68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use.

OBJECTIVE: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. MATERIAL AND METHODS: Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT. All patients were referred to 68 Ga-PSMA-11 PET/CT. PROTOCOL: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. RESULTS: The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL). One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. CONCLUSION: 68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Ga-PSMA-11 PET/TC en la recidiva bioquímica oculta del carcinoma de próstata, con 18F-Colina PET/TC negativa. Valoración preliminar de su uso clínico / Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use

Objetivo: Valorar la utilidad de los estudios 68Ga-PSMA PET/TC en la práctica clínica de los pacientes con recidiva bioquímica oculta de carcinoma de próstata, con estudios de imagen radiológicos y 18F-Colina PET/TC negativos o no concluyentes.Material y métodosobservacional retrospectivo y de exactitud diagnóstica. Se seleccionaron los primeros 14 pacientes con antecedentes de carcinoma de próstata, tratados con intención curativa y que presentaban sospecha de recidiva bioquímica con valores bajos de antígeno prostático específico (PSA) (< 3 ng/mL). Los estudios de imagen, ecografía prostática, tomografía computarizada (TC) y/o resonancia magnética (RM) pélvica eran negativos, y todos ellos tenían un 18F-Colina PET/TC negativo o no concluyente. Se derivó a todos los pacientes para realizarse un 68Ga-PSMA-11 PET/TC. Protocolo: Dosis 2,2 MBq/kg, 20 mg de furosemida en el minuto 0. Imágenes PET/TC desde calota craneal hasta el tercio proximal de muslos a los 60 min, e imágenes tardías a las tres horas, si precisara.ResultadosEn nueve de los 14 pacientes (64,2%) el 68Ga-PSMA-11 PET/TC consiguió localizar la recidiva bioquímica oculta, y en todos ellos hubo cambios en la actitud terapéutica. En cuatro de los 14 pacientes (28,5%) el 68Ga-PSMA-11 PET/TC resultó negativo o no concluyente, se prosiguió con la actitud vigilante con controles de PSA y estudios de imagen, según los protocolos habituales. Estos pacientes presentaban los valores más bajos de PSA (inferiores a 1 ng/mL). Uno de los estudios 68Ga-PSMA-11 PET/TC fue no concluyente, informándose la presencia de una dudosa adenopatía iliaca derecha. (AU)

Objective: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18F-Choline PET/CT imaging studies.Material and methodsRetrospective observational and diagnostic accuracy. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (< 3 ng/ml) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.All patients were referred to 68Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 MBq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 hours if needed.ResultsThe 68Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.Four patients (28.5%) obtained a negative or inconclusive 68Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/ml).One of the 68Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. (AU)

Defects and plasticity in ultrastrong supercrystalline nanocomposites.

Supercrystalline nanocomposites are nanoarchitected materials with a growing range of applications but unexplored in their structural behavior. They typically consist of organically functionalized inorganic nanoparticles arranged into periodic structures analogous to crystalline lattices, including superlattice imperfections induced by processing or mechanical loading. Although featuring a variety of promising functional properties, their lack of mechanical robustness and unknown deformation mechanisms hamper their implementation into devices. We show that supercrystalline materials react to indentation with the same deformation patterns encountered in single crystals. Supercrystals accommodate plastic deformation in the form of pile-ups, dislocations, and slip bands. These phenomena occur, at least partially, also after cross-linking of the organic ligands, which leads to a multifold strengthening of the nanocomposites. The classic shear theories of crystalline materials are found to describe well the behavior of supercrystalline nanocomposites, which result to feature an elastoplastic behavior, accompanied by compaction.

