RESUMO
BACKGROUND: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. AIM: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. MATERIAL AND METHODS: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. RESULTS: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. CONCLUSIONS: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Biópsia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgiaRESUMO
Background: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. Aim: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. Material and Methods: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. Results: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. Conclusions: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Biópsia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Cintilografia , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Cuidados Intraoperatórios , Excisão de Linfonodo , Metástase LinfáticaRESUMO
El PET-FDG es una técnica que evalúa el metabolismo glucídico celular. Su mayor utilidad es en oncología, ya que permite distinguir tumores malignos de benignos, seleccionar los sitios de biopsia, etapificar las neoplasias, determinar la respuesta a tratamiento y distinguir entre cicatriz y enfermedad residual post tratamiento. En niños, las principales indicaciones son linfomas, tumores del sistema nervioso central, sarcomas de tejidos blandos, osteosarcoma y sarcoma de Ewing, neuroblastoma y nefroblastoma. Existen otros tumores menos comunes que también pueden ser evaluados eficazmente con FDG tales como: tumores de la vaina de nervios periféricos, hepatoblastomas, tumor de Wilms y cáncer de tiroides. Hay pocas publicaciones en esta población debido al pequeño número de pacientes estudiados y la baja incidencia de cáncer. Es importante considerar las variaciones en la distribución normal del trazador respecto al adulto para optimizar la interpretación de las imágenes. El objetivo de este artículo es efectuar una revisión de las indicaciones del PETFDG y presentar nuestra casuística inicial en población pediátrica.
Assuntos
Criança , Humanos , Neoplasias , Tomografia Computadorizada de Emissão , Compostos Radiofarmacêuticos/uso terapêuticoRESUMO
Positron emission tomography (PET) with fluorine-18 labeled deoxyglucose (FDG) is useful in the management of lymphomas. In this review, some general concepts of this metabolic test are defined. It has an excellent diagnostic yield in Hodgkin disease as well as in most non Hodgkin lymphomas. Staging, restaging residual mass evaluation and the control of therapy are the main indications for FDG-PET. Images with FDG have a high diagnostic and prognostic value, that is superior to anatomical images and conventional staging techniques. They are also helpful for the assessment of tumor activity in abnormal lymph nodes or large masses that have been treated and reduce their size slowly or show an incomplete resolution. Currently, the resolution of dedicated PET equipments is 6 mm and bigger lesions can easily be detected. The main differences and advantages of FDG versus gallium-67 in lymphoma are also discussed, as well as the initial local experience with the technique in lymphoma patients.
Assuntos
Fluordesoxiglucose F18 , Doença de Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Radioisótopos de Gálio , Doença de Hodgkin/patologia , Doença de Hodgkin/radioterapia , Humanos , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/radioterapia , Masculino , Estadiamento de Neoplasias , Prognóstico , Sensibilidade e EspecificidadeRESUMO
Positron emission tomography (PET) with fluorine-18 labeled deoxyglucose (FDG) is useful in the management of lymphomas. In this review, some general concepts of this metabolic test are defined. It has an excellent diagnostic yield in Hodgkin disease as well as in most non Hodgkin lymphomas. Staging, restaging residual mass evaluation and the control of therapy are the main indications for FDG-PET. Images with FDG have a high diagnostic and prognostic value, that is superior to anatomical images and conventional staging techniques. They are also helpful for the assessment of tumor activity in abnormal lymph nodes or large masses that have been treated and reduce their size slowly or show an incomplete resolution. Currently, the resolution of dedicated PET equipments is 6 mm and bigger lesions can easily be detected. The main differences and advantages of FDG versus gallium-67 in lymphoma are also discussed, as well as the initial local experience with the technique in lymphoma patients.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Doença de Hodgkin , Linfoma não Hodgkin , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Intervalo Livre de Doença , Radioisótopos de Gálio , Doença de Hodgkin/patologia , Doença de Hodgkin/radioterapia , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/radioterapia , Estadiamento de Neoplasias , Prognóstico , Sensibilidade e EspecificidadeRESUMO
