ABSTRACT
La cirugía radioguiada puede ser útil en la localización de tumores neuroendocrinos, detectando más lesiones y de menor tamaño que las pruebas de imagen prequirúrgicas y la palpación por el cirujano, detectando lesiones residuales e indicando una ruta más corta para acceder a la lesión. No obstante, su uso no se ha generalizado, ya que plantea dificultades técnicas, las series publicadas son limitadas, y no existe una uniformidad de criterios, debido a la gran variabilidad en cuanto al tipo de radiofármaco, dosis a emplear e intervalo entre la inyección del trazador y la cirugía. De estos aspectos nos ocupamos en esta revisión, describiendo la experiencia de distintos grupos, en los diversos tumores (AU)
Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors (AU)
Subject(s)
Humans , Male , Female , Neuroendocrine Tumors/surgery , Neuroendocrine Tumors , Somatostatin/therapeutic use , Radiopharmaceuticals/therapeutic use , Technetium , 50303 , Paraganglioma , Nuclear Medicine/methods , Pheochromocytoma , NeuroblastomaABSTRACT
A 61-year-old patient was diagnosed with squamous cell carcinoma of the penis (SCCP) and treated with partial penectomy (pT1,N0,M0,G2). Seven months later, a palpable adenopathy was found in the left inguinal region. An 18F-FDG PET/CT exploration showed hypermetabolic lymphadenopathies in inguinal, pelvic, retroperitoneal regions, in both lung hila and in the left supraclavicular regions. At the end of the 4th cycle of chemotherapy (cisplatin + 5FU) the patient developed numerous skin metastases at the root of the left thigh and a pleural effusion in the right lung. In a new exploration with 18F-FDG PET/CT the number, size and metabolic activity of known lymphadenopathies decreased. Right pleural carcinomatosis and intense FDG uptake in cutaneous metastases were observed. Weeks later, the patient died. 18F-FDG-PET/TC may be useful in patients with SCCP and metastatic inguinal lymphadenopathies, to assess the response to chemotherapy and to detect other unsuspected metastases in the rare cases of cutaneous metastases (AU)
Paciente de 61 años diagnosticado de carcinoma de células escamosas de pene (CCEP) tratado mediante penectomía parcial (pT1,N0,M0,G2). Siete meses más tarde, se constata una adenopatía palpable en la región inguinal izquierda. Una exploración 18F-FDG PET/TC demostró adenopatías hipermetabólicas inguinales, pélvicas, retroperitoneales, en ambos hilios pulmonares y en la región supraclavicular izquierda. Al finalizar el 4° ciclo de quimioterapia (cisplatino + 5FU) el paciente desarrolla numerosas letálides en la raíz del muslo izquierdo y un derrame pleural derecho. En una nueva exploración 18F-FDG PET/TC se apreció disminución del número, tamaño y actividad metabólica de las adenopatías conocidas, carcinomatosis pleural derecha e intensa captación de FDG en las metástasis cutáneas. El paciente fallece semanas más tarde. La 18F-FDG-PET/TC puede ser útil en pacientes con CCEP y adenopatías inguinales metastásicas, para valorar la respuesta al tratamiento quimioterápico y en los raros casos de metástasis cutáneas para detectar otras metástasis no sospechadas (AU)
Subject(s)
Humans , Male , Middle Aged , Penile Neoplasms/pathology , Skin Neoplasms , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Neoplasm Metastasis , Skin Neoplasms/secondary , Carcinoma, Squamous Cell/pathologyABSTRACT
Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors.