18F-FDG PET/CT and sentinel lymph node biopsy in the staging of patients with cervical and endometrial cancer. Role of dual-time-point imaging / PET/TC con 18F-FDG y biopsia del ganglio centinela en la estadificación de pacientes con cáncer de cérvix y endometrio. Utilidad de la imagen dual-time-point

Objective. Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference. Material and methods. A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results. Results. In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found. Conclusions. PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes (AU)

Objetivo. La estadificación definitiva del cáncer de cérvix (CC) y de endometrio (CE) tiene lugar tras la cirugía. Nuestro objetivo fue evaluar la utilidad de la PET/TC para la detección de metástasis ganglionares en el CC y en el CE con imagen dual-time-point (DPI), considerando como gold standard la histopatología del ganglio centinela (GC) y la linfadenectomía. Material y métodos. Diecisiete pacientes con CC inicial y 13 con CE de alto riesgo fueron incluidas prospectivamente. Preoperatoriamente se realizó una PET/TC, RM, detección del GC y linfadenectomía en los casos indicados. Se comparó la PET/TC con la histopatología. Resultados. En el estudio anatomopatológico, 4 pacientes con CC y 4 con CE tuvieron metástasis ganglionares. La PET/TC mostró ganglios hipermetabólicos en una paciente con CC y en 5 con CE. Cuatro de ellas tenían metástasis, una detectada en el GC. Cuatro pacientes con PET/TC negativa presentaron micrometástasis en el GC, una paciente con ganglios adicionales infiltrados. La sensibilidad, especificidad, valor predictivo positivo y negativo y la exactitud diagnóstica de la PET/TC para detectar metástasis ganglionares fueron 20,0; 100,0; 100,0; 87,9 y 88,2% para el CC, y 57,1; 88,9; 66,7; 84,2 y 80,0% para el CE. La DPI mostró un índice de retención superior en ganglios infiltrados respecto a los inflamatorios, sin hallar diferencias estadísticamente significativas. Conclusiones. La PET/TC tiene baja sensibilidad para estadificar el CC y CE por la incapacidad de detectar micrometástasis y, por tanto, no sustituye la detección del GC. Aunque no hubo diferencias estadísticamente significativas, la DPI podría ayudar a diferenciar ganglios inflamatorios de tumorales (AU)

18F-FDG PET/CT and sentinel lymph node biopsy in the staging of patients with cervical and endometrial cancer. Role of dual-time-point imaging.

OBJECTIVE: Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference. MATERIAL AND METHODS: A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results. RESULTS: In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found. CONCLUSIONS: PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes.

PET/CT with [18F] fluorodeoxyglucose in the assessment of metabolic response to neoadjuvant chemotherapy in locally advanced breast cancer.

AIM: The aim of this paper was to prospectively evaluate FDG PET/CT in the assessment of metabolic response to neoadjuvant chemotherapy and correlation with tumor cellularity in locally advanced breast cancer. METHODS: Images were acquired with a PET/CT scanner in 50 patients at baseline and after completion of treatment, just before surgery. All findings were confirmed by histopathological analysis. PET/CT quantification (SUVmax) at baseline and after finishing neoadjuvant chemotherapy (4 cycles of epirubicin + cyclophosphamide +/- taxanes) were compared using RECIST criteria and Miller & Payne (M&P) scale. RESULTS: Baseline mean tumor size was 4.4±1.6 cm. Thirty eight patients were considered responders and 12 nonresponders. According to M&P scale, 10 patients had good prognosis (grades 4-5) and 40 patients had bad prognosis (grades 1-3). All patients with grade 5 M&P had no significant postchemotherapy FDG uptake. Patients with bad prognosis had lower SUVmax variation (∆SUVmax) than patients with good prognosis (60.7% vs. 80.5%, P=0.0016). ∆SUVmax was lower in nonresponders than in partial responders according to RECIST criteria (38.9% vs. 67.6%, p<0.001), and was also lower in partial responders than complete responders (67.6% vs. 85.4%, P=0.005). A cut-off ∆SUVmax value of 52% differentiates responders from nonresponders with a sensitivity of 86% and a specificity of 90%. Probability densities of the ∆SUVmax (%) for stable disease (<45), partial (>45 to <82) and complete response (>82) showed an overall accuracy of 78% (Weighted Kappa=0.74). CONCLUSION: PET/CT is useful to monitor response to neoadjuvant chemotherapy in locally advanced breast cancer. ∆SUVmax on PET/CT correlates with tumor cellularity after completion of neoadjuvant chemotherapy.

