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1.
Eur J Breast Health ; 20(2): 94-101, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38571688

RESUMO

Objective: High rates of negative sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) breast cancer (BC) after neoadjuvant chemotherapy (NAC) have been described. These results are associated with triple-negative (TNBC) and human epidermal growth factor receptor 2 (HER2+) subtypes achieving pathologic complete response (pCR). This study evaluates predictive variables and survival in order to assess the possible omission of SLNB after NAC. Materials and Methods: Prospective study of women with cN0 BC treated with NAC and subsequent surgery, between April 2010 and May 2021. SLNB technique included, performing axillary lymphadenectomy in the absence of detection or SLNB-positivity. Multivariable logistic regression was used for analysis of NAC-response and SLNB-results in molecular subtypes: HR-/HER2+, TNBC, HR+/HER2- and HR+/HER2+. Kaplan-Meyer and log-rank were used for survival analysis. Results: A total of 179 patients (50.5±10.1 years) were included. Of these, 39.7% achieved pCR (ypT0/Tis). HR-negative subtypes had higher pCR rates (HR-/HER2+: 59.4%; TNBC: 53.4%), with no cases of SLNB-positive. With residual disease, HR-/HER2+ and TNBC showed low rates of SLNB-positivity (6.7% and 10.3%) versus HR+ (HR+/HER2+: 20%; HR+/HER2-: 44%; p<0.001). Multivariable analysis identified independent predictors of SLNB-negativity (p<0.0001) to be: HR- [odds ratio (OR)=0.15; 95% confidence interval (CI): 0.06-0.37; p = 0.0001], HER2+ (OR=0.34; 95% CI: 0.14-0.81; p = 0.015) and high-grade Nottingham (OR=0.42; 95% CI: 0.18-0.99; p = 0.048). Disease-free survival showed worse outcomes with SLNB-positivity (p<0.0001), HR+/HER2- (p = 0.0277), larger tumor size (p = 0.002) and residual disease after NAC (p<0.0001). Conclusion: Patient selection based on NAC response, molecular subtype, and survival outcomes is a priority for establishing individualized therapeutic strategies after NAC. Molecular subtypes with higher pCR rates and lower rates of SLNB-positivity could benefit from non-invasive strategies that include omission of SLNB.

2.
Clin Nucl Med ; 49(2): e65-e67, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38048549

RESUMO

ABSTRACT: [ 99m Tc]Tc-DPD (3,3-diphosphono-1,2-propanodicarboxylic acid) scintigraphy is an essential tool for diagnosing transthyretin amyloid cardiac amyloidosis. An 86-year-old woman suffering from heart failure with preserved ejection fraction underwent [ 99m Tc]Tc-DPD scintigraphy and a SPECT/CT for suspected transthyretin amyloid cardiac amyloidosis. The scan showed intracardiac and liver uptake. As the patient had taken intravenous iron on the morning of the scan, we decided to repeat the scan, but this time, it showed no uptake in the heart or the liver. Accordingly, we concluded the first result was a false positive due to drug interaction.


Assuntos
Amiloidose , Cardiomiopatias , Feminino , Humanos , Idoso de 80 Anos ou mais , Pré-Albumina , Compostos de Organotecnécio , Amiloidose/diagnóstico por imagem , Coração , Cintilografia , Amiloide , Cardiomiopatias/diagnóstico por imagem
3.
Rev Esp Enferm Dig ; 115(8): 452-453, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35791794

RESUMO

A 22-year-old woman with a history of surgically treated pelvic teratoma and solid liver lesion in the extension study. Radiological follow-up was decided. This liver lesion experienced a progressive increase in size, reaching 6 cm. Contrast-enhanced liver MRI was performed, revealing a heterogeneous mass in the right hepatic lobe with non-hepatocyte-like behaviour. With this information, the following entities were ruled out: haemangioma, adenoma, hepatocarcinoma and focal nodular hyperplasia. Given that it could be a teratoma metastasis, a tumour of any other origin or a non-tumoral lesion with no hepatocyte component, it was decided to perform a 2-[18F]FDG PET/CT scan. It showed the liver mass with notable glycolytic hypermetabolism, suggestive of malignancy. In a multidisciplinary committee, it was decided to perform a laparoscopic right hepatectomy. Pathological examination revealed a benign hepatocytic lesion compatible with a steatotic adenoma.


Assuntos
Adenoma de Células Hepáticas , Adenoma , Carcinoma Hepatocelular , Fígado Gorduroso , Neoplasias Hepáticas , Feminino , Humanos , Adulto Jovem , Adenoma/patologia , Adenoma de Células Hepáticas/complicações , Adenoma de Células Hepáticas/diagnóstico por imagem , Adenoma de Células Hepáticas/cirurgia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Diagnóstico Diferencial , Fígado Gorduroso/patologia , Fígado/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
13.
Med. clín (Ed. impr.) ; 137(10): 440-443, oct. 2011.
Artigo em Espanhol | IBECS | ID: ibc-91915

RESUMO

Fundamento y objetivo: Evaluar el estado funcional de la vía nigro-estriada utilizando N-ω-fluoropropil-2ß-carbometoxi-3ß-(4-Iodofenil) nortropano (FP-CIT-I-123) en pacientes con diagnóstico clínico de atrofia multisistémica (AMS) subtipo C. Pacientes y método: Se incluyen 10 pacientes con diagnóstico clínico de AMS-C y se comparan con 10 diagnosticados de temblor esencial (controles) y otros 10 con enfermedad de Parkinson (EP). Los estudios son valorados mediante el índice estriado/occipital (E/O), calculando la validez diagnóstica del procedimiento mediante curvas ROC. Resultados: El valor medio (DE) del índice E/O fue de 1,48 (0,23), 1,59 (0,17) y 1,22 (0,16), correspondientes, respectivamente, a AMS-C, controles (p=0,25) y EP (p=0,00). Curva ROC: Az: 0,650; sensibilidad: 0,50; especificidad: 0,80. La correlación del estudio con FP-CIT y la clínica predominante mostró 4 pacientes con clínica parkinsoniana y estudio patológico, 4 sin clínica parkinsoniana y estudio normal, uno con clínica parkinsoniana y estudio normal, y uno sin clínica parkinsoniana y estudio patológico. Conclusiones: El estudio con FP-CIT no permite descartar totalmente la existencia de una AMS-C. Desde el punto de vista funcional, no siempre parece existir congruencia entre el estado de la vía nigro-estriada y la existencia de parkinsonismo (AU)


Background and objective: To assess the functional state of nigro-striatal pathway using FP-CIT-I-123 in patients with clinical diagnosis of Multiple System Atrophy (MSA) subtype C. Patients and methods: We included 10 patients with a clinical diagnosis of MSA-C and compared them with 10 patients diagnosed with essential tremor (controls) and 10 with Parkinson Disease (PD). The studies are evaluated by the striatum/occipital index (S/O). We calculated the diagnostic validity of the procedure by ROC curve analysis. Results: The average value of the S/O index showed a mean of 1.48 (0.23), 1.59 (0.17) and 1.22 (0.16) respectively for MSA-C, control group (p=0.25) and PD (p=0.00). ROC curve analysis: Az: 0.650; sensitivity: 0.50; specificity: 0.80. The comparison between the results of FP-CIT and clinical manifestations showed: 4 patients with parkinsonism (PK) and pathological study; 4 without PK and normal study; 1 with PK and normal study and 1 without PK and pathological study. Conclusions: FP-CIT study does not exclude completely the existence of an MSA-C. From a functional point of view, there does not always seem to be a consistency between the state of the nigro-striatal pathway and the existence of parkinsonism (AU)


Assuntos
Humanos , Atrofias Olivopontocerebelares/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Proteínas da Membrana Plasmática de Transporte de Dopamina/análise , Corpo Estriado/fisiopatologia
14.
Med Clin (Barc) ; 137(10): 440-3, 2011 Oct 15.
Artigo em Espanhol | MEDLINE | ID: mdl-21396668

RESUMO

BACKGROUND AND OBJECTIVE: To assess the functional state of nigro-striatal pathway using FP-CIT-I-123 in patients with clinical diagnosis of Multiple System Atrophy (MSA) subtype C. PATIENTS AND METHODS: We included 10 patients with a clinical diagnosis of MSA-C and compared them with 10 patients diagnosed with essential tremor (controls) and 10 with Parkinson Disease (PD). The studies are evaluated by the striatum/occipital index (S/O). We calculated the diagnostic validity of the procedure by ROC curve analysis. RESULTS: The average value of the S/O index showed a mean of 1.48 (0.23), 1.59 (0.17) and 1.22 (0.16) respectively for MSA-C, control group (p=0.25) and PD (p=0.00). ROC curve analysis: Az: 0.650; sensitivity: 0.50; specificity: 0.80. The comparison between the results of FP-CIT and clinical manifestations showed: 4 patients with parkinsonism (PK) and pathological study; 4 without PK and normal study; 1 with PK and normal study and 1 without PK and pathological study. CONCLUSIONS: FP-CIT study does not exclude completely the existence of an MSA-C. From a functional point of view, there does not always seem to be a consistency between the state of the nigro-striatal pathway and the existence of parkinsonism.


Assuntos
Radioisótopos de Carbono , Corpo Estriado/diagnóstico por imagem , Proteínas da Membrana Plasmática de Transporte de Dopamina/análise , Radioisótopos de Flúor , Radioisótopos do Iodo , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Idoso , Idoso de 80 Anos ou mais , Radioisótopos de Carbono/farmacocinética , Cerebelo/fisiopatologia , Corpo Estriado/química , Tremor Essencial/diagnóstico por imagem , Feminino , Radioisótopos de Flúor/farmacocinética , Humanos , Radioisótopos do Iodo/farmacocinética , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/classificação , Atrofia de Múltiplos Sistemas/complicações , Atrofia de Múltiplos Sistemas/metabolismo , Proteínas do Tecido Nervoso/análise , Doença de Parkinson/diagnóstico por imagem , Transtornos Parkinsonianos/etiologia , Curva ROC , Compostos Radiofarmacêuticos/farmacocinética , Tropanos/farmacocinética
15.
Eur J Nucl Med Mol Imaging ; 37(3): 556-64, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19862520

RESUMO

PURPOSE: To determine clinical predictors and accuracy of (123)I-FP-CIT SPECT imaging in the differentiation of drug-induced parkinsonism (DIP) and Parkinson's disease (PD). METHODS: Several clinical features and (123)I-FP-CIT SPECT images in 32 patients with DIP, 25 patients with PD unmasked by antidopaminergic drugs (PDu) and 22 patients with PD without a previous history of antidopaminergic treatment (PDc) were retrospectively evaluated. RESULTS: DIP and PD shared all clinical features except symmetry of parkinsonian signs which was more frequently observed in patients with DIP (46.9%) than in patients with PDu (16.0%, p<0.05) or PDc (4.5%, p<0.01). Qualitatively (123)I-FP-CIT SPECT images were normal in 29 patients with DIP (90.6%) and abnormal in all patients with PD, and this imaging technique showed high levels of accuracy. CONCLUSION: DIP and PD are difficult to differentiate based on clinical signs. The precision of clinical diagnosis could be reliably enhanced by (123)I-FP-CIT SPECT imaging.


Assuntos
Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/etiologia , Transtornos Parkinsonianos/induzido quimicamente , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Idoso , Estudos de Coortes , Diagnóstico Diferencial , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/metabolismo , Transtornos Parkinsonianos/diagnóstico , Transtornos Parkinsonianos/metabolismo , Estudos Retrospectivos , Sensibilidade e Especificidade , Tropanos/metabolismo
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