Subject(s)
Neuroendocrine Tumors/surgery , Radiography, Interventional/methods , Surgery, Computer-Assisted/methods , Humans , Neoplasm Proteins/analysis , Neuroendocrine Tumors/chemistry , Radiopharmaceuticals/analysis , Radiopharmaceuticals/pharmacokinetics , Receptors, Somatostatin/analysis , Somatostatin/analogs & derivativesABSTRACT
A 61-year-old patient was diagnosed with squamous cell carcinoma of the penis (SCCP) and treated with partial penectomy (pT1,N0,M0,G2). Seven months later, a palpable adenopathy was found in the left inguinal region. An (18)F-FDG PET/CT exploration showed hypermetabolic lymphadenopathies in inguinal, pelvic, retroperitoneal regions, in both lung hila and in the left supraclavicular regions. At the end of the 4th cycle of chemotherapy (cisplatin+5FU) the patient developed numerous skin metastases at the root of the left thigh and a pleural effusion in the right lung. In a new exploration with (18)F-FDG PET/CT the number, size and metabolic activity of known lymphadenopathies decreased. Right pleural carcinomatosis and intense FDG uptake in cutaneous metastases were observed. Weeks later, the patient died. (18)F-FDG-PET/TC may be useful in patients with SCCP and metastatic inguinal lymphadenopathies, to assess the response to chemotherapy and to detect other unsuspected metastases in the rare cases of cutaneous metastases.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/secondary , Fluorodeoxyglucose F18 , Multimodal Imaging , Penile Neoplasms/pathology , Positron-Emission Tomography , Radiopharmaceuticals , Skin Neoplasms/diagnosis , Skin Neoplasms/secondary , Tomography, X-Ray Computed , Humans , Male , Middle AgedABSTRACT
El uso generalizado de la exploración 18F-FDG PET-TC en pacientes de cáncer ha permitido demostrar la existencia de grasa parda metabólicamente activa, también llamada tejido adiposo pardo (TAP), en sujetos humanos adultos, y conocer su distribución anatómica in vivo. Como determinantes fisiológicos de la captación de 18F-FDG por el TAP se han identificado el sexo, la edad, la temperatura y el índice de masa corporal. Hemos observado una extensa activación del TAP, incluyendo la región mesentérica, en un paciente con un paranganglioma paravesical secretor de catecolaminas. La activación extensa del TAP podría ser secundaria a la estimulación adrenérgica por un exceso de la concentración de noradrenalina circulante (AU)
The widespread use of 18F-FDG PET-CT scanning in oncological patients has allowed to demonstrate the existence of metabolically active brown fat, also called brown adipose tissue (BAT), in adult humans, and specifying its anatomical distribution in vivo. As physiological determinants to BAT 18F-FDG uptake has been identified gender, age, temperature, and body mass index. We have observed extensive activation of the BAT, including the mesenteric region, in a patient with a catecholamine-secreting para-vesical paranganglioma. The extensive BAT activation could be secondary to adrenergic stimulation due to excess of circulating norepinephrine concentration (AU)
Subject(s)
Humans , Male , Adult , Fluorodeoxyglucose F18 , Paraganglioma/pathology , Paraganglioma , Adipose Tissue/pathology , Adipose Tissue , 3-Iodobenzylguanidine/analysis , 3-Iodobenzylguanidine/isolation & purification , Adipose Tissue, Brown/pathology , Adipose Tissue, Brown , Tomography, Emission-Computed, Single-PhotonABSTRACT
The widespread use of (18)F-FDG PET-CT scanning in oncological patients has allowed to demonstrate the existence of metabolically active brown fat, also called brown adipose tissue (BAT), in adult humans, and specifying its anatomical distribution in vivo. As physiological determinants to BAT (18)F-FDG uptake has been identified gender, age, temperature, and body mass index. We have observed extensive activation of the BAT, including the mesenteric region, in a patient with a catecholamine-secreting para-vesical paranganglioma. The extensive BAT activation could be secondary to adrenergic stimulation due to excess of circulating norepinephrine concentration.