Trombosis arterial del injerto renal diagnosticada con renograma 99mTc-MAG3 en un paciente con poliquistosis / Arterial thrombosis of the renal graft diagnosed with 99mTc-MAG3 renogram in a female

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[Sentinel node in gynaecological cancers. Our experience]. / Ganglio centinela en cánceres ginecológicos. Nuestra experiencia.

UNLABELLED: Although sentinel lymph node (SLN) identification is widespread used in melanoma and breast cancer some concerns exist in other malignancies, such gynaecologic cancers, and this staging method has not been adopted in many centers due to lack or large validation studies. AIM: To evaluate the applicability and results of SLN technique in gynaecological malignancies referred to our institution. METHOD: We studied 155 patients with different malignancies (70 vulvar, 50 cervical and 35 endometrial cancers). The day before surgery a lymphoscintigraphy was performed by injecting 111 MBq of (99m)Tc-nanocolloid in several ways depending on the type of cancer studied. Intraoperative detection of the SLN was always performed by using a hand-held gammaprobe and, in 100 cases with the aid of blue dye injection (70 vulvar and 30 in cervical cancer) few minutes before surgical intervention. Pathological study of SLN was performed in all cases. Lymphadenectomy was done in all cervix and endometrial cancer patients and in the first 35 vulvar cancer patients. RESULTS: Pre-surgical lymphoscintigraphy demonstrated one, at least, SLN in 97% of vulvar cancer patients, 92% in the cervical malignancy and 64% in the endometrial cancer patients. During surgery, SLN was harvested in 97%, 90% and 62% of patients, respectively. The pathological study showed metastases in 24.2%, 8.8 and 4.5% of patients with vulvar, cervical and endometrial cancer, respectively. The false negative percentage was 5.5% in vulvar cancer patients, with 2 cases in the endometrial cancer and without any case in the cervical cancer patients. CONCLUSION: Lymphoscintigraphy is a relatively simple and useful technique to identify the SLN in this kind of tumours. However, in endometrial cancer more effort has to be made to reach a suitable result. Sentinel lymph node biopsy seems to be a reliable technique in vulvar and cervical malignancies.

Ganglio centinela en cánceres ginecológicos. Nuestra experiencia / Sentinel node in gynaecological cancers. Our experience

Aunque la identificación del ganglio centinela (GC) presenta en la actualidad una amplia aplicación en el melanoma y el cáncer de mama, no se utiliza rutinariamente en otras neoplasias, como pueden ser las ginecológicas.ObjetivoEvaluar la aplicabilidad y los resultados de la técnica de localización del GC en pacientes con cánceres ginecológicos.MétodoSe estudiaron 155 pacientes con diversas neoplasias ginecológicas (70 vulvares, 50 de cuello uterino y 35 endometriales). Se realizó una linfogammagrafía el día previo a la intervención quirúrgica mediante la inyección de 111 MBq de 99mTc-nanocoloide por diversas vías según el tipo de lesión. La localización intraoperatoria se realizó mediante una sonda detectora y en 100 casos (70 vulvares y 30 de cuello uterino) se administró también un colorante vital pocos minutos antes del inicio de la intervención. Se realizó estudio anatomopatológico del GC. Se practicó linfadenectomía reglada en todas las pacientes con cáncer de cérvix y de endometrio y en las primeras 35 pacientes con cáncer de vulva.ResultadosLa linfogammagrafía prequirúrgica visualizó como mínimo un GC en el 97% de los cánceres de vulva, en el 92% de cérvix y el 64% de tumores de endometrio. Intraoperatoriamente la localización del GC mostró unos porcentajes del 97, del 90 y del 62%, respectivamente. El estudio anatomopatológico demostró metástasis en el 24,2% de las pacientes con lesiones vulvares, el 8,8% en las de cérvix y el 4,5% en las de endometrio. El porcentaje de falsos negativos fue del 5,5% en los cánceres de vulva (1 caso), presentándose 2 casos en el endometrio y ninguno en las pacientes con cáncer de cérvix.ConclusiónLa linfogammagrafía es una técnica útil y sencilla para identificar los GC en este tipo de tumores. La biopsia del GC ofrece resultados fiables en los cánceres de vulva y cuello uterino. Sin embargo, en el cáncer de endometrio nuestros resultados no son óptimos y debe valorarse la adecuación de la técnica(AU)

