Cirugía radioguiada con semillas de yodo-125 en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante / Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy

Objetivo: Evaluar la utilización de las semillas radiactivas de yodo-125 (SRI-125) en la cirugía de mama o axila, en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante (QtNeo).Material y métodos: Estudio prospectivo, entre enero del 2016 y junio del 2020; 80 mujeres T1-3, N0-2, M0: 30 marcaje SRI-125 del tumor en mama, 36 tanto del tumor como del ganglio axilar positivo biopsiado, y 14 solo de axila. Edad: 54,7±11,4 años. Tamaño tumoral: 34,1±14,6mm. Tipo histológico: ductal infiltrante 90,0%. Subtipos moleculares: luminal-A 23,8%; luminal-B/HER2- 33,7%; luminal-B/HER2+ 18,8%; HER2+ 7,5%; triple negativo 16,2%.Resultados: De las 66 pacientes con marcaje SRI-125 del tumor (51 pre-QtNeo, 15 post-QtNeo), el 92,1% presentaba márgenes quirúrgicos libres, con un volumen de las piezas de 126,7±111,2 cm3. De las 5 reintervenciones, en 3 la ampliación fue positiva (una mastectomía).De las 50 pacientes N1 con marcaje SRI-125 (GM), 44 pre-QtNeo y 6 post-QtNeo, se identificó el GM en el 97,2%: negativo en 23, positivo en 26. En 45 se realizó biopsia selectiva del ganglio centinela y se identificó en el 93,3%: negativo en 26, positivo en 16. En un caso la SRI-125 no se colocó correctamente y tampoco se localizó GC por no migración.En el 61,9% de las pacientes el GM se encontraba entre el/los GC identificados en la cirugía. En 5 pacientes, con GC y GM no coincidentes, el resultado anatomopatológico del GC fue negativo y el GM positivo. En 53,8% de las pacientes se realizó linfadenectomía axilar. Conclusión: Las SRI-125 permiten realizar cirugía conservadora de la mama y mejorar la detección de enfermedad residual axilar, en pacientes tratadas con QtNeo (AU)

Objective: To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC).Material and methods: Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7±11.4 years. Tumor size: 34.1±14.6mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%.Results: Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7±111.2 cm3. Of the 5 second local excisions, in 3 the resection margin was involved (1 mastectomy).Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration.In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients.Conclusion: RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC (AU)

Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy.

OBJECTIVE: To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS: Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7 ±â€¯11.4 years. Tumor size: 34.1 ±â€¯14.6 mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%. RESULTS: Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7 ±â€¯111.2 cm3. Of the 5 s local excisions, in 3 the resection margin was involved (1 mastectomy). Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration. In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients. CONCLUSION: RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC.

Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy. / Cirugía radioguiada con semillas de yodo-125 en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante.

OBJECTIVE: To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS: Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7±11.4 years. Tumor size: 34.1±14.6mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%. RESULTS: Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7±111.2 cm3. Of the 5 second local excisions, in 3 the resection margin was involved (1 mastectomy). Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration. In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients. CONCLUSION: RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC.

Procedimiento combinado de marcaje del ganglio axilar positivo biopsiado con semilla de yodo-125 y biopsia del ganglio centinela en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante / Combined procedure of marking axillary positive node with iodine-125 seed and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy

OBJETIVO: Presentar nuestra experiencia inicial en el procedimiento combinado de detección intraoperatoria del ganglio axilar positivo biopsiado marcado con semilla de 125I (GM) y biopsia del ganglio centinela (GC) después de quimioterapia neoadyuvante, en pacientes con cáncer de mama. MATERIAL Y MÉTODOS: Estudio prospectivo, enero de 2017 - marzo de 2019, 16 pacientes con cáncer de mama T1-3N1. Estadio TNM: II-A: 3, II-B: 10, III-A: 3. Tipo histológico ductal infiltrante: 14. Subtipos moleculares: luminal-A: 3, luminal-B: 9, HER2: 3, triple negativo: 1. El GM se marcó 227+/-36 días antes de iniciar la quimioterapia neoadyuvante (n: 10), o 1-6 días antes de la cirugía, sobre el ganglio previamente identificado con un marcador ecovisible tipo hidrogel (n: 3) o tridimensional-3D (n: 3). En 10 pacientes se realizó linfadenectomía axilar. RESULTADOS: GM y GC se identificaron en la cirugía en el 93,7% (15/16) de los casos, en 33,3% (5/15) GM no se encontraba entre los GC, y solo en una enferma (1/5) existió discrepancia entre el resultado de GM y GC (macrometástasis y negativo 0/2). Número medio ganglios GC: 2,2+/-0,9 (rango 1-3) y linfadenectomía axilar: 13,5+/-5,2 (rango 7-23). En todos los casos, el análisis anatomopatológico del GM, con semilla de 125I y/o marcador, predijo correctamente el estatus axilar posneoadyuvancia. En todas las pacientes se recuperó la semilla radiactiva de 125I. CONCLUSIONES: La colocación de semillas de 125I es una técnica factible para la localización intraoperatoria del ganglio positivo biopsiado en combinación con la biopsia del ganglio centinela. El resultado anatomopatológico del GM permite determinar el estatus axilar posneoadyuvancia

OBJECTIVE: To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS: Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227+/-36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS: ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2+/-0.9 (range 1-3) and AD: 13.5+/-5.2 (range 7-23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. CONCLUSIONS: Placing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy

Arpón quirúrgico vs. semilla de iodo (125I) en la localización de lesiones no palpables malignas de mama. Resultados preliminares / Surgical clips vs. iodine-125 (125I) seeds for marking the location of nonpalpable malignant breast lesions: preliminary results

OBJETIVOS: Evaluar los resultados de la cirugía radioguiada mediante semillas de 125I como alternativa al arpón quirúrgico en pacientes con lesiones no palpables malignas de mama. MATERIAL Y MÉTODOS: Se incluyeron pacientes con diagnóstico anatomopatológico de cáncer de mama, con lesiones no palpables, candidatas a tratamiento quirúrgico durante 2015-2016. Las pacientes fueron asignadas de manera aleatoria al marcaje prequirúrgico con arpón metálico (grupo A) o con semilla (grupo B). En ambos grupos, el procedimiento fue guiado mediante ecografía y/o mamografía en función de las características de la lesión radiológica. Durante la cirugía se utilizó una sonda gammadetectora y, posteriormente, se comprobó mediante radiología la presencia de las semillas en las piezas quirúrgicas. Se realizó el análisis histológico de las piezas, considerando márgenes libres la ausencia de tumor en la tinta. Las variables analizadas fueron la edad de las pacientes y varias características de la lesión (lateralidad, tamaño medido por resonancia magnética y en la pieza quirúrgica, tipo radiológico y presencia de márgenes quirúrgicos libres). RESULTADOS: En el grupo A (n=53), los subtipos histológicos más frecuentes fueron el carcinoma ductal infiltrante (CDI, 84,9%) y el luminal A (LA, 49,1%); el tamaño medio lesional (TML=1,8cm). En el grupo B (n=45), los resultados fueron CDI=82,2%, LA=46,5%, TML=1,5 cm. En el grupo A, la tasa de márgenes afectados fue del 13,2% y la tasa de reintervenciones, de un 13,2% (p = 0,7), y en el grupo B, la tasa de márgenes afectados fue 11,4% y la tasa de reintervenciones, del 7,5% (p = 0,5). Los volúmenes de las piezas quirúrgicas fueron significativamente menores en el grupo B (V=128,68 cm3) que en el grupo A (V=189,37 cm3) (p <0,05). CONCLUSIONES: La utilización de semillas de 125I se ha mostrado como una técnica factible en la localización de lesiones no palpables de mama, mostrando diferencias significativas en el tamaño de las piezas quirúrgicas respecto al arpón