Subject(s)
Adipose Tissue, Brown/metabolism , Fluorodeoxyglucose F18 , Multimodal Imaging , Paraganglioma/diagnosis , Paraganglioma/metabolism , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/metabolism , Catecholamines/metabolism , Humans , Male , Young AdultABSTRACT
El diagnóstico, la localización y el tratamiento de los quistes renales o hepáticos infectados en pacientes con enfermedad poliquística renal autosómica dominante (EPRAD) sigue siendo un reto clínico. Comunicamos los hallazgos de la 18F-FDG PET-TAC en un paciente diagnosticado de EPRAD, trasplantado renal hace 5 años, que presentó episodios repetidos de bacteriemia sin foco conocido en las exploraciones radiológicas practicadas. La exploración con 18F-FDG PET-TAC demostró numerosas imágenes hipermetabólicas de morfología focal o anular relacionadas con el contenido y la pared de alguno de los quistes hepáticos. La mayor actividad metabólica se localizó en los segmentos vi y vii . Se procedió a la punción y drenaje de uno de los quistes del segmento vi extrayendo 110 cc de un líquido purulento en el que creció Escherichia coli (E. coli) BLEE. La exploración de la 18F-FDG PET-TAC debería incluirse en el algoritmo diagnóstico para detectar quistes hepáticos infectados en pacientes con EPRAD y fiebre de origen desconocido(AU)
The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of 18F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The 18F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The 18F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin(AU)
Subject(s)
Humans , Male , Middle Aged , Fluorodeoxyglucose F18 , Fever of Unknown Origin/complications , Fever of Unknown Origin/diagnosis , Fever of Unknown Origin/etiology , Cysts/complications , Cysts , Bacteremia/complications , Bacteremia/diagnosis , Immunosuppressive Agents/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Infections/complications , Infections , Escherichia coli/isolation & purification , Klebsiella pneumoniae/isolation & purification , Liver/pathology , LiverABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Freezing/adverse effects , Foot/pathology , Foot , Cold Temperature/adverse effects , Frostbite , Aspirin/therapeutic use , Vasodilator Agents/therapeutic use , Heparin/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Toe Joint , 35073 , Foot/blood supply , Frostbite/complications , Altitude Sickness/blood , Altitude Sickness/complications , Dehydration/complications , Amputation, Traumatic/prevention & control , Technetium Tc 99m MedronateABSTRACT
The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of (18)F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The (18)F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The (18)F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin.
Subject(s)
Cysts/complications , Cysts/diagnosis , Escherichia coli Infections/complications , Escherichia coli Infections/diagnosis , Fever of Unknown Origin/etiology , Fluorodeoxyglucose F18 , Liver Diseases/complications , Liver Diseases/diagnosis , Multimodal Imaging , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/diagnosis , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Cysts/microbiology , Humans , Liver Diseases/microbiology , Male , Middle AgedSubject(s)
Brain Death/diagnostic imaging , Brain/diagnostic imaging , Tissue and Organ Harvesting , Tomography, Emission-Computed, Single-Photon , Brain Death/legislation & jurisprudence , Cerebral Angiography , Cerebrovascular Circulation , Coma/diagnostic imaging , Death , Humans , Intensive Care Units , Nuclear Medicine Department, Hospital , Pentetic Acid/pharmacokinetics , Radiopharmaceuticals/pharmacokinetics , Software Design , Spain , Technetium Tc 99m Exametazime/pharmacokinetics , Tissue Distribution , Tissue Donors/legislation & jurisprudence , Tissue and Organ Harvesting/legislation & jurisprudenceABSTRACT
The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of (18)F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in (18)F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy.