Although sentinel lymph node (SLN) identification is widespread used in melanoma and breast cancer some concerns exist in other malignancies, such gynaecologic cancers, and this staging method has not been adopted in many centers due to lack or large validation studies.AimTo evaluate the applicability and results of SLN technique in gynaecological malignancies referred to our institution.MethodWe studied 155 patients with different malignancies (70 vulvar, 50 cervical and 35 endometrial cancers). The day before surgery a lymphoscintigraphy was performed by injecting 111MBq of 99mTc-nanocolloid in several ways depending on the type of cancer studied. Intraoperative detection of the SLN was always performed by using a hand-held gammaprobe and, in 100 cases with the aid of blue dye injection (70 vulvar and 30 in cervical cancer) few minutes before surgical intervention. Pathological study of SLN was performed in all cases. Lymphadenectomy was done in all cervix and endometrial cancer patients and in the first 35 vulvar cancer patients.ResultsPre-surgical lymphoscintigraphy demonstrated one, at least, SLN in 97% of vulvar cancer patients, 92% in the cervical malignancy and 64% in the endometrial cancer patiuents. During surgery, SLN was harvested in 97%, 90% and 62% of patients, respectively. The pathological study showed metastases in 24.2%, 8.8 and 4.5% of patients with vulvar, cervical and endometrial cancer, respectively. The false negative percentage was 5.5% in vulvar cancer patients, with 2 cases in the endometrial cancer and without any case in the cervical cancer patients.ConclusionLymphoscintigraphy is a relatively simple and useful technique to identify the SLN in this kind of tumours. However, in endometrial cancer more effort has to be made to reach a suitable result. Sentinel lymphm node biopsy seems to be a reliable technique in vulvar and cervical malignancies(AU)

[In-transit sentinel lymph nodes in malignant melanoma. What is their importance?]. / Ganglios centinela ''en tránsito'' en el melanoma maligno. Cuál es su importancia?

UNLABELLED: The sentinel lymph node (SLN) is the first node in a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. AIM: It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. METHOD. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of 99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. RESULTS: The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell deposits were identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. CONCLUSIONS: Lymphoscintigraphy is mandatory in the location of in-transit SLNs. Moreover, although the incidence of these nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases.

[Potential use of bone marrow scintigraphy in suspected prosthetic hip infection evaluated with 99mTc-HMPAO-leukocytes]. / Valor de la gammagrafía de médula macrofágica en el diagnóstico de infección de prótesis total de cadera estudiada con leucocitos Tc-HMPAO.

AIM: To evaluate the usefulness of (99m)Tc-Sulphur colloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from (99m)Tc-HMPAO-leukocyte scintigraphy alone. MATERIALS AND METHODS: Seventy patients (42 women, 28 men; mean age 68 +/- 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, (99m)Tc-HMPAO-labelled white blood cell scintigraphy and (99m)Tc-Sulphur colloid bone marrow scintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months. RESULTS: Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and 3 polymicrobial agents). ESR and CRP values were higher in patients with infection than in patients without infection (51.8 +/- 29.4 vs. 25.4 +/- 16.4 and 2.8 +/- 2.2 vs. 1.1 +/- 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificity of the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively. CONCLUSION: Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bone scintigraphy did not help to differentiate aseptic loosening from infection in this series.