OBJECTIVES: To assess the usefulness of iodine-125 (125I) seeds as an alternative to surgical clips for marking the location of nonpalpable malignant breast lesions for surgery. MATERIAL AND METHODS: We included patients with histologically confirmed nonpalpable malignant lesions treated by surgery in 2015 or 2016. Patients were randomly assigned to presurgical marking with metallic clips (Group A) or with 125I seeds (Group B). In both groups, marking was guided by ultrasound and/or mammography depending on the radiologic characteristics of the lesion. During surgery, a gamma probe was used and afterward the presence of seeds in the surgical specimen was checked radiologically. In the histological analysis, the absence of tumor in the stain was considered free margins. We analyzed the following variables: age, lesion characteristics (laterality, mean size on MRI and in the surgical specimen, radiological type), and presence/absence of free margins. RESULTS: In Group A (n=53), the most common histologic subtypes were infiltrating ductal carcinoma (IDC, 84.9%) and luminal A (LA, 49.1%); the mean size of the lesions was 1.8cm. In Group B (n=45), the most common histologic subtypes were IDC (82.2%) and LA (46.5%); the mean size of the lesions was 1.5cm. In Group A, 13.2% had involved margins and 13.2% underwent a second surgical intervention. In Group, B 11.4% had involved margins and 7.5% underwent a second surgical intervention. The differences between groups were not significant (p = 0.7 for involved margins and p = 0.5 for reintervention). The volume of the surgical specimens was significantly lower in Group B than in Group A (128.68cm3 vs. 189.37cm3; p < 0.05). CONCLUSIONS: Using 125I seeds was feasible and enabled significantly smaller surgical specimens than using metallic clips

Surgical clips vs. iodine-125 (125I) seeds for marking the location of nonpalpable malignant breast lesions: preliminary results. / Arpón quirúrgico vs. semilla de iodo (125I) en la localización de lesiones no palpables malignas de mama. Resultados preliminares.

OBJECTIVES: To assess the usefulness of iodine-125 (125I) seeds as an alternative to surgical clips for marking the location of nonpalpable malignant breast lesions for surgery. MATERIAL AND METHODS: We included patients with histologically confirmed nonpalpable malignant lesions treated by surgery in 2015 or 2016. Patients were randomly assigned to presurgical marking with metallic clips (Group A) or with 125I seeds (Group B). In both groups, marking was guided by ultrasound and/or mammography depending on the radiologic characteristics of the lesion. During surgery, a gamma probe was used and afterward the presence of seeds in the surgical specimen was checked radiologically. In the histological analysis, the absence of tumor in the stain was considered free margins. We analyzed the following variables: age, lesion characteristics (laterality, mean size on MRI and in the surgical specimen, radiological type), and presence/absence of free margins. RESULTS: In Group A (n=53), the most common histologic subtypes were infiltrating ductal carcinoma (IDC, 84.9%) and luminal A (LA, 49.1%); the mean size of the lesions was 1.8cm. In Group B (n=45), the most common histologic subtypes were IDC (82.2%) and LA (46.5%); the mean size of the lesions was 1.5cm. In Group A, 13.2% had involved margins and 13.2% underwent a second surgical intervention. In Group, B 11.4% had involved margins and 7.5% underwent a second surgical intervention. The differences between groups were not significant (p=0.7 for involved margins and p=0.5 for reintervention). The volume of the surgical specimens was significantly lower in Group B than in Group A (128.68cm3 vs. 189.37cm3; p<0.05). CONCLUSIONS: Using 125I seeds was feasible and enabled significantly smaller surgical specimens than using metallic clips.

Combined procedure of marking axillary positive node with iodine-125 seed and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. / Procedimiento combinado de marcaje del ganglio axilar positivo biopsiado con semilla de yodo-125 y biopsia del ganglio centinela en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante.

OBJECTIVE: To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS: Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS: ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. CONCLUSIONS: Placing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.

