A hybrid approach: a safe option for surgical treatment of early-stage cervical cancer.

OBJECTIVE: The aim of the study was to describe the surgical treatment of early-stage cervical cancer (CC) via minimally invasive surgery (MIS) and a sequential hybrid approach combining MIS and mini-Pfannenstiel. Evaluate sentinel lymph node (SLN) detection using a hybrid tracer (ICG-99m Tc nanocolloid). PATIENTS AND METHODS: Prospective, observational, descriptive, single-center study conducted at Son Espases University Hospital between January 2019 and September 2021. Patients with early-stage CC (FIGO 2018 IA1 with ILV-IIA1) who underwent surgical treatment with a follow-up of at least one year were included. RESULTS: Thirty early-stage CC patients were included, of whom four (13.3%) were upstaged due to positive SLNs. In these cases, laparotomy was avoided, and paraaortic lymphadenectomy was performed via MIS approach. Twenty-six patients had a radical hysterectomy: 15 underwent a hybrid approach, 10 laparoscopy, and one laparotomy. Patients undergoing laparoscopic surgery had a smaller estimated tumor size than those undergoing the hybrid approach. The overall SLN detection rate was 96.1%, with 88.5% of cases occurring bilaterally. Five out of 26 patients (19.2%) presented SLN macrometastases, and five (19.2%) had atypical drainage. Surgery refined staging in 33.3% (10/30) of cases. No recurrences were reported after an average follow-up of 32 months. CONCLUSIONS: MIS for SLN avoids laparotomy leading to rapid recovery and early adjuvant treatment initiation in nodal metastasis. In our study, tumor size is an important clinical implication in the surgical approach to be used. The hybrid tracer provided a high detection rate and combined the advantages of the two tracers. The hybrid approach has a quick recovery and optimal results.

Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

[Solitary hypermetabolic bone focus in the initial extension study of a prostate carcinoma]. / Foco óseo hipermetabólico único en el estudio de extensión inicial de un carcinoma de próstata.

56 year old male who was diagnosed of Prostatic Neoplasm by transrectal biopsy after elevated PSA level was found by chance in a routine control. The initial extension study with abdominal and pelvic CT did not show significant radiological abnormalities. This was followed by a whole body bone scintigraphy with 99mTc-MDP that showed a solitary hypermetabolic lesion within skull. A SPECT study placed this lesion at the left occipital region. An MRI and a CT head scan were carried out to characterize the isotopic lesion, finding no bone abnormalities to justify the mentioned uptake. Given the absence of a radiological benign diagnosis, a further FDG-PET scan was carried out which did not show either increased glycolytic activity at the left occipital region, or in the prostatic gland. In order to guide the biopsy, a CT head scan was repeated which showed what appeared to be an incipient blastic lesion in the scale of the left occipital bone, establishing the differential diagnosis between a metastasis and a benign process. The anatomopathologic analysis of the bone tissue describes a necrotic process without inflammatory reaction (osteonecrosis).

Foco óseo hipermetabólico único en el estudio de extensión inicial de un carcinoma de próstata / Solitary hypermetabolic bone focus in the initial extension study of a prostate carcinoma

Varón de 56 años a quien tras detectarse de forma casual un antígeno específico prostático (PSA) elevado en un control laboral rutinario, se le diagnostica un carcinoma de próstata por biopsia transrectal. Se inicia el estudio de extensión correspondiente mediante una tomografía computarizada (TC) abdominopélvica, sin evidenciar alteraciones radiológicas significativas, y una gammagrafía ósea de cuerpo entero con 99mTc-MDP, que detecta una lesión única hipermetabólica en calota craneal, y que el estudio tomográfico de SPECT localiza en la región occipital izquierda. Con la finalidad de caracterizar la lesión isotópica se le realiza una resonancia magnética (RM) y una TC craneal con ventana ósea sin que se evidencien alteraciones óseas que la justifiquen. En ausencia de un diagnóstico radiológico de benignidad se le realiza un estudio de PET-FDG, en el que no se visualiza actividad glucolítica aumentada ni en la región occipital izquierda ni a nivel prostático. Para dirigir la biopsia se repite la TC craneal y parece definirse entonces una lesión blástica incipiente en la escama del hueso occipital izquierdo, estableciéndose el diagnóstico diferencial entre una metástasis y un proceso benigno. El análisis anatomopatológico del tejido óseo describe un proceso necrótico sin reacción inflamatoria (osteonecrosis)