Ganglios centinela “en tránsito” en el melanoma maligno. ¿Cuál es su importancia? / In-transit sentinel lymph nodes in malignant melanoma. What is their importance?

El ganglio centinela (GC) es el primer ganglio linfático de un determinado lecho ganglionar que recibe directamente drenaje linfático del tumor primario. Sin embargo, en algunos pacientes existen nódulos linfáticos que se sitúan entre el tumor primario y la primera estación ganglionar regional. Se trata de "ganglios en tránsito" y deben ser considerados GC. Objetivo. Fue determinar el porcentaje y la localización de los GC en tránsito obtenidos de una muestra de pacientes con melanoma maligno y valorar la necesidad de resecar este tipo de ganglios. Método. Se incluyeron en el estudio un total de 900 pacientes con melanoma maligno. El día previo a la cirugía se realizó la linfogammagrafía mediante la administración de 4 inyecciones intradérmicas de 74-111 MBq de 99mTc-Nanocoloide alrededor de la lesión primaria o en la zona de la biopsia escisional. Resultados. Las imágenes revelaron la presencia de GC en tránsito en 80 pacientes (8,9 %). Durante el acto quirúrgico se consiguieron extirpar los GC en tránsito en 77 de los 80 pacientes (96,2 %). En el análisis histológico se hallaron metástasis en 15 pacientes (19,5 %) y, de éstos, 4 no presentaron afectación tumoral del lecho linfático regional. Conclusiones. La linfogammagrafía es imprescindible en la localización de los GC en tránsito. Asimismo, aunque el porcentaje de GC en tránsito en pacientes afectos de melanoma maligno es relativamente bajo, la afectación tumoral de los mismos alcanza un porcentaje significativo. Por ello, creemos que la resección de los GC en tránsito es necesaria en todos los casos

The sentinel lymph node (SLN) is the first nodein a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. Aim. It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. Method. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. Results. The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell depositswere identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. Conclusions. Lymphoscintigraphy is mandatory in the locationof in-transit SLNs. Moreover, although the incidence ofthese nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases (AU)

Valor de la gammagrafía de médula macrofágica en el diagnóstico de infección de prótesis total de cadera estudiada con leucocitos 99mTc-HMPAO / Potential use of bone marrow scintigraphy in suspected prosthetic hip infection evaluated with 99mTc-HMPAO-leukocytes

Objetivo. Analizar la utilidad de la gammagrafía de médula macrofágica en el diagnóstico diferencial de infección de prótesis total de cadera dolorosa valorada con gammagrafía con leucocitos marcados. Material y métodos. Se han estudiado prospectivamente 70 pacientes (42 mujeres, 28 hombres) con una edad de 68 ± 13 años con prótesis total de cadera y dolor local. Se determinó la velocidad de sedimentación globular (VSG) y proteína C reactiva (PCR) y se realizó gammagrafía ósea con leucocitos marcados con 99mTc-HMPAO y de médula macrofágica con 99mTc-sulfuro coloidal a todos los pacientes. El diagnóstico definitivo se realizó mediante estudio microbiológico o seguimiento clínico mínimo de 12 meses. Resultados. Se diagnosticó infección en 12 de los 70 casos (3 estafilococo coagulasa negativo, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 Enterococcus y 3 polimicrobianas). La VSG y la PCR en el grupo de pacientes con infección resultó significativamente mayor que en el grupo de no infectados (51,8 ± 29,4 frente a 25,4 ± 16,4 y 2,8 ± 2,2 frente a 1,1 ± 1,3 respectivamente; p < 0,05). La gammagrafía ósea no mostró un patrón de captación que permitiese diferenciar entre infección y aflojamiento aséptico. La fase vascular de la gammagrafía ósea fue positiva en 3 de 12 pacientes infectados. La gammagrafía con leucocitos marcados aislada mostró una sensibilidad y especificidad de 83 y 57 %, respectivamente. La gammagrafía de médula macrofágica incrementó estos resultados a cifras de 92 y 98 %, respectivamente. Conclusiones. La práctica adicional de una gammagrafía de médula macrofágica mejora significativamente los resultados de la gammagrafía con leucocitos marcados en el diagnóstico de infección de prótesis total de cadera. La gammagrafía ósea no permite diferenciar entre aflojamiento aséptico e infección protésica en esta serie de pacientes

Aim. To evaluate the usefulness of 99mTc-Sulphurcolloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from 99mTc-HMPAO-leukocyte scintigraphy alone. Materials and methods. Seventy patients (42 women, 28 men; mean age 68 ± 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, 99mTc-HMPAO-labelled white blood cell scintigraphy and 99mTc-Sulphur colloid bone marrowscintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months. Results. Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and3 polymicrobial agents). ESR and CRP values were higherin patients with infection than in patients without infection (51.8 ± 29.4 vs. 25.4 ± 16.4 and 2.8 ± 2.2 vs. 1.1 ± 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificityof the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively. Conclusion. Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bonescintigraphy did not help to differentiate aseptic loosening from infection in this series

Localising imaging in secondary hyperparathyroidism.

Preoperative imaging has proved its use successful in the localization of solitary parathyroid adenomas in patients with suspected primary hyperparathyroidism. However, due to multiglandular disease at presentation patients with renal hyperparathyroidism need to be analyzed separately, making the usefulness of imaging techniques controversial. Recently, improved methods of functional imaging like parathyroid scan with 99mTc-sestamibi or positron emission tomography, especially when combined with computed tomography, can provide additional quantitative and qualitative information that has yet to be assessed. Nuclear medicine procedures could prove useful not only in preoperative diagnosis, but also in the selection of medical or surgical therapeutic alternatives in secondary hyperparathyroidism patients. There is evidence that 99mTc-sestamibi uptake in parathyroid hyperplasia or adenoma is related to biochemical markers of parathyroid function. We are only beginning to identify the factors involved in radiotracer uptake by parathyroid cells and how it can be modulated to obtain more accurate results. This review analyzes the current use of non-invasive imaging modalities in patients with secondary hyperparathyroidism, taking into account the latest trends in the field combining anatomic and functional modalities and the relevant factors linked to radiotracer uptake in abnormal hyperfunctioning parathyroid glands.

[Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience]. / Localización del ganglio centinela en el carcinoma escamoso de pene. Experiencia inicial.

OBJECTIVE: To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. MATERIAL AND METHODS: Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. RESULTS: In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. CONCLUSIONS: Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.

Localización del ganglio centinela en el carcinoma escamoso de pene. Experiencia inicial / Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience

Objetivo. Valorar la validez de la técnica de biopsia radioguiada del ganglio centinela (GC) en el carcinoma escamoso de pene. Material y métodos. Se han estudiado un total de 15 pacientes con carcinoma escamoso de pene. Los 5 primeros pacientes constituyeron un grupo de validación de la técnica al cual se le realizó linfadenectomía inguinal reglada, tras los procedimientos descritos a continuación. Los 10 pacientes restantes constituyeron el grupo de aplicación de la técnica. El día previo a la cirugía se realizó linfogammagrafía a todos los pacientes, y durante el acto quirúrgico se procedió a la biopsia radioguiada de los GC. En 10 de los pacientes se realizó inyección de azul de metileno antes de la intervención. Se ha realizado un seguimiento de los pacientes durante una media de 32 meses. Resultados. En el grupo de validación la linfogammagrafía mostró drenaje inguinal en 5/5 pacientes. Fueron detectadas metástasis unilaterales en 3 de ellos. No mostró infiltración tumoral ninguno de los ganglios linfáticos extirpados en la linfadenectomía. En el grupo de aplicación, la linfogammagrafía mostró drenaje inguinal en 9/10 pacientes. Se extirparon un total de 19 GC, sin detectarse infiltración tumoral en ninguno de ellos. En el seguimiento no se ha detectado progresión de la enfermedad en ningún paciente. Conclusiones. La localización del GC mediante biopsia radioguiada del mismo permite evitar linfadenectomías innecesarias en pacientes con carcinoma escamoso de pene y riesgo intermedio o alto de presentar afectación ganglionar. La técnica ofrece una elevada fiabilidad y valor predictivo negativo en el carcinoma escamoso de pene