Subject(s)
Breast Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast/secondary , Carcinoma, Papillary/diagnostic imaging , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Incidental Findings , Lymphatic Metastasis/diagnostic imaging , Multimodal Imaging , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Unknown Primary/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Thyroid Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Aged , Axilla , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Female , Fluorine Radioisotopes/pharmacokinetics , Fluorodeoxyglucose F18/pharmacokinetics , Hemorrhage/pathology , Humans , Nipples/pathology , Radiopharmaceuticals/pharmacokineticsSubject(s)
Humans , Male , Female , /instrumentation , /methods , Perfusion/methods , Perfusion/trends , Nuclear Medicine/methods , Decision Making/radiation effects , Cerebral Angiography , /trends , Technetium Tc 99m Sulfur Colloid , Technetium , Nuclear Medicine/ethics , Nuclear Medicine/instrumentation , Nuclear Medicine/organization & administration , Decision Support TechniquesABSTRACT
La causa más frecuente de afectación metastásica de los ganglios linfáticos axilares en mujeres es una neoplasia en la mama ipsilateral. La definición de neoplasia oculta de mama se ha modificado con el tiempo. Actualmente, hay que considerar una neoplasia oculta de mama cuando coincide una linfadenopatía axilar metastásica aislada en ausencia de una tumoración palpable en la mama ipsilateral, una mamografía no diagnóstica para un tumor mamario y la no detección de una neoplasia primaria fuera de la mama, que potencialmente pudiera afectar a los ganglios axilares. En estos casos, el valor de la exploración 18F-FDG-PET-TAC no está establecido, aunque puede ser de utilidad en pacientes con una RM no diagnóstica. No es infrecuente que, en una exploración 18F-FDG-PET-TAC, se identifique de forma casual una imagen hipermetabólica focal en tiroides. La elevada prevalencia de cáncer en este tipo de lesiones, aconseja practicar una exploración con US y/o PAAF(AU)
The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of 18F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in 18F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy(AU)
Subject(s)
Humans , Female , Middle Aged , Carcinoma, Papillary , Thyroid Neoplasms , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Positron Emission Tomography Computed Tomography , Magnetic Resonance Imaging/methods , Chemotherapy, Adjuvant/instrumentation , Chemotherapy, Adjuvant/methods , Thyroidectomy/methods , Thyroid Neoplasms/complications , Biopsy, Needle/instrumentation , Biopsy, Needle/methods , Biopsy, Needle , Cohort StudiesABSTRACT
El linfoma de Hodgkin de predominio linfocítico nodular (LHPLN) es una rara entidad que representa menos del 5% de los casos de linfoma de Hodgkin (LH) con rasgos morfológicos, inmunofenotípicos, genéticos y de comportamiento clínico distintos del LH clásico. En una minoría de pacientes, la evolución del LHPLN se complica por transformación a un linfoma no Hodgkin difuso B de células grandes (LNHDBCG) con implicaciones pronósticas y terapéuticas. Los cambios metabólicos precoces observados mediante 18F-FDG PET en pacientes con LH y LNH, después de 1-3 ciclos de quimioterapia predicen la respuesta final al tratamiento y la supervivencia libre de progresión. En el caso que presentamos, tanto si se trata de LHPLN transformado a LNHDBCG o la coexistencia de los dos tipos de linfoma en el mismo paciente, la exploración 18F-FDG PET/TAC fue determinante para identificar la resistencia del tumor a la primera línea de quimioterapia, orientar la toma de una segunda biopsia y modificar el régimen de quimioterapia(AU)
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by 18F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the 18F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen(AU)
Subject(s)
Humans , Male , Middle Aged , Drug Resistance , Drug Resistance/radiation effects , Hodgkin Disease/diagnosis , Fluorodeoxyglucose F18 , Lymphoma, Large B-Cell, Diffuse/diagnosis , Nuclear Medicine/methods , Nuclear Medicine/trends , Fluorodeoxyglucose F18/immunology , Fluorodeoxyglucose F18/metabolism , Lymphoma, Large B-Cell, Diffuse , BiopsyABSTRACT
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by (18)F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the (18)F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Hodgkin Disease/drug therapy , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Multimodal Imaging , Positron-Emission Tomography , Radiopharmaceuticals , Splenic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Antibodies, Monoclonal, Murine-Derived/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Biomarkers, Tumor , Biopsy , Bleomycin/administration & dosage , Bleomycin/pharmacology , Cyclophosphamide/administration & dosage , Dacarbazine/administration & dosage , Dacarbazine/pharmacology , Disease Progression , Doxorubicin/administration & dosage , Doxorubicin/pharmacology , Drug Resistance, Neoplasm , Hodgkin Disease/diagnostic imaging , Hodgkin Disease/pathology , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Male , Middle Aged , Neoplasms, Multiple Primary/diagnostic imaging , Prednisone/administration & dosage , Prognosis , Rituximab , Splenic Neoplasms/drug therapy , Splenic Neoplasms/pathology , Ultrasonography, Interventional , Vinblastine/administration & dosage , Vinblastine/pharmacology , Vincristine/administration & dosageABSTRACT
