A. Benítez

Patients with Breast Cancer and Negative Sentinel Lymph Node Biopsy without Additional Axillary Lymph Node Dissection: A Follow-Up Study of up to 5 Years

Objective: To analyze the rate of axillary recurrences and survival in patients operated on for breast cancer who had not undergone an axillary lymph node dissection (ALND) because of a negative sentinel node biopsy. Methods: The study includes 97 patients operated on for breast cancer and selective node biopsy from June 2000 to December 2001 who had a negative sentinel node biopsy and did not undergo ALND. Mean age was 58.2 years (55.9–60.5). Follow-up was done up to 5 years. After surgery all patients underwent clinical examination. Complementary treatment depended on the hospital protocol. Rate of axillary recurrences, presence of distant metastases and survival (Kaplan-Meier method) were studied. Results: After a median follow-up of 4.1 years (2.18–5.25), only 2/95 patients (2.1%) developed distant metastases. Four patients died but only the death of the patient who presented multiple metastases was related to the primary breast cancer (1%). The 5-year overall survival rate was 96%. Conclusions: (1) Only 1/95 patients studied developed nodal extra-axillary recurrence together with distant metastases. (2) The results obtained support the selective sentinel node biopsy as an accurate technique in the axillary stratification of patients with breast cancer, offering in the cases of negative sentinel node biopsy a safe axillary control after a 5-year follow-up.

Removal of the internal mammary sentinel node in breast cancer.

ObjectiveThe aim of the study was to determine the evolution of patients with internal mammary chain (IMC) drainage whether the IMC-sentinel lymph node (IMC-SLN) was biopsied or not, as well as to determine the clinical implications of the biopsy of the IMC-SLN (IMC-SLNB) in patients with breast cancer and IMC drainage in the lymphoscintigraphy. MethodsEighty-two out of 914 patients included in a prospective database of sentinel node (9%) showed IMC drainage and were included in the study. Two groups were established depending on the IMC-SLN removal: group A (IMC-SLN were removed): 44 patients, mean age 48.8 years, mean follow-up, 35.8 months. Group B (IMC-SLN were not removed): 38 patients, mean age 54.5 years, mean follow-up, 33.5 months. Kaplan–Meier plots were used to determine the overall survival rates. ResultsGroup A: four patients showed only IMC drainage, six patients presented positive IMC-SLN, nodal staging changed in five patients, treatment changed in two patients and tumour node metastasis stage grouping changed in three patients. All patients are currently disease-free. Group B: two patients showed only IMC drainage, axillary-SLN were positive in 12 patients, one patient presented nodal axillary and breast recurrence as well as distant disease and one patient presented multiorganic disease. This last patient died. The overall survival rates were very similar in both the groups. ConclusionIMC-SLNB improves nodal staging in breast cancer but has little impact on adjuvant treatment. However, it should be performed to obtain results, which will determine in the future whether it improves survival rates or not.

Utilidad clínica de las imágenes de fusión 67Ga SPECT/TC en pacientes con linfoma

Resumen Objetivo El objetivo de este trabajo es la valoracion de la utilidad clinica de las imagenes de fusion SPECT 67Ga/TC en los pacientes afectos de procesos linfoproliferativos. Material y metodo Se estudiaron 44 pacientes (22 hombres) con linfoma (22 enfermedad de Hodgkin, 22 linfoma no Hodgkin). Se realizaron 59 estudios con una gammacamara hibrida, adquiriendose consecutivamente un rastreo de cuerpo entero, un SPECT y una tomografia computarizada (TC) de la zona/s afecta/s para su fusion con el SPECT. El estudio de fusion se centro en las siguientes areas: 33 toraco-cervical (T), 24 abdomen (A) y 2 craneo-cervical (CC). Las imagenes fueron evaluadas por 2 medicos nucleares sin conocimiento de los datos del paciente, clasificando la aportacion de la fusion de imagines respecto al SPECT como: no cambia, mejora la localizacion o extension de las lesiones y cambia la estadificacion. Se confirmaron los resultados con la realizacion de una TC de alta resolucion en el periodo de un mes. Resultados En 32/59 estudios no se observaron cambios (20 T, 12 A), en 23/59 estudios cambio la localizacion o extension de las lesiones (12 T, 9 A y 2 CC) y en 4/59 estudios (1 T y 3 A) el cambio de localizacion implico un cambio de estadificacion respecto al observado en el SPECT. Conclusion La realizacion de estudios de fusion de imagines SPECT 67Ga/TC en pacientes con linfoma permite mejorar la precision diagnostica en un 46 % de los casos, principalmente en los estudios abdominales, oseos y del area diafragmatica.

Evaluation of the anxiety state in patients receiving radioiodine treatment or who undergo a sentinel lymph node examination in the Nuclear Medicine Department

OBJECTIVE: To analyze the presence of anxiety in patients referred to a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: A total of 148 patients were included: 67 were referred for radioiodine therapy, 48 with hyperthyroidism (HT), 19 with differentiated thyroid carcinoma (DTC), and 81 were referred for detection and biopsy of the sentinel node in breast cancer (BC). The following documents were filled out: personal data, a state-trait anxiety inventory, a scale of pre-disposing factors causing anxiety and an information questionnaire. Anxiety-predisposing factors and the influence of the information on the presence of anxiety were studied. RESULTS: HT patients: 47% had anxiety in the moment of the visit that was not related to the level of information received. The factor that worried them the most was the radioiodine administration. Being the first visit to a NMD significantly influenced (p<0.05) on the presence of anxiety. DTC patients: 42% had anxiety in the moment of the visit not related to the level of information received. The factor that worried them the most was the illness itself. No factor had a significant influence on the presence of anxiety. BC patients: 53% had anxiety in the moment of the visit that was not related to the level of information received. What worried them the most were the results. Having anxiety and/or depression significantly influenced (p<0.05) the presence of anxiety. CONCLUSION: The quantity of information given before a procedure in a NMD does not influence on the presence of anxiety. Nevertheless, it is our duty to give the best possible information.

[Clinical utility of attenuation correction with X-rays in myocardial perfusion SPECT studies].

OBJECTIVE We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. METHODS In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemars test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. RESULTS Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). CONCLUSIONS Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated.

Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women

Abstract Objective The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. Method A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥70 years old; B, younger postmenopausal, 89 patients, 55–69 years old; C, premenopausal, 85 patients, Results SLN metastasis was significantly (P Conclusions SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.