breast lesions detected by mammography and/or ultrasonography were studied. All the patients were diagnosed of breast cancer and treated with primary chemotherapy. All the patients underwent total axillary dissection. At 24 hours of the intervention, all patients received one dose of 37 MBq (1 mCi) of 99mTc labeled macroaggregated albumin (MAA) in the center of the lesion by ultrasonographic guide. Scintigraphic images were performed in anterior and lateral projections (in prone decubitus with hanging breast) to verify the correct location of the radiopharmaceutical. After, a study of the SN was performed by subdermal administration of an 18 MBq (0.5 mCi) dose of 99mTc labeled nanocolloid. The SN site was labeled on the skin with indelible ink. The intrasurgical site of the breast lesion and SN was performed using a gamma detector probe. Correct placement of the intralesional radiopharmaceutical, existence of disease free borders and histological study of SN were performed by the pathologist in the surgical act. The differed pathology study was performed with hematoxilin-eosin and immunohistochemistry. RESULT: In 29 of the 31 lesion sites, there was good placement of the radiotracer (93.5 %). There was 1 case of contamination of the needle pathway and another that did not coincide with the lesion, due to poor placement. Location of the SN was 96 % in the axilla and 4 % in axilla and internal mammary chain. The SN was located in surgery in 28/31 patients (90 %). CONCLUSION: Simultaneous radioguided location of the hidden breast lesions and sentinel node is a simple method, which is well tolerated by the patients and can be done in a single operation act.

[Sentinel lymph node (SN) detection in patients with breast cancer. Influence of tumor size and age of the patient]. / Localización del ganglio centinela en el carcinoma de mama. Influencia del tamaño tumoral y edad de la paciente.

OBJECTIVE: The objective of this study is to analyze the influence of tumor size and age of the patient in the detection of the SN in breast neoplasms. MATERIAL AND METHODS: A total of 190 patients affected of breast cancer with a mean age of 57 years (range from 28 to 87 years) were studied. According to age, the following were distinguished: under 40 years, 23 patients; between 40 and 60 years, 102 patients and over 60 years, 65 patients. The lesions were classified based on size (in mm) into: less than 10 in 27 patients, between 10 and 20 in 61 patients, between 20 and 30 in 64 patients, and greater than 30 in 38 patients. In all the cases, a scintigraphy was performed at 2 hr. post-injection of 3 mCi of 99mTc-nanocoloide, in the peritumoral area. After lymphoscintigraphy detection of the SN, cutaneous labeling was performed and it was detected surgically by a gamma detector probe. A complete lymphadenectomy was performed in all the patients. The histopathology was performed with hematoxylin-eosin and immunohistochemistry techniques and the state of the SN was compared with the remaining lymph nodes of the lymphadenectomy. RESULTS: The SN was located in 169 of the 190 cases (89%). In 164 cases, it was found in the axilla. The greatest percentage of those not detected was observed in tumors over 30 mm (32%) and patients older than 60 years (30%). No false negative were observed in tumors under 10 mm or in patients under 40 years, but the false negative rate increased with the patient's age and the tumor size. CONCLUSIONS: The patient's age and tumor size seem to influence SN detection rates. The FN rates seem to be superior in patients over 60 years. Patients under 40 years with tumors less than 10 mm are those who benefit most from this technique.

Localización del ganglio centinela en el carcinoma de mama. Influencia del tamaño tumoral y edad de la paciente / Sentinel lymph node (sn) detection in patients with breast cancer. Influence of tumor size and age of the patient

Objetivo: El objetivo de este estudio es analizar la influencia del tamaño del tumor y la edad de la paciente en la detección del GC en neoplasias de mama. Material y métodos: Se estudiaron 190 pacientes afectas de neoplasia de mama. Edad media de 57 años (rango comprendido entre 28 y 87 años). Según la edad distinguieron: menores de 40 años, 23 pacientes; entre 40 y 60 años, 102 pacientes y mayores de 60 años, 65 pacientes. Las lesiones se clasificaron en función del tamaño (en mm) en: menor de 10 en 27 pacientes, entre 10 y 20 en 61 pacientes, entre 20 y 30 en 64 pacientes, y superior a 30 en 38 pacientes. En todos los casos se practicó una gammagrafía a las 2 h post-inyección de 3 mCi de 99mTc-nanocoloide, en el área peritumoral. Tras la detección linfogammagráfica del GC se realizó un marcaje cutáneo, y mediante una sonda gammadetectora se detectó quirúrgicamente. En todas las pacientes se realizó linfadenectomia completa. La histopatología se realizó con técnicas de hematoxilina-eosina e inmunohistoquimia, y se comparó el estado del GC con el resto de ganglios de la linfadenectomía. Resultados: El GC se localizó en 169 de los 190 casos (89 por ciento). En 164 casos se localizó en axila. El mayor porcentaje de no detecciones se observó en tumores mayores de 30 mm (32 por ciento) y pacientes mayores de 60 años (30 por ciento). No se observaron falsos negativos en tumores de menos de 10 mm ni en pacientes menores de 40 años, pero la tasa de falsos negativos aumenta con la edad de la paciente y el tamaño del tumor. Conclusiones: La edad de las pacientes y el tamaño del tumor parece influir en las tasas de detección del GC. Las tasas de FN parecen ser superiores en las pacientes mayores a 60 años. Las pacientes menores de 40 años y con tumores de menos de 10 mm son las que más se benefician de esta técnica (AU)