Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients.

OBJECTIVE: Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device. METHODS: A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test. RESULTS: Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak ( K = 0.349, P = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype. CONCLUSION: The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.

Major ambulatory surgery in breast diseases. / Cirugía mayor ambulatoria en patología mamaria.

INTRODUCTION: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. METHODS: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. RESULTS: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). CONCLUSIONS: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

Linfangioma quístico retroperitoneal: Un tumor infrecuente en la edad adulta / Retroperitoneal cystic lymphangioma: A rare tumor in adulthood

Los linfangiomas son tumores benignos raros del sistema linfático, más comunes en la población pediátrica. La localización intraabdominal es muy infrecuente: tan solo el 1% de los linfangiomas aparece en el retroperitoneo. Se describe una tumoración quística infrecuente tanto por su localización como por la edad de presentación. Los linfangiomas retroperitoneales son tumores raros y su etiopatogenia es incierta. El diagnóstico se realiza mediante estudios de imagen; las técnicas de elección son la ultrasonografía (USG), la resonancia magnética (RM) o la tomografía computarizada (TC). A pesar de que se trata de tumores de naturaleza benigna, la exéresis quirúrgica completa es el tratamiento de elección para prevenir complicaciones como la sobreinfección, la rotura o el sangrado. Nuestro caso resulta infrecuente tanto por la localización retroperitoneal del tumor como por la tardía edad de presentación.

Background: lymphangiomas are rare benign tumors of the lymphatic system, being more common in the pediatric population. Intra-abdominal localization is very rare; only 1 % of lymphangiomas appear in the retroperitoneum. We report a case of a rare tumor because of its location and the elderly age of presentation. Retroperitoneal lymphangioma is a rare tumor with an unertain pathogenesis. Diagnosis is usually confirmed by imaging studies , e.g., US, MRI or CT. Although they are benign tumors, complete surgical resection is the treatment of choice. With this treatment, complications like infection, perforation or bleeding are prevented. Our case is unusual because of the retroperitoneal location of the tumor and the late age of presentation.

Malignant eccrine breast spiradenoma. A case report and literature review.

INTRODUCTION: Eccrine spiradenomas are rare adnexal tumours of the skin that originate in the sweat glands. There are only three cases, including ours, diagnosed as malignant transformation in the breast. PRESENTATION OF CASE: We present a case of an asymptomatic 48 year old woman in whom the lesion was detected on the basis of breast cancer prevention programme. The metastatic study detection and the sentinel lymph node biopsy were negative so wide excision of the mass was performed with no further treatment. After 32 months of follow-up, there is no evidence of recurrent or metastatic disease in our patient. DISCUSSION: The lesions usually show a typical history of a long-standing unchanged cutaneous solitary nodule that becomes enlarged. The imaging findings of breast eccrine spiradenomas have not been clearly demonstrated. Diagnosis is based in histopathological findings of malignant focus. A large list of uncommon dermatological skin malignancies and breast benign lesions can mimic malignant eccrine spiradenomas (MES); therefore, determination of inmunophenotype allows narrowing differential diagnosis. Distant metastases portend an ominous prognosis. The mainstay of treatment is surgical removal with wide excision margins. Radiation and hyperthermic chemotherapy can also be administered to prevent focal recurrence. Due to the high risk of developing metastases, close follow up of these patients for early detection of recurrence should be carried out. CONCLUSION: Eccrine spiradenomas are rare adnexal tumours of the skin. Intraparenquimatous breast location is especially infrequent. Diagnosis is based on histopathological examination. MES metastasizes (40%), so a close follow up is recommended.