Biopsia selectiva de ganglio centinela en el carcinoma escamoso de vulva. Análisis de seguimiento a 10 años / Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis

OBJETIVO: Aplicación de la biopsia selectiva de ganglio centinela (BSGC) en el carcinoma de vulva en estadios iniciales y análisis de los resultados, recurrencias y complicaciones. MATERIAL Y MÉTODOS: Se revisaron retrospectivamente 40 pacientes con cáncer de vulva y BSGC entre 2008 y 2018. El día de la intervención se rastrearon las cadenas ganglionares inguinales mediante sonda gammadetectora para identificar los ganglios centinela que se extirparon y remitieron para estudio anatomopatológico intraoperatorio. Posteriormente, se realizó seguimiento a largo plazo con análisis de complicaciones, recaída y mortalidad. RESULTADOS: De las 40 pacientes (edad media: 72 años [47-86]), la tasa de detección global por paciente fue del 95%, con un total de 129 ganglios centinela (GC) (3,22 GC/paciente). En tres de 25 pacientes con lesiones tumorales laterales el drenaje fue bilateral y en dos de 15 con lesiones de línea media fue unilateral. De las 40 linfogammagrafías 16 presentaban drenaje bilateral y 24 unilateral. Se obtuvieron un total de 119 GC- y 10 GC+, realizándose vaciamiento en ocho. En el grupo de GC- se incluyeron un caso de bloqueo linfático y un falso negativo. En 12 de 40 pacientes hubo complicaciones posquirúrgicas, cuatro de ellas linfedemas. Durante una mediana de seguimiento de 40 meses, recayeron seis de 10 con GC+ (40% mortalidad) y siete de 30 GC- (16% mortalidad). CONCLUSIONES: La BSGC en cáncer de vulva es la técnica de elección para una correcta estadificación y tratamiento locorregional. Es importante una adecuada estadificación ganglionar previa a la cirugía para evitar posibles bloqueos linfáticos que puedan inducir falsos negativos

AIM: Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications. MATERIAL AND METHODS: 40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality. RESULTS: 40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences. CONCLUSIONS: SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN

18F-FDG PET/CT y el síndrome de intolerancia inmunológica en el injerto renal no funcionante / 18F-FDG PET/CT and non-functioning renal graft intolerance syndrome

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Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis. / Biopsia selectiva de ganglio centinela en el carcinoma escamoso de vulva. Análisis de seguimiento a 10 años.

AIM: Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications. MATERIAL AND METHODS: 40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality. RESULTS: 40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences. CONCLUSIONS: SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN.

Análisis de recurrencias axilares tras biopsia selectiva del ganglio centinela en cáncer de mama inicial / Axillary recurrences after sentinel lymph node biopsy in initial breast cancer

Objetivo. Analizar los resultados de la aplicación de la biopsia selectiva del ganglio centinela en cáncer de mama en nuestro medio, mediante el análisis de recurrencias axilares en pacientes con Ganglio Centinela (GC) negativo sin vaciamiento axilar convencional, tras seguimiento clínico posterior. Material y métodos. Se han incluido un total de 218 pacientes a quienes se aplicó la BSGC tras diagnóstico de cáncer de mama en estadio inicial (T1-2N0) con vaciamiento axilar convencional únicamente si GC positivo. Se aplicó en todos los casos protocolo de 2 días para detección del GC tras inyección de 99mTc- Nanocoloide. Resultados. La media de seguimiento clínico posterior fue de 27 meses. Se extirparon un total de 413 GC con una media de 1,89/paciente (1–5). En un 33,9% se detectó infiltración [59,45% macrometástasis, 22,97% micrometástasis y 17,5% células tumorales aisladas (CTA)], siendo negativo el resto de ganglios extirpados en el vaciamiento axilar convencional en el 60% de los casos. En nuestra serie de pacientes se detectó un único caso de falso negativo de GC por bloqueo linfático masivo, identificándose intraoperatoriamente una adenopatía no captante adyacente al GC, sin detectarse ningún caso de recidiva axilar durante un seguimiento clínico medio de 27 meses. Conclusión. La ausencia de recidivas axilares en nuestra serie de pacientes con GC negativo sin vaciamiento axilar convencional indica el adecuado control local que la biopsia selectiva del ganglio centinela ofrece en el cáncer de mama en estadios iniciales(AU)

