[Presence of intramammary lymph nodes in the preoperative lymphoscintigraphy to locate the sentinel lymph node. Clinical significance]. / Presencia de ganglios intramamarios en la linfogammagrafía prequirúrgica para localizar el ganglio centinela. Relevancia clínica.

OBJECTIVE: The routes of lymphatic drainage from a breast cancer are the axilla (the most frequent) and the extra axillary regions. Among the latter, there are the so-called intrammamary lymph nodes (IMLN). This study has aimed to assess the incidence of IMLNs in our patients and study the evolution of these cases with IMLN in the lymphoscintigraphy. MATERIAL AND METHODS: Thirty-eight patients (out of 1725) with IMLN in the pre-operative lymphoscintigraphy were assessed. During the surgical procedure, using a gamma probe, IMLNs were located and excised. After their harvesting, a meticulous surgical field scan was performed. When the axillary sentinel node was positive for metastasis, a complete axillary lymphadenectomy was performed. In those where the axillary sentinel node was negative and IMLN was positive (IMLN+), axillary lymphadenectomy was also performed, except for one case. RESULTS: Thirty-four out of the 38 IMLNs were obtained (89.5%), because no lymphatic tissue was found in pathology analysis in three cases (8%) and in one patient (3%) IMLN was not found during surgery. Ten (26%) metastatic IMLNs were located and the remaining 24 IMLNs cases (63%) were metastasis-free. During the clinical follow-up, one patient with IMLN+ developed hepatic metastases. The remaining 33 patients did not present any recurrence. No follow-up data were available for three patients. CONCLUSIONS: IMLN and axillary sentinel node biopsy are recommended when both are depicted in preoperative lymphoscintigraphy. The axilla treatment will only depend on the axillary sentinel node status. Based on the data from other authors and our own experience, avoiding the axillary lymphadenectomy when a metastatic IMLN without axillary involvement seems reasonable.

Localización radioguiada de lesiones ocultas en cáncer de mama con gammacámara portátil. Experiencia inicial / No disponible

Objetivo: La localización radioguiada de lesiones ocultas(ROLL) de mama se ha realizado tradicionalmente mediante lautilización de sondas detectoras. No obstante, uno de los inconvenientesde esta técnica es que el radiotrazador inyectadopuede esparcirse por la glándula mamaria dificultando la resecciónde la lesión. La utilización de un dispositivo que permiteobtener una imagen en tiempo real podría ayudar a confirmarla correcta resección de la lesión.Pacientes y método: Estudio prospectivo de 70 pacientesdiagnosticadas de cáncer de mama con lesiones no palpables.Se realizó una linfogammagrafía el día previo a la intervenciónquirúrgica después de la administración de un nanocoloidemarcado con 99mTc. Durante la cirugía se utilizó una sondadetectora para guiar al cirujano (53 pacientes) y una gammacámaraportátil para valorar los márgenes de la lesión y el lechoquirúrgico. En un subgrupo de pacientes (17) se utilizóúnicamente la gammacámara para lograr estos objetivos.Resultados: En la fase 1 (42 pacientes) se visualizó con lagammacámara una lesión centrada en 23/42 pacientes, nocentrada en 15/42 y en contacto con el margen en 4 casos.El estudio patológico determinó márgenes libres en 15/23 casoscon lesión centrada (65%), márgenes afectos en 10/19casos con lesión no centrada. La congruencia global fue del60%. En la segunda fase (28 pacientes) la congruencia globalfue del 68%.Conclusión: La utilización de gammacámaras portátiles enquirófano se encuentra en su fase de desarrollo y mejoría técnicasiendo posible su aplicación clínica con resultados similaresa los obtenidos con las sondas detectoras(AU)

Objective: Radioguided occult localization lesion (ROLL) inbreast cancer has been classically performed by using handheldgamma probes. However, one of the important drawbacksof such a technique is the radiotracer spillage within themammary gland that difficult the precise lesion resection. Theuse of a device that can obtain a real-time image could help toconfirm if the lesion is correctly removed and to assess the surgicalbed remaining tissue.Patients and method: Prospective study including 70 patientswith non-palpable breast cancer lesions. A lymphoscintigraphywas performed, the day before surgery, after injectionof nanocolloid labelled with 99mTc. A hand-held gamma probewas used to guide the surgeon during surgical procedure(53 patients) and, afterwards a portable gammacamera wasused to assess the surgical lesion margins. This device was solelyused in a subgroup of 17 patients to reach all targets.Results: In the first group (42 patients), a centered lesion insurgical specimen was observed by means of the portablegammacamera (23/42 patients), no centered in 15/42 and inclose contact with a margin in the remaining 4 patients. Pathologicalstudy demonstrated free margins in 15 out of 23 caseswith centered lesion (65%), involved margins en 10/19patients with non-centered lesions. Overall congruence reached60%. In the second group (28 patients), overall congruencearose to 68%.Conclusion: The intraoperative use of portable gammacamerasis in its early phase, but the clinical application of thesedevices with similar results of those achieved with the classicalhand-held gamma probes is possible(AU)