Presentamos el caso de una paciente con cáncer de mama a la que se le realizó biopsia selectiva de ganglio centinela. En la linfogammagrafía preoperatoria se identificó mediante SPECT/TAC un ganglio centinela intramamario. Describimos nuestro procedimiento diagnóstico-terapéutico en relación con este hallazgo y la revisión bibliográfica para evaluar el significado clínico de su identificación y de su afectación metastásica, sobre todo en cuanto al manejo axilar más apropiado. Son necesarios estudios más amplios y con mayor significación estadística para dilucidar la actitud más adecuada ante la detección linfogammagráfica de un ganglio centinela intramamario(AU)
We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy(AU)
Subject(s)
Humans , Female , Middle Aged , Tomography, Emission-Computed, Single-Photon/instrumentation , Tomography, Emission-Computed, Single-Photon/methods , /instrumentation , /methods , Lymphatic Metastasis , Breast Neoplasms , Sentinel Lymph Node Biopsy/trends , Sentinel Lymph Node Biopsy , Tomography, Emission-Computed, Single-Photon/trends , Tomography, Emission-Computed, Single-Photon , Ganglia , Axilla/pathology , AxillaABSTRACT
We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Sentinel Lymph Node Biopsy , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Aged , Axilla , Breast/diagnostic imaging , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/surgery , Female , Humans , Lymph Node Excision , Mastectomy, Segmental , Preoperative Care , Radiopharmaceuticals , Technetium Tc 99m Aggregated AlbuminABSTRACT
Objetivo. Determinar el valor de la gammagrafía de paratiroides con 99mTc-MIBI y de la cirugía radiodirigida en el diagnóstico y tratamiento del hiperparatiroidismo primario (HPP) por adenoma ectópico. Material y métodos. Se han revisado 105 paratiroidectomías radiodirigidas practicadas entre marzo de 2004 y diciembre de 2008. Para el presente trabajo se han incluido 20 pacientes (19%) operados por adenoma ectópico. Los pacientes tenían diagnóstico de HPP, gammagrafía positiva, detección radiodirigida de adenoma ectópico, confirmación anatomopatológica de adenoma y seguimiento clínico de al menos 1 año desde la cirugía. La gammagrafía con 99mTc-MIBI consistió en imágenes planares en doble fase y tomográficas (SPECT o SPECT/TAC). Durante la paratiroidectomía se determinó PTH basal y a los 7, 15 y 30 minutos de la exéresis. El seguimiento se realizó mediante determinaciones de PTH, calcio, fósforo y vitamina D séricos y función renal. Resultados. La gammagrafía detectó todos los adenomas. La localización gammagráfica coincidió con la quirúrgica en 18 pacientes (90%). La localización definitiva fue: 9 paraesofágicos, 5 timicocervicales, 4 cervicomediastínicos posteriores, 1 mediastínico anterior y 1 paratimo. La paratiroidectomía radiodirigida identificó todos los adenomas y se efectuó mediante cirugía mínimamente invasiva en 12 pacientes, cervicotomía unilateral en 2, cervicotomía bilateral en 4 y esternotomía en 2. No se observó persistencia/recurrencia del HPP durante el seguimiento clínico. Conclusiones. La gammagrafía (SPECT/TAC) y la cirugía radiodirigida son métodos de gran eficacia en la localización y tratamiento del HPP debido a adenoma ectópico de paratiroides. En nuestra serie se detectaron y extirparon todos los adenomas, sin observarse hiperparatiroidismo persistente o recurrente(AU)
Aim. The aim of this study was to evaluate the role of 99mTc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas. Methods. We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function. Results. Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up. Conclusions. Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Adenoma/complications , Adenoma/diagnosis , Parathyroid Neoplasms , Tomography, Emission-Computed, Single-Photon/instrumentation , Tomography, Emission-Computed, Single-Photon/methods , Hyperparathyroidism/diagnosis , Hyperparathyroidism/therapy , Diagnostic Imaging , Adenoma , Parathyroid Neoplasms/diagnosis , Parathyroid Neoplasms/pathology , Parathyroid Glands/pathology , Parathyroid Glands , Tomography, Emission-Computed, Single-Photon/trends , Tomography, Emission-Computed, Single-Photon , Minimally Invasive Surgical ProceduresABSTRACT
AIM: The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas. METHODS: We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function. RESULTS: Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up. CONCLUSIONS: Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.