El PET es un técnica de imágenes que permite evaluar el hipermetabolismo glucídico tumoral con Flúor-18deoxiglucosa (FDG). Su utilidad en cáncer de mama ha sido ampliamente estudiada. El objetivo fue evaluar los resultados del PET-FDG en nuestro medio en pacientes con cáncer de mama. Método: SE analizaron 52 estudios en 44 pacientes con cáncer de mama (100 por ciento mujeres, edad: 52 ± 12 años). Se utilizó equipo PET dedicado y se realizaron imágenes de cuerpo entero. Se efectuó seguimiento clínico e histológico cuando estaba disponible. Resultados: A. Diagnóstico inicial y etapificación: En 2 pacientes, se encontraron focos hipermetabólicos en mamas, sin compromiso a distancia y fueron sometidas a cirugía con confirmación histológica. Tres pacientes fueron evaluadas sólo para etapificación. B. Reetapificación: De 23 pacientes, en 11 se demostró diseminación secundaria, por lo que fueron tratadas con quimioterapia u hormonoterapia, sin confirmación histológica de las lesiones. En 12 pacientes, el PET fue negativo y el seguimiento clínico no ha demostrado alteraciones hasta la fecha. C. Sospecha de recidiva: En 15 pacientes se realizó el PET por alteraciones en la mamografía, elevación de marcadores tumorales o alteraciones sospechosas en otros estudios. Se encontró recidiva local en 2 pacientes, metástasis en 6 y PET normal en 7. D. Evaluación de terapia: En 9 pacientes, se controló la respuesta a tratamiento, encontrando regresión parcial, progresión o respuesta mixta en 8 de ellas y un estudio negativo (respuesta completa). Conclusión: En esta serie inicial, se confirma que el PET FDG es una herramienta útil en el control del cáncer de mama, tanto en diagnóstico, etapificación, reetapificación, evaluación de recurrencia y control de terapia.
Assuntos
Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama , Estadiamento de Neoplasias , Chile , Reações Falso-Negativas , Seguimentos , Metástase Neoplásica , Quimioterapia Adjuvante/efeitos adversos , Recidiva , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
Positron-emission tomography (PET) with F18-fluorodeoxyglucose (FDG) is very helpful in the evaluation and management of lung lesions. It is specially useful for the characterization of solitary nodules, for the staging, evaluation of recurrence and therapeutic response in non-small cell lung cancer, for the evaluation of small cell lung cancer and for the assessment of pulmonary metastases. This article is a literature review on PET with FDG in lung cancer. A preliminary analysis of PET results at the Military Hospital in Santiago, Chile, is also presented.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pulmonares , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Carcinoma Pulmonar de Células não Pequenas , Carcinoma de Células Pequenas , Nódulo Pulmonar SolitárioRESUMO
We report a 38 years old female patient with a pancreatic mucinous cystadenocarcinoma. She presented at the onset with a peritoneal rupture that required emergency surgery. Five months later, the patient was subjected to a segmental pancreatectomy and splenectomy. One year later, the patient had a serious gastric bleeding secondary to a gastric ulcer. Due to a persistent increase in her CA 19-9 levels, a Positron Emission Tomography (PET) functional imaging with fluorine 18-deoxyglucose (F18FDG) was done. It showed an intense focal hypermetabolism in the gastric wall reported as a secondary tumour location. The patient was subjected to a total gastrectomy and Roux en Y anastomosis, with a good outcome. The pathological study confirmed the presence of a metastasis of an adenocarcinoma in the gastric wall. The relative value of CA 19-9 markers and FDG PET in pancreatic and gastric carcinomas is discussed (Rev MÚd Chile 2004; 132: 347-52).
Assuntos
Humanos , Adulto , Feminino , Neoplasias Pancreáticas , /metabolismo , /uso terapêutico , Tomografia Computadorizada de EmissãoRESUMO
Se presenta un caso clínico de una paciente estudiada por nódulo pulmonar solitario con Tomografía por Emisión de Positrones utilizando Flúor18-deoxiglucosa. Con el estudio metabólico quedó en evidencia la malignidad del nódulo y la aparición de dos nuevos focos sugerentes de diseminación, no demostrados por otras técnicas diagnósticas.