56 year old male who was diagnosed of Prostatic Neoplasm by transrectal biopsy after elevated PSA level was found by chance in a routine control. The initial extension study with abdominal and pelvic CT did not show significant radiological abnormalities. This was followed by a whole body bone scintigraphy with 99mTc-MDP that showed a solitary hypermetabolic lesion within skull. A SPECT study placed this lesion at the left occipital region. An MRI and a CT head scan were carried out to characterize the isotopic lesion, finding no bone abnormalities to justify the mentioned uptake. Given the absence of a radiological benign diagnosis, a further FDG-PET scan was carried out which did not show either increased glycolytic activity at the left occipital region, or in the prostatic gland. In order to guide the biopsy, a CT head scan was repeated which showed what appeared to be an incipient blastic lesion in the scale of the left occipital bone, establishing the differential diagnosis between a metastasis and a benign process. The anatomopathologic analysis of the bone tissue describes a necrotic process without inflammatory reaction (osteonecrosis)

Captación de 123I-MIBG en un hemangioma hepático en el estudio gammagráfico de una lesión suprarrenal / Uptake of 123I-MIBG in a hepatic hemangioma in the scintigraphic study of an adrenal glandlesion

Mujer de 60 años, asintomática, a la que se le detecta por TAC, de forma casual, una lesión suprarrenal izquierda con catecolaminas en sangre y orina elevadas. La gammagrafía con 123I-MIBG detecta un acúmulo no fisiológico a nivel de la glándula suprarrenal derecha que retiene en la imagen tardía, siendo la izquierda normal. La RMN confirma la existencia de una masa a nivel de la glándula suprarrenal izquierda sugestiva de adenoma y detecta una lesión hepática derecha que coincide en ubicación con la imagen de MIBG, siendo etiquetada de hemangioma. Dicha lesión explicaría la imagen obtenida en el estudio isotópico con MIBG debiendo ser interpretada como un falso positivo para feocromocitoma. Los niveles altos de catecolaminas en sangre y orina se explicaron por interferencia medicamentosa

A 60 year old symptom free female in whom a lesion in left adrenal gland was found by chance in a CT scan is presented. She also had increased serum and urine catecholamines levels. 123I-MIBG scintigraphy showed a non-physiological uptake in right adrenal gland that is still seen in the delayed image, with normal left gland. MRI confirmed the presence of a mass in the left adrenal gland suggestive of an adenoma and found a lesion in the right hepatic area at the level of the previously seen MIBG image. This lesion was labelled as a hemangioma and would explain the findings of the isotopic study with MIBG. It must be considered as a false positive for phaechromocytoma. The increased catecholamine serum and urine levels were due to drug interactions

[Uptake of 123I-MIBG in a hepatic hemangioma in the scintigraphic study of an adrenal gland lesion]. / Captación de 123I-MIBG en un hemangioma hepático en el estudio gammagráfico de una lesión suprarrenal.

A 60 year old symptom free female in whom a lesion in left adrenal gland was found by chance in a CT scan is presented. She also had increased serum and urine catecholamines levels. 123I-MIBG scintigraphy showed a non-physiological uptake in right adrenal gland that is still seen in the delayed image, with normal left gland. MRI confirmed the presence of a mass in the left adrenal gland suggestive of an adenoma and found a lesion in the right hepatic area at the level of the previously seen MIBG image. This lesion was labelled as a hemangioma and would explain the findings of the isotopic study with MIBG. It must be considered as a false positive for phaechromocytoma. The increased catecholamine serum and urine levels were due to drug interactions.