Correlação entre PET-CT com Fluoreto e densitometria óssea em pacientes com câncer de mama / Correlation between PET-CT with Fluoride and bone densitometry in patients with breast cancer

Introdução: As metástases ósseas afetam aproximadamente 8% de todas as pacientes com câncer de mama, com uma incidência de 47 a 85%. A adjuvância tem um papel significativo no tratamento do câncer de mama, porém, a quimioterapia e a terapia endócrina estão relacionadas com a perda de densidade mineral óssea (DMO) e um aumento no risco de fraturas. Após o tratamento, aproximadamente 70% das pacientes com doença avançada cursam com metástases ósseas. A cintilografia óssea é tradicionalmente utilizada para a pesquisa de metástases em pacientes com câncer de mama porque permite avaliar o corpo todo num único exame. Entretanto, esse método não é específico. Recentemente, a Tomografia por Emissão de Pósitron/Tomografia Computadorizada (PET-CT) com Fluoreto tem permitido uma melhor avaliação dessas pacientes com maior resolução espacial e especificidade do que a cintilografia. O valor padronizado de captação (SUV) é um parâmetro usado nos exames de PET-CT para quantificar a concentração do radiofármaco nos tecidos. No entanto, até o momento não existem valores de referência para o SUV nos exames de PET-CT com NaF-18F e não há estudos que avaliem a influencia da DMO nos valores de SUV. Objetivo: Avaliar a existência de uma correlação entre a densidade mineral óssea (DMO) e SUV através da PET-CT com NaF-18F em pacientes com câncer de mama. Metodologia: Revisamos retrospectivamente as imagens de 76 pacientes com câncer de mama que realizaram o exame PET-CT com Fluoreto. As imagens da PET-CT foram utilizadas para definição dos pontos anatômicos de atividade metabólica em L4 e no fêmur proximal. O SUV máximo (SUVmáx) foi comparado e correlacionado com a densidade obtida através da Tomografia Computadorizada em Unidades Hounsfield (HU) e DMO. Resultados: O SUV e a DMO estão correlacionados na quarta vértebra lombar (p < 0.05) bem como no fêmur proximal direito (colo femoral) (p < 0.01). Também há uma correlação significativa entre o HU e a DMO em L4. Verificou-se a presença de uma correlação significativa entre o SUV e a DMO no fêmur proximal (colo femoral), entretanto, não houve diferença estatisticamente significante entre o HU e a DMO no fêmur proximal. Conclusão: Este estudo demonstrou que há correlação entre a DMO e o SUV (L4) em pacientes com câncer de mama, sem evidência de metástases nos sítios utilizados para verificação da DMO nesse estudo. Também há uma correlação estatisticamente significativa entre o HU e DMO em L4 bem como entre o SUV e a DMO no fêmur proximal (colo femoral). Uma limitação encontrada nesse estudo é que há variação da captação do Fluoreto a depender dos valores de DMO (AU)

Introduction: Bone metastases affect approximately 8% of all breast cancer patients, with an incidence ranging from 47% to 85% in advanced disease. Adjuvant therapy is playing a significant role in breast cancer treatment, but chemotherapy and endocrine therapy are related with accelerated bone mineral density (BMD) loss as well as increase in fracture risk. Besides treatment, around 70% of patients with advanced disease experience bone metastases. Bone scintigraphy has traditionally been used to search for metastases in breast cancer patients because it evaluates the entire body in a single examination. However, this method is not very specific. Recently, PET-CT (Positron Emission Tomography-Computed Tomography) with Sodium Fluoride (NaF-18F) has allowed a better evaluation of these patients, with a higher spatial resolution and specificity regarding scintigraphy. The SUV (Standard Uptake Value) is a parameter used in PET-CT scans to quantify the concentration of the radiopharmaceutical in the tissues. However, there are as yet no reference values for the SUV on PET-CT examinations with NaF-18F and there are no studies evaluating the influence of bone mineral density (BMD) on SUV values. Main Objectives: To evaluate the association between bone mineral density (BMD) and Standardized Uptake Value (SUV) on 18F-NaF PET-CT in patients with breast cancer. Materials and Methods: We retrospectively reviewed the Images of 76 breast cancer patients who underwent Fluoride PET-CT. PET-CT images were used to define the anatomical points of metabolic activity in L4 and in the proximal femur. Maximum SUV (SUVmax) was compared and correlated with density obtained through Computadorized Tomography in Hounsfield Units (HU) and BMD. Results: SUV and BMD are correlated in the fourth lumbar vertebrae (L4) (p < 0.05) as well as in the proximal femur (femoral neck) (p < 0.01). There is also a significant correlation between HU and BMD in L4. There was no statistically significant difference between HU and BMD in the proximal femur Conclusion: This study showed that there is a correlation between SUV and BMD (L4) in breast cancer patients with no evidence of metastases in the sites used to verify BMD in this study. There is also a statistically significant correlation between HU and BMD in L4 as well as between SUV and BMD in the proximal femur. A limitation found in this study is that there is variation in fluoride uptake depending on BMD values (AU)

Prevalence of anxiety in women undergoing mammography

Objective:The aim of this study was to evaluate the frequency and possible causes of anxiety in women undergoing mammography and verify the impact of prior information as a tool to reduce anxiety. Material and Methods: The sample consisted of female patients who underwent mammography at an oncology reference center in Brazil. Total sample was divided into two groups and only one group received an explanatory folder with information regarding the mammography and its follow-up. All patients received a questionnaire containing demographic and clinical data, questions about the mammographic exam and the State-Trait Anxiety Inventory (STAI). Results: Two hundred and seventy-four patients were included, aged between 21 and 89 years. Exam purpose was screening in 48.3%. Self-perception of anxiety was reported in 52.2% and most frequent causes of anxiety referred by patients were worry over results (35.3%) and fear of having pain or discomfort during the procedure (26.6%). The levels of anxiety according to the STAI were moderate or high on 52.6% on the state component, and 82.1% on the trait component. There was no statistically significant difference on anxiety levels according to any of the demographic or clinical variables, or between patients who received and did not receive the educational folder prior to the exam. Conclusion: Anxiety is a common feature of women undergoing mammography, mainly caused by fear of the results and lack of knowledge of the exam. According to the results of this and other studies, there was no impact on reducing levels of anxiety with information measures immediately before the exam.