Estudio comparativo de la sensibilidad del MAMMI-PET en el diagnóstico de cáncer de mama con respecto a otras pruebas de imagen / Comparative study of the sensitivity of MAMMI-PET in the diagnosis of breast cancer with regard to other imaging tests

Introducción: el empleo de dispositivos de tomografía por emisión de positrones mamodedicados (dbPET) mejora la resolución espacial respecto a la PET corporal total. La mamografía mediante imagen molecular PET (MAMMI-PET) es una nueva técnica, pero los estudios clínicos realizados son escasos. El objetivo del trabajo es determinar la sensibilidad, especificidad, los valores predictivos positivos y negativos de la MAMMI-PET, así como comparar el dispositivo con las pruebas de imagen tradicionales. Material y métodos: estudio observacional prospectivo y analítico sobre una muestra de pacientes con cáncer de mama confirmado histológicamente, atendidas en el Hospital General de Valencia (enero 2017-noviembre 2018). Se realizó un estudio preoperatorio con ecografía, mamografía, resonancia magnética nuclear y MAMMI-PET. Se consideró a la anatomía patológica como el patrón oro del número y tipo de lesiones existentes en cada mama. Se comprobó si el diagnóstico del MAMMI-PET para cada lesión coincidió con el resultado de la anatomía patológica. Se comparó la sensibilidad de cada prueba con la del MAMMI-PET empleando la prueba de Chi cuadrado con nivel de significación de 0,05. Resultados: se evaluaron los datos de 32 pacientes y 44 lesiones (36 malignas y 8 benignas). Dos pacientes fueron excluidas del estudio. Se obtuvo una sensibilidad del 75% para el MAMMI-PET. La mejor sensibilidad se obtuvo para la resonancia magnética nuclear con 85,3% mientras que para la ecografía y la mamografía fue de 77,8 y 69,4%, respectivamente. No se evidenciaron diferencias estadísticamente significativas en el estudio comparativo entre el MAMMI-PET y el resto de las pruebas de imagen. Conclusiones: la sensibilidad del MAMMI-PET (75%) para el diagnóstico de cáncer de mama fue similar a las otras pruebas de imagen. (AU)

Introduction: The use of mammo dedicated breast PET (dbPET) scanners improves spacial resolution compared to Whole Body Pet images (WBPET). Mammography with Molecular Imaging PET (MAMMI-PET) is a new device with hardly any clinical studies. The aim of the study is to estimate the sensitivity of MAMMI-PET and compare it with classic imaging devices. Material and methods: A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. Preoperative study of patients was performed with ultrasound, mammography, Magnetic Resonance Imaging (MRI) and MAMMI-PET. Findings (number and benignant/malignant lesions) of the anatomopathological (AP) study were used as the gold standard. Results between MAMMI-PET and AP were compared. The sensitivity of each test was compared with that of the MAMMI-PET using the Chi square test with a significance level of 0.05. Results: Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. Two patients were excluded. The MAMMI-PET sensitivity was 75%. The best sensitivity was obtained for MRI with 85.3%, while for ultrasound and mammography it was 77.8% and 69.4% respectively. No statistically significant differences were found between the sensitivity of MAMMIPET and the rest of the imaging tests. Conclusions: The sensitivity obtained for the MAMMI-PET scanner (75%) was similar to the other imaging tests. (AU)

Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients.

OBJECTIVE: Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device. METHODS: A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test. RESULTS: Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak ( K = 0.349, P = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype. CONCLUSION: The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.

Cirugía mayor ambulatoria en patología mamaria / Major ambulatory surgery in breast diseases

Introducción: El tratamiento quirúrgico de la patología mamaria (PM) ha evolucionado aumentando su manejo como cirugía mayor ambulatoria (CMA). El objetivo de este estudio es analizar una serie de pacientes intervenidas de PM en régimen de CMA durante el año 2017 para evaluar su calidad y seguridad. Métodos: Se realiza análisis retrospectivo de las pacientes intervenidas de PM en el Consorcio Hospital General Universitario de Valencia desde enero hasta diciembre del 2017 incluidos en programa de CMA, estudiando el número de pacientes, los motivos de exclusión, el tipo de procedimientos quirúrgicos realizados, el índice de sustitución (IS), la tasa de ingreso (TI) y las causas de conversión al ingreso, complicaciones postoperatorias y el índice de satisfacción. Se compara con un grupo control del año 2013. Resultados: En 2017 se realizaron 396 intervenciones por PM, siendo de PM benigna (PMB) 170 intervenciones y de PM maligna (PMM) 226 intervenciones. El IS para la PM global es del 72,8% y para PMB fue 93,4%. El IS para PMM fue 57,2%, que ha progresado en los últimos años desde el 45,4% en 2013. La TI inesperado de la PMM fue del 14,1%, mientras que en la PMB fue del 0,6%. La PMM con ingreso presentó más morbilidad (17%) que la PMM sin ingreso (8,5%) y la PMB (6,5%). Conclusiones: En PMM del Consorcio Hospital General Universitario de Valencia el IS ha aumentado y la TI depende de la linfadenectomía tras biopsia peroperatoria del ganglio centinela. La CMA para el tratamiento de la PM es segura y eficiente

Introduction: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. Methods: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. Results: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). Conclusions: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe

Major ambulatory surgery in breast diseases. / Cirugía mayor ambulatoria en patología mamaria.

INTRODUCTION: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. METHODS: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. RESULTS: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). CONCLUSIONS: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

Lesiones inflamatorias mamarias benignas / Benign inflammatory breast lesions

El proceso diagnóstico de las lesiones inflamatorias mamarias incluye la descripción de su patrón histopatológico. El objetivo del trabajo es identificar los patrones inflamatorios mamarios. Se ha realizado una revisión de la literatura científica. Los patrones identificados son mastitis aguda con galactoforitis infecciosa inespecífica, galactoforitis crónica supurativa recidivante con mastitis periductal y de células plasmáticas, mastitis eosinofílica, lobulillitis linfocítica, mastitis granulomatosas, vasculitis mamaria, pseudotumores inflamatorios y necrosis grasa. Estos patrones y sus subtipos se han diferenciado analizando su composición, localización, mecanismo de producción y diagnóstico diferencial. En las biopsias de las inflamaciones mamarias se pueden identificar patrones histológicos inflamatorios desde los que se definen subtipos de mastitis. Para realizar el diagnóstico debe realizarse un completo estudio histopatológico y microbiológico de la biopsia de una mastitis y completar el diagnóstico con una adecuada correlación clinicopatológica (AU)

The diagnosis of chronic inflammatory breast disease includes the description of the histological pattern and location. The objective of this revision of the literature is to identify breast inflammatory patterns which are: acute mastitis with nonspecific infectious galactoforitis, chronic suppurative galactoforitis with periductal and plasma cell mastitis, eosinophilic mastitis, lymphocytic lobulillitis, granulomatous mastitis, breast vasculitis, inflammatory pseudotumour and fat necrosis. The composition, location, production mechanism and differential diagnosis of all types and subtypes are analyzed. Several inflammatory histological patterns with subtypes can be identified in biopsies of mastitis. A correct diagnosis requires a comprehensive histopathological and microbiological study in correlation with adequate clinicopathological data (AU)

Tumor bed segmentation: first step for partial breast irradiation.

INTRODUCTION: In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS: On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS: Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS: The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe.