Failure of scintigraphy lymphatic mapping in endometrial cancer. Causes and solutions.

AIM: To evaluate the effect of technical problems and patient characteristics on sentinel lymph node (SLN) scintigraphic detection and mapping success in early stages of endometrial cancer (EC). METHODS: Patients with clinical early stage EC (IA-IB) underwent SLN mapping using technetium-99m-nanocolloid, between September 2011 and February 2020 were included. There were excluded cases with technical problems, 92 patients were included for the analysis of the diagnostic performance and the relation of mapping failure (pelvic unilateral or not detected SLN) with patient (age, body mass index, previous pelvic disease or surgery) and disease characteristics (histology, grade, myometrial invasion, lymphovascular space infiltration, tumor size, and lymphatic infiltration risk). RESULTS: The overall detection rate was 79%. Lymph node metastases were diagnosed in 7 patients. Age (P = .01), depth of myometrial invasion ≥50% (P = .04) and high risk of lymphatic infiltration (P = .02) were positively associated with mapping failure. In multivariate analysis, age was significantly associated with mapping failure [odds ratio = 1.63, 95%CI: 1.06-2.50; P = .027]. CONCLUSIONS: Age, depth of myometrial invasion and high risk of lymphatic infiltration were the factors associated with higher mapping failure. An individualized injection technique, optimizing the methodology, could minimize the detection failures.

La sinoviortesis radioisotópica en el control de la sinovitis refractaria en Castilla La-Mancha. Una experiencia de 10 años / Radioisotope synoviorthesis in the control of refractory synovitis in Castilla-La Mancha. A 10-year experience

Nuestro hospital es el hospital de referencia en medicina nuclear para la realización de la sinoviortesis radioisotópica para toda Castilla La-Mancha. OBJETIVO: Describir la experiencia en la realización de la sinoviortesis radioisotópica en las artritis refractarias a otros tratamientos en nuestro hospital. METODOLOGÍA: Estudio observacional, descriptivo y transversal protocolizado a través de la revisión de la base de datos de las sinoviortesis radioisotópicas realizadas entre 2007 y 2017. Se recopilaron datos clínicos previos (edad, sexo, proceso patológico, tratamientos previos, infiltración previa y articulación afectada) y evolutivos a los 6 meses tras administrar el isótopo. Se creó una base de datos Excel para un análisis de frecuencias con SPSS 21. RESULTADOS: Se realizaron 30 radiosinoviortesis, siendo las enfermedades más frecuentes, por este orden: sinovitis villonodular pigmentada (40%), artritis reumatoide (23,3%), espondiloartritis (13,3%), osteoartritis (10%) y artritis inespecíficas (6,7%), seguido de lupus eritematoso sistémico y gota. Tras 6 meses un 56,7% de los pacientes mejoraron frente a un 36,7% que seguían igual. Así mismo, ninguno de ellos presentó complicaciones relacionadas con el procedimiento. A un 6,6% de los pacientes se les perdió el seguimiento. DISCUSIÓN Y CONCLUSIONES: En los pacientes con episodios de artritis de repetición con derrame articular asociado en una o 2 articulaciones, refractarias a tratamientos sistémicos, a las infiltraciones locales con corticoides y en aquellos pacientes en los que otros tratamientos puedan estar contraindicados, debemos considerar la posibilidad de realizar una radiosinoviortesis isotópica, pues es una técnica sencilla, segura y con una tasa de éxito superior al 50%

Our hospital is the nuclear medicine referral hospital for radioisotopic synoviorthesis for all of Castilla-La Mancha. OBJECTIVE: To describe the experience in the performance of radioisotopic synoviorthesis for arthritis refractory to other treatments in our hospital. METHODOLOGY: Observational, descriptive and cross-sectional study protocolised through the review of the database of radioisotopic synoviorthesis performed between 2007 and 2017. Previous clinical data were collected (age, sex, pathology, previous treatments, previous infiltration and affected joint), and progress at 6 months after administering the isotope. An Excel database was created for a frequency analysis with SPSS 21. RESULTS: 30 radiosynovitis interventions were performed. The most frequent pathologies in this order were: pigmented villonodular synovitis (40%), rheumatoid arthritis (23.3%), spondyloarthritis (13.3%), osteoarthritis (10%) and nonspecific arthritis (6.7%), followed by systemic lupus erythematosus and gout. After 6 months, 56.7% of the patients improved compared to 36.7% who remained the same. Likewise, none of them presented complications related to the procedure. Six point six percent of the patients were lost to follow-up. DISCUSSION AND CONCLUSIONS: In patients with episodes of recurrent arthritis with associated joint effusion in one or two joints, refractory to systemic treatments, to local infiltrations with corticosteroids and for patients for whom other treatments may be contraindicated, we must consider the possibility of performing an isotope radiosinoviortesis, as it is a simple, safe technique with a success rate of more than 50%