Utilidad de la tomografía por emisión de positrones en el diagnóstico del nódulo pulmonar solitario con alta probabilidad de malignidad / Utility of the positron emission tomography in the diagnosis of solitary pulmonary nodule with high likelihood of malignancy

Introducción y objetivo. El diagnóstico del nódulo pulmonar solitario (NPS) sigue siendo un reto para los clínicos. El objetivo de este trabajo fue analizar, de forma retrospectiva, la rentabilidad de la tomografía por emisión de positrones (PET) en el estudio del NPS. Pacientes y métodos. Se evaluaron pacientes diagnosticados de NPS entre los años 2000 y 2006 en nuestro hospital y estudiados mediante PET, en los que se dispusiera de biopsia y/o seguimiento radiológico. Resultados. Un total de 31 pacientes, 23 hombres y 8 mujeres, cumplieron los criterios de inclusión. En 20 de ellos, el NPS fue diagnosticado como maligno. El valor estándar de captación (SUV) con el cual el área bajo la curva operadorreceptor (COR) fue máxima, fue de 1.75. Los valores de sensibilidad (SE), especificidad (SP), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) fueron: a) usando el valor de SUV > 2,5 como punto de corte: SE 65%, SP 90,9, VPP 92,9, VPN 58,8; b) usando el valor de SUV > 1,75: SE 90%, SP 72,7%, VPP 58,7%, VPN 80%; c) considerando criterios subjetivos (captación sospechosa vs. no sospechosa): SE 60%, SP 100%, VPP 100%, VPN 57,9%. Conclusiones. La PET, en pacientes con una probabilidad pretest alta de cáncer, puede no ser capaz de determinar definitivamente si es necesario efectuar una prueba invasora en el diagnóstico del NPS. Además existe una probabilidad nada desdeñable de falsos positivos y negativos (AU)

Introduction and objective. The diagnosis of solitary pulmonary nodule (SPN) remains a challenge for clinicians. The aim of this study was to examine, in retrospect, the accuracy of positron emission tomography (PET) in the study of the SPN. Patients and Methods. We evaluated patients diagnosed with SPN between 2000 and 2006 in our hospital and studied using PET, which had biopsy and/or radiological monitoring. Results. A total of 31 patients, 23 males and 8 females, met the inclusion criteria. In 20 of them, the SPN was diagnosed as malignant. The standard uptake value (SUV) with which the area under the receiver operator curve (ROC) is maximum was 1.75. Sensitivity values (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were: a) using the value of SUV> 2.5 as a cutoff point: SE 65%, SP 90.9, PPV 92.9, VPN 58.8 b) using the value of SUV> 1.75: SE 90%, SP 72.7%, PPV 58.7%, NPV 80% c) considering subjective criteria (suspicious up-take vs nonsuspicious): SE 60%, SP 100%, PPV 100%, PNV 57.9%. Conclusion. PET, if done in patients with a high pretest probability of cancer, may not be able to determine definitively whether it is necessary or not to perform a invasive test in the diagnosis of NPS. Furthermore, there is a negligible probability of false positives and negatives (AU)

Tumoral angiogenesis and breast cancer.

Breast cancer (BC) is the most common neoplasm in women in Western countries. Tumoral angiogenesis (TA) is essential for the growth and spread of BC cells. There are at least 6 different angiogenic growth factors associated with TA in BC. The major mediator of TA is vascular endothelial growth factor (VEGF), a homodimeric heparin-binding glycoprotein. VEGF signals through VEGF receptor-2 (VEGFR-2), the major VEGF signalling receptor that mediates sprouting angiogenesis. Recently, different antiangiogenic agents have shown efficacy in the treatment of advanced BC. Bevacizumab, a humanised monoclonal antibody against VEGF, in combination with taxanes improves progression-free survival and overall response rate in first-line therapy. Other new antiangiogenic agents, called multi-kinase inhibitors (sunitinib and pazopanib), are under investigation. Finally, a schedule of treatment called metronomic chemotherapy, with antiangiogenic activity, has also demonstrated efficacy in the treatment of advanced BC.

Tumoral angiogenesis and breast cancer

Breast cancer (BC) is the most common neoplasm in women in Western countries. Tumoral angiogenesis (TA) is essential for the growth and spread of BC cells. There are at least 6 different angiogenic growth factors associated with TA in BC. The major mediator of TA is vascular endothelial growth factor (VEGF), a homodimeric heparin-binding glycoprotein. VEGF signals through VEGF receptor-2 (VEGFR-2), the major VEGF signalling receptor that mediates sprouting angiogenesis. Recently, different antiangiogenic agents have shown efficacy in the treatment of advanced BC. Bevacizumab, a humanised monoclonal antibody against VEGF, in combination with taxanes improves progression-free survival and overall response rate in first-line therapy. Other new antiangiogenic agents, called multi-kinase inhibitors (sunitinib and pazopanib), are under investigation. Finally, a schedule of treatment called metronomic chemotherapy, with antiangiogenic activity, has also demonstrated efficacy in the treatment of advanced BC (AU)

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