Hallazgos en imagen de un caso de hidrocolpos neonatal asociado a persistencia de sinus urogenital / Imaging findings in the case of neonatal hydrocolpoceles associated to persistent urogenital sinus

Las anomalías por obstrucción útero-vaginales en recién nacidas suelen ser consecuencia de malformaciones del tipo sinus urogenital o de la cloaca. Presentamos el caso de una recién nacida que manifestaba una masa abdominal. La resonancia magnética demostró la existencia de atresia vaginal, asociada a persistencia de sinus urogenital, que provocaba un hidrocolpos masivo, con el útero y el cérvix normales. Pensamos que la información obtenida con resonancia magnética es superior a la ecografía y a la tomografía computarizada y constituye la prueba diagnóstica prequirúrgica de elección (AU)

Eficacia de la ecografía en el diagnóstico de apendicitis aguda / Effectiyeness of ultrasonography for diagnosis of acute appendicitis

La presentación atípica o precoz de la apendicitis aguda en niños produce falsos diagnósticos. Objetivos. Determinar la validez y fiabilidad de la ecografía en el diagnóstico de la apendicitis aguda. Pacientes y métodos. Pacientes con sospecha de apendicitis aguda atendidos durante un año (1998). Se han dividido en dos grupos. Grupo 1: pacientes con apendicitis; grupo 2: pacientes con dolor abdominal inespecífico (97). Material: ecógrafo (de 5 y 7,5 MHz). Método: la prueba se ha considerado positiva si han concurrido tres o más de los signos típicos. Unidad de análisis: positividad de la prueba y presencia o ausencia de enfermedad confirmada por el análisis histológico del apéndice obtenido por laparotomía. Resultados. Número de pacientes seleccionados para el estudio: 139. Edad media: 8 años (rango: 2 a 14 años). Sexo: hombres, 75 por ciento; mujeres, 25 por ciento. Pacientes grupo 1: 42; pacientes grupo 2: 97. La tasa de falsos positivos ha sido del 12,23 por ciento y la de falsos negativos del 7,19 por ciento. La sensibilidad ha sido del 76 por ciento, la especificidad del 82 por ciento, el valor predictivo positivo del 65 por ciento, el valor predictivo negativo del 88 por ciento, y la precisión del 80 por ciento. Odds preprueba: 0,43; odds postprueba: 0,64. Conclusiones. La ecografía aumenta en un 20 por ciento la probabilidad del grado de certeza del diagnóstico de apendicitis aguda en la infancia (AU)

[Efficiency of ultrasonography in the diagnosis of acute appendicitis]. / Eficacia de la ecografía en el diagnóstico de apendicitis aguda.

UNLABELLED: Importance of the problem. Atypical or precocious presentation of acute appendicitis in children causes false diagnosis. OBJECTIVES: To determine internal and external validity of ultrasonography for confirmation diagnosis of acute appendicitis. PATIENTS AND METHODS: Patients with suspicious acute appendicitis treated in 1998. They have been classified into two groups. Group 1: patients with appendicitis; Group 2: patients with non-specific abdominal pain. MATERIAL: Ultrasonography equipment (5 and 7.5 MHz). METHOD: Ultrasonography has been considered as positive when 3 or more of the typical signs of appendicitis have been detected. Analysis unit: positivity of the test and presence or absence of illness confirmed by histologic analysis of the appendix obtained through laparotomy. RESULTS: Number of patients selected for the work: 139. Middle age: 8 years-old (range: 2 to 14 years); 75% were males, 25% females. Patients included in group 1: 42; patients included in group 2:97. False positive rate was 12.23%, while false negative rate was 7.19%. Sensibility was 76%, specificity was 82%, positive predictive value was 65%, negative predictive value was 88% and precision was 80%. Odds-ratio pre-test: 0.43; Odds-ratio post-test: 0.64. CONCLUSIONS: Probability of accuracy diagnosis is duplicated by ultrasonography. Liability of the test is diminished by variability due to observer.

Scrotal lymphangioma in children.

The intrascrotal localization of lymphangioma in children is uncommon, especially when the lymphangioma does not depend on testicular structures. We present the case of a 13-year-old male who started with a right intrascrotal mass unconnected with the testicle, clinically and ultrasonically compatible with cystic lymphangioma. The mass was excised because of progressive growth over the previous 5 months, and at surgery a scrotal lymphangioma was disclosed projecting towards the umbilical area through the subcutaneous cell tissue of the anterior abdominal wall. There have been no complications or recurrences to date, 6 months afterwards. Surgical removal is the only efficacious therapeutic approach and is the best way to achieve a definitive diagnosis in these patients.