Nuevos criterios ASAS para el diagnóstico de espondiloartritis. Diagnóstico de sacroileítis por resonancia magnética / New ASAS criteria for the diagnosis of spondyloarthritis: Diagnosing sacroiliitis by magnetic resonance imaging

La sacroileítis radiográfica ha formado parte del diagnóstico de las espondiloartropatías desde su inclusión en los criterios de Roma en 1961. Sin embargo, en la última década, la resonancia magnética (RM) ha demostrado ser más sensible para valorar las articulaciones sacroilíacas en los pacientes con sospecha de espondiloartritis y síntomas de sacroileítis, no solo para diagnosticarla, sino también para seguir la evolución de la enfermedad y el tratamiento de estos pacientes. El grupo The Assessment of SpondyloArthritis international Society (ASAS) desarrolló en el año 2009 unos criterios para clasificar y diagnosticar a los pacientes con espondiloartritis, entre los que destacaba la inclusión de un estudio de RM positivo para sacroileítis como criterio diagnóstico mayor. Este artículo incide en la parte radiológica de esta clasificación. Se describen e ilustran las diferentes alteraciones que podemos encontrarnos en los estudios de RM en pacientes con sacroileítis, resaltando las limitaciones y potenciales errores diagnósticos (AU)

Radiographic sacroiliitis has been included in the diagnostic criteria for spondyloarthropathies since the Rome criteria were defined in 1961. However, in the last ten years, magnetic resonance imaging (MRI) has proven more sensitive in the evaluation of the sacroiliac joints in patients with suspected spondyloarthritis and symptoms of sacroiliitis; MRI has proven its usefulness not only for diagnosis of this disease, but also for the follow-up of the disease and response to treatment in these patients. In 2009, The Assessment of SpondyloArthritis international Society (ASAS) developed a new set of criteria for classifying and diagnosing patients with spondyloarthritis; one important development with respect to previous classifications is the inclusion of MRI positive for sacroiliitis as a major diagnostic criterion. This article focuses on the radiologic part of the new classification. We describe and illustrate the different alterations that can be seen on MRI in patients with sacroiliitis, pointing out the limitations of the technique and diagnostic pitfalls (AU)

[New ASAS criteria for the diagnosis of spondyloarthritis: diagnosing sacroiliitis by magnetic resonance imaging]. / Nuevos criterios ASAS para el diagnóstico de espondiloartritis. Diagnóstico de sacroileítis por resonancia magnética.

Radiographic sacroiliitis has been included in the diagnostic criteria for spondyloarthropathies since the Rome criteria were defined in 1961. However, in the last ten years, magnetic resonance imaging (MRI) has proven more sensitive in the evaluation of the sacroiliac joints in patients with suspected spondyloarthritis and symptoms of sacroiliitis; MRI has proven its usefulness not only for diagnosis of this disease, but also for the follow-up of the disease and response to treatment in these patients. In 2009, The Assessment of SpondyloArthritis international Society (ASAS) developed a new set of criteria for classifying and diagnosing patients with spondyloarthritis; one important development with respect to previous classifications is the inclusion of MRI positive for sacroiliitis as a major diagnostic criterion. This article focuses on the radiologic part of the new classification. We describe and illustrate the different alterations that can be seen on MRI in patients with sacroiliitis, pointing out the limitations of the technique and diagnostic pitfalls.

Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada / Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy

Objetivo. Analizar el papel de la biopsia con aguja gruesa de adenopatías axilares con sospecha ecográfica de metástasis en pacientes con cáncer de mama, y la correlación radiopatológica. Material y métodos. Estudio retrospectivo de 74 pacientes diagnosticadas de cáncer de mama, a las que se realizó biopsia con aguja gruesa ecoguiada de adenopatías axilares con características ecográficas indicativas de metástasis. Consideramos hallazgos ecográficos sospechosos de metástasis: engrosamiento cortical, alteración de la grasa hiliar y/o flujo vascular cortical no hiliar. Las pacientes con biopsia axilar negativa se incluyeron en el protocolo de biopsia de ganglio centinela. Resultados. La biopsia con aguja gruesa confirmó metástasis ganglionar en 47 (63,5%) pacientes. Las 27 pacientes (36,5%) con biopsia negativa se incluyeron en el protocolo de biopsia de ganglio centinela y 3 (11%) presentaron ganglio centinela positivo, realizándose linfadenectomía axilar. De las 50 adenopatías con metástasis, 44 (88%) presentaron engrosamiento cortical, 20 (40%) alteración de la grasa hiliar y 29 (58%) flujo vascular cortical no hiliar. En todas las adenopatías con engrosamiento cortical y flujo vascular cortical no hiliar la biopsia fue positiva, indicando un valor predictivo positivo del 100% en esta serie. Conclusiones. La biopsia con aguja gruesa ecoguiada de adenopatías axilares con sospecha ecográfica de metástasis por cáncer de mama es un procedimiento con alta efectividad diagnóstica y baja morbilidad. La presencia de engrosamiento cortical y flujo vascular cortical no hiliar en la misma adenopatía mostró un valor predictivo positivo del 100% en esta serie (AU)

Objective. To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. Material and methods. We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. Results. Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. Conclusions. Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series (AU)

[Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy]. / Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada.

OBJECTIVE: To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. MATERIAL AND METHODS: We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. RESULTS: Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. CONCLUSIONS: Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series.