Identificación con azul patente de ganglio centinela en cáncer de mama / Patent blue for identification of sentinel nodes in breast cancer

Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.

Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.

Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento / Validity of lung ultrasound to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure

Introducción La ecografía ha demostrado ser una herramienta útil para el diagnóstico del neumotórax en manos expertas. Tras los procedimientos broncopleurales se recomienda realizar una radiografía de tórax para descartar complicaciones. Nuestro objetivo ha sido determinar la validez de la ecografía torácica para descartar neumotórax tras procedimientos invasivos, realizada por neumólogos sin experiencia en este procedimiento. Material y métodos Estudio observacional prospectivo que incluyó pacientes consecutivos sometidos a biopsia transbronquial (BTB), toracocentesis evacuadora (TE) y/o biopsias pleurales transparietales (BPT) a los que se les indicó radiografía de tórax posterior para descartar complicaciones. En todos los casos el mismo neumólogo que hizo la técnica, realizó una ecografía inmediatamente después del procedimiento. Se consideró diagnóstica de neumotórax la presencia de punto pulmonar o la combinación de los signos: ausencia de deslizamiento pleural, ausencia de líneas B y presencia del signo de «código de barras». Resultados Se incluyeron 275 procedimientos (149 BTB, 36 BPT, 90 TE) entre los que se produjeron 14 (5,1%) neumotórax iatrogénicos. La ecografía presentó una sensibilidad de 78,5%, una especificidad de 85%, y un valor predictivo positivo y negativo de 22% y 98,6%, respectivamente. La ecografía no permitió detectar la presencia de tres neumotórax, precisando uno de ellos drenaje torácico y diagnosticó adecuadamente dos neumotórax que no se detectaban en la radiografía inicial. Conclusiones La ecografía torácica realizada por neumólogos que inician su curva de aprendizaje permite descartar neumotórax con un valor predictivo negativo (VPN) del 98,6%, evitando realizar en un número considerable de casos estudios radiográficos de control innecesarios (AU)

Introduction Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of lung ultrasound, conducted by pulmonologists without experience in this procedure, to rule out pneumothorax after invasive procedures. Material and methods Our prospective observational study consecutively included patients who underwent transbronchial lung biopsy (TBLB), therapeutic thoracentesis (TT) and/or transparietal pleural biopsies (PB) for whom subsequent chest radiography to rule out complications was indicated. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered in the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the “barcode” sign. Results We included 275 procedures (149 TBLBs, 36 BPs, 90 TTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. Conclusions Lung ultrasound performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases (AU)

Validity of thoracic ultrasonography to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure. / Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento.

INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of thoracic ultrasonography to rule out pneumothorax after invasive procedures, conducted by pulmonologists without experience in this procedure. MATERIAL AND METHODS: Our observational prospective study consecutively included patients who underwent transbronchial biopsy (TBB), evacuating thoracentesis (ECT) and/or transparietal pleural biopsies (TPB) who were indicated subsequent chest radiography to rule out complications. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the «barcode¼ sign. RESULTS: We included 275 procedures (149 TBBs, 36 TPBs, 90 ECTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and a positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Thoracic ultrasonography performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.

Utilidad de una escala de riesgo para identificar pacientes con disglucemia / Utility of a risk scale to identify patients with dysglycemia

Introducción: la prevalencia de diabetes y prediabetes ha ido en aumento a nivel global y en Cuba. Para identificar individuos en riesgo de disglucemia se han desarrollado varias escalas. Objetivo: evaluar el desempeño de la escala de Bang y otros, para identificar individuos con disglucemia, en una población cubana laboralmente activa. Métodos: se realizó un estudio transversal en 2 902 pacientes, fueron clasificados en portadores o no de disglucemia, a través de las pruebas de glucemia en ayunas, de tolerancia a la glucosa y hemoglobina glucosilada. Se determinó la frecuencia de factores de riesgo de diabetes mellitus tipo 2 comprendidos en la escala de Bang y otros, y en el proceder enfocado en factores de riesgo de American Diabetes Association. Se determinó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y Odds Ratio de ambas estrategias. En ambos se calculó el área bajo la curva operativa del receptor. Resultados: se encontró relación entre cada uno de los factores de riesgo previstos en ambos procederes con el diagnóstico de disglucemia. Se encontró sensibilidad de 96,5 por ciento y 79,9 por ciento; especificidad de 20,9 por ciento y 59,1 por ciento; valor predictivo positivo de 10,7 por ciento y 16,1 por ciento; valor predictivo negativo de 98,4 por ciento y 96,8 por ciento; OR de 7,33 y 6,76 y área bajo la curva 0,77 y 0,79 para la escala de Bang y otros, y el procedimiento enfocado en factores de riesgo, respectivamente. Conclusiones: ambos procederes identificaron de forma aceptable el grupo de pacientes con disglucemia(AU)