Objective. The aim of our study was to analyze the application of the Selective Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer of our population, through the analysis of axillary recurrences in patients with false negative sentinel node procedures without complete axillary lymphadenectomy, after a subsequent clinical follow-up. Material and methods. A total of 218 early Breast Cancer patients who underwent SLNB after being diagnosed of early breast cancer (T1-2N0) with complete axillary dissection only when the SLNB was positive in the histopathological analysis. In every case, a 2-day protocol was used to localize the sentinel node after injection of 99mTc-Nanocolloid. Results. The mean subsequent clinical follow-up was 27 months. A total of 413 sentinel nodes were removed with a median of 1.89/p (range 1–5). Infiltration was detected in 33.9% of patients (59.45% macrometastasis, 22.97% micrometastasis and 17.5% Isolated Tumor Cells (ITC)) and negative for the other nodes excised after conventional lymphadenectomy in 60% of cases. In our population, there was only one case of false negative (FN) SLN due to massive lymphatic blockage, and an abnormal lymph node without uptake adjacent to the SLN was identified intraoperatively. No case of axillary recurrence was detected during an average follow-up of 27 months. Conclusion. The absence of axillary recurrences in our population with negative SLNB without complete axillary dissection demonstrates the appropriate local control offered by this procedure in early Breast Cancer(AU)

[Axillary recurrences after sentinel lymph node biopsy in initial breast cancer]. / Análisis de recurrencias axilares tras biopsia selectiva del ganglio centinela en cáncer de mama inicial.

OBJECTIVE: The aim of our study was to analyze the application of the Selective Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer of our population, through the analysis of axillary recurrences in patients with false negative sentinel node procedures without complete axillary lymphadenectomy, after a subsequent clinical follow-up. MATERIAL AND METHODS: A total of 218 early Breast Cancer patients who underwent SLNB after being diagnosed of early breast cancer (T1-2N0) with complete axillary dissection only when the SLNB was positive in the histopathological analysis. In every case, a 2-day protocol was used to localize the sentinel node after injection of (99m)Tc-Nanocolloid. RESULTS: The mean subsequent clinical follow-up was 27 months. A total of 413 sentinel nodes were removed with a median of 1.89/p (range 1-5). Infiltration was detected in 33.9% of patients (59.45% macrometastasis, 22.97% micrometastasis and 17.5% Isolated Tumor Cells (ITC)) and negative for the other nodes excised after conventional lymphadenectomy in 60% of cases. In our population, there was only one case of false negative (FN) SLN due to massive lymphatic blockage, and an abnormal lymph node without uptake adjacent to the SLN was identified intraoperatively. No case of axillary recurrence was detected during an average follow-up of 27 months. CONCLUSION: The absence of axillary recurrences in our population with negative SLNB without complete axillary dissection demonstrates the appropriate local control offered by this procedure in early Breast Cancer.

[Determination of serum digoxin concentrations using radioimmunoassay. Evaluation and application of the analytical method]. / Determinación de las concentraciones séricas de digoxina por radioinmunoensayo. Valoración y aplicaciones del método analítico

The different laboratory technich for the determination of digoxin serum concentrations are analysed. Special emphasis is placed on the radioimmunoassay technic. The advantages and disadvantages of this technic are studied and the standard curves obtained in our determinations (n=39) are analysed. It can be seen that they can be reproduced in all cases with a high degree of similarity. The possible causes of error in this microtechnic are also analysed and a modification in the decanting fase, with which the number of repetitions in our laboratory has decreased, is suggested. Finally the criteria for the actual evaluation of the seric digoxin levels used in our laboratory are described and new possibilities in pharmacological investigation by this technic are mentioned.