Objective. To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. Material and methods. Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. Results. In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. Conclusions. Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma

Localización radioguiada de lesiones ocultas en cáncer de mama con gammacámara portátil. Experiencia inicial / No disponible

Objetivo: La localización radioguiada de lesiones ocultas(ROLL) de mama se ha realizado tradicionalmente mediante lautilización de sondas detectoras. No obstante, uno de los inconvenientesde esta técnica es que el radiotrazador inyectadopuede esparcirse por la glándula mamaria dificultando la resecciónde la lesión. La utilización de un dispositivo que permiteobtener una imagen en tiempo real podría ayudar a confirmarla correcta resección de la lesión.Pacientes y método: Estudio prospectivo de 70 pacientesdiagnosticadas de cáncer de mama con lesiones no palpables.Se realizó una linfogammagrafía el día previo a la intervenciónquirúrgica después de la administración de un nanocoloidemarcado con 99mTc. Durante la cirugía se utilizó una sondadetectora para guiar al cirujano (53 pacientes) y una gammacámaraportátil para valorar los márgenes de la lesión y el lechoquirúrgico. En un subgrupo de pacientes (17) se utilizóúnicamente la gammacámara para lograr estos objetivos.Resultados: En la fase 1 (42 pacientes) se visualizó con lagammacámara una lesión centrada en 23/42 pacientes, nocentrada en 15/42 y en contacto con el margen en 4 casos.El estudio patológico determinó márgenes libres en 15/23 casoscon lesión centrada (65%), márgenes afectos en 10/19casos con lesión no centrada. La congruencia global fue del60%. En la segunda fase (28 pacientes) la congruencia globalfue del 68%.Conclusión: La utilización de gammacámaras portátiles enquirófano se encuentra en su fase de desarrollo y mejoría técnicasiendo posible su aplicación clínica con resultados similaresa los obtenidos con las sondas detectoras(AU)

Objective: Radioguided occult localization lesion (ROLL) inbreast cancer has been classically performed by using handheldgamma probes. However, one of the important drawbacksof such a technique is the radiotracer spillage within themammary gland that difficult the precise lesion resection. Theuse of a device that can obtain a real-time image could help toconfirm if the lesion is correctly removed and to assess the surgicalbed remaining tissue.Patients and method: Prospective study including 70 patientswith non-palpable breast cancer lesions. A lymphoscintigraphywas performed, the day before surgery, after injectionof nanocolloid labelled with 99mTc. A hand-held gamma probewas used to guide the surgeon during surgical procedure(53 patients) and, afterwards a portable gammacamera wasused to assess the surgical lesion margins. This device was solelyused in a subgroup of 17 patients to reach all targets.Results: In the first group (42 patients), a centered lesion insurgical specimen was observed by means of the portablegammacamera (23/42 patients), no centered in 15/42 and inclose contact with a margin in the remaining 4 patients. Pathologicalstudy demonstrated free margins in 15 out of 23 caseswith centered lesion (65%), involved margins en 10/19patients with non-centered lesions. Overall congruence reached60%. In the second group (28 patients), overall congruencearose to 68%.Conclusion: The intraoperative use of portable gammacamerasis in its early phase, but the clinical application of thesedevices with similar results of those achieved with the classicalhand-held gamma probes is possible(AU)