Introduction: The prevalence of diabetes and prediabetes has been increasing globally and also in Cuba. Several scales have been developed to identify individuals at risk for dysglycemia. Objective: To evaluate the performance of the Bang et al. scale to identify individuals with dysglycemia in a Cuban labor-active population. Methods: A cross-sectional study was carried out on 2 902 patients, classified as having or not suffering from dysglycemia, through fasting glycemia, glucose tolerance test and glycosylated hemoglobin. The frequencies of risk factors for type 2 diabetes mellitus included in the Bang et al. scale and in the risk factor approach of the American Diabetes Association were determined. Sensitivity, specificity, positive predictive value, negative predictive value and Odds Ratio of both strategies were determined. In both, the area under the receiver operating curve was calculated. Results: A relationship was found between each of the predicted risk factors in both procedures with the diagnosis of dysglycemia. Sensitivity was 96.5 percent and 79.9 percent; Specificity of 20.9 percent and 59.1 percent; Positive predictive value of 10.7 percent and 16.1 percent; Negative predictive value of 98.4 percent and 96.8 percent; OR of 7.33 and 6.76 and area under the curve 0.77 and 0.79 for the scale of Bang et al. and the procedure focused on risk factors respectively. Conclusions: Both procedures identified in an acceptable manner the group of patients with dysglycemia(AU)

Impact of the endoscopist's experience on the negative predictive value of capsule endoscopy. / Influencia de la experiencia acumulada del explorador en el valor predictivo negativo de la cápsula endoscópica.

INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training.

Symptom-based screening tool in ruling out active tuberculosis among HIV-infected patients eligible for isoniazid preventive therapy in Tanzania.

OBJECTIVES: We assessed the usefulness of the National TB and Leprosy Control Program (NTLP) symptom-based tuberculosis (TB) screening tool in identifying HIV-infected patients eligible for isoniazid preventive therapy in Muhimbili National Hospital, Dar es Salaam Tanzania. METHODS: Descriptive cross-sectional study. Data collected included socio-demographic and clinical data. Chest X-ray, sputum for acid-fast bacilli (AFB) microscopy, mycobacterial culture, CD4 + count and complete blood count were performed. Patients were considered not having active TB if they presented with no symptom in the screening tool, which comprised these symptoms: cough, fever and excessive night sweats for ≥2 weeks; weight loss of ≥3 kg in 4 weeks and haemoptysis of any duration. The reference standard was a negative culture for Mycobacterium tuberculosis. RESULTS: We enroled 373 patients, of whom 72.1% were females. Active pulmonary TB was found in 4.1% (14/338) of the participants as defined by a positive culture. The sensitivity and specificity of the NTLP screening tool were 71.4% (10/14) and 75.9% (246/324), respectively. False-negative rate was 28.6% (4/10). Cough, fever for ≥2 weeks and weight loss were independent predictors of NTLP-defined TB. Cough ≥2 weeks predicted TB when a positive culture was used to define TB. CONCLUSION: The screening tool had fairly good sensitivity and specificity for TB screening; however, there is a possibility that about 29% of the screened population will be given IPT while they are supposed to receive a full course of TB treatment.

Generalidades de las pruebas diagnósticas, y su utilidad en la toma de decisiones médicas / Overview of Diagnostic Tests and Their Usefulness in Medical Decisions Making

Introducción: La utilidad de las pruebas diagnósticas se basa en la capacidad de separar adecuadamente las personas sanas de las enfermas, y de no producir falsos positivos o negativos. Las propiedades de las pruebas diagnósticas se describen tradicionalmente como sensibilidad, especificidad y valores predictivos. Una forma adicional de considerar la probabilidad de la enfermedad es mediante el cálculo de la razón de probabilidades o likelihood ratio; este permite conocer cuánto más probable es un resultado (positivo o negativo) según la presencia o ausencia de la enfermedad. Objetivo: Describir en términos generales las propiedades de las pruebas diagnósticas. Se explican los conceptos de sensibilidad, especificidad, valores predictivos y likelihood ratio, así como su utilidad y aplicabilidad en la práctica médica. Metodología y desarrollo: Se realizó una revisión de artículos y textos sobre las propiedades de las pruebas diagnósticas, para definir y analizar sus características operativas; posteriormente, se exponen ejemplos para facilitar su entendimiento e interpretación...

Introduction: The usefulness of diagnostic tests consists of the ability to detect and separate a person with a disease from a healthy person, and not to produce false positives or negatives. The properties of diagnostic tests have traditionally been described using sensitivity, specificity, and positive and negative predictive values. An additional way to consider the probability of a disease is by calculating the likelihood ratio which helps to estimate how many times more (or less) likely patients with a disease are to have a particular result than patients without the disease. Objective: To describe the main properties of diagnostic tests. Important concepts, such as sensitivity, specificity, predictive value and likelihood ratio are explained, as well as their usefulness and applicability in clinical practice. Method: Articles and texts have been reviewed to define and analyze the operative characteristics of diagnostic tests. Similarly, examples are given to facilitate understanding and interpretation...