José Luis del Cura

Sonographically Guided Percutaneous Needle Lavage in Calcific Tendinitis of the Shoulder: Short- and Long-Term Results

OBJECTIVE The purpose of our study was to evaluate the short- and long-term effectiveness of sonographically guided percutaneous needle aspiration and lavage in calcific tendinitis of the shoulder and to study the progress of calcifications and symptoms in the first year after treatment. MATERIALS AND METHODS Symptoms and radiologic findings after percutaneous aspiration of calcific tendinitis were prospectively evaluated in the short and the long term using a shoulder pain and disability index, evaluation of shoulder motion, and a survey of the self-perception by the patients regarding the progress of their disease. RESULTS Sixty-seven consecutive shoulders were treated. A significant improvement was seen in shoulder motion, pain, and disability in the short term and in the long term (p < 0.0001). One year after treatment, 91% of shoulders had substantially or completely improved, 64% had perfect motion, and calcifications on radiography had resolved completely or nearly completely in 89%. A transitory recurrence was observed approximately 15 weeks after treatment in 44.3% of shoulders that improved. CONCLUSION Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. Progress after treatment may include a transitory period of recurrence of the pain.

Treatment of renal tumors by percutaneous ultrasound-guided radiofrequency ablation using a multitined electrode: effectiveness and complications.

BACKGROUND Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery. OBJECTIVE To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patients refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging. INTERVENTION Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes. MEASUREMENTS Incomplete ablation rate, therapeutic success rate, and complications rate. RESULTS AND LIMITATIONS Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy. CONCLUSIONS RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.

Usefulness and limitations of ultrasound-guided core biopsy in the diagnosis of musculoskeletal tumours†

Ultrasound‐guided needle biopsy is a safe and efficient diagnostic method increasingly used in the initial approach to superficial and deep musculoskeletal tumours. However, so far no general consensus has been reached regarding its reliability. During a 6‐year period (1999–2004), biopsies were taken from 188 patients (100 females, 88 males; age average 55.8 years) with musculoskeletal tumours under ultrasound guidance using 18G BioPince® or 14G ProMag® 2.2 true‐cut type needles. Cytological (imprints and cytocentrifugates) and histological material was obtained for diagnosis in every case. The lower extremity (59 cases) and the abdominal wall (29 cases) were the most commonly affected sites. Benign/reactive tumours (77 cases), metastatic epithelial malignancies (40 cases), and sarcomas (36 cases) were most frequently diagnosed. In 180 (95.75%) cases, core needle results were concordant with the definitive diagnosis (97 true positives and 83 true negatives). Relevant diagnostic discordance was seen in 8 (4.25%) cases (8 false negatives and 0 false positives). Sensitivity, specificity and positive and negative predictive values were 92%, 100%, 100%, and 91%, respectively. Ultrasound‐guided core biopsy is thus a useful method in the initial approach to musculoskeletal tumours that allows correct patient management in the vast majority of cases.

Role of ultrasound-guided core biopsy in the evaluation of spleen pathology.

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post‐core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince® needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B‐cell lymphomas, two follicular lymphomas, one Hodgkins disease, one B‐cell lymphoma, NOS). In addition, there was one littoral‐cell angioma, one well‐differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.

Utilidad de la biopsia cilindro guiada por control ecográfico en el diagnóstico y manejo de los tumores renales

Resumen Antecedentes La biopsia guiada por control ecografico esta siendo utilizada de manera creciente en los ultimos anos como aproximacion diagnostica inicial en los tumores renales, aunque su aceptacion entre radiologos y patologos aun no es generalizada. Metodos Durante un periodo de 6 anos (2000-2005), se han biopsiado por este metodo y con agujas 18G un total de 48 tumores renales en 47 pacientes. Resultados Se observo un predominio de varones (34V/13M) y la edad promedio se situo en 51,7 anos (rango 1-92). Treinta y siete (77,1%) casos correspondieron a neoplasias, incluyendo adenocarcinomas renales (25 casos), oncocitomas (3 casos), linfomas (3 casos), tumores de Wilms (2 casos), un tumor carcinoide metastasico, un carcinoma epidermoide metastatico, un nefroma quistico y un sarcoma fusocelular. Cinco casos (10,4%) correspondieron a pseudotumores (3 quistes renales y 2 pielonefritis cronicas). La biopsia proporciono tejido renal normal en 4 casos y tejido fibroadiposo en 2. Se detectaron minimas discrepancias en la adjudicacion de la variante histologica del cancer en 2 casos. Conclusiones La biopsia cilindro guiada por ecografia es un metodo muy util y fiable para el diagnostico de los tumores renales, y deberia ser incluida como herramienta de primera linea en su manejo. Sin embargo, para la obtencion de optimos resultados que puedan llevar a un tratamiento individualizado, se precisa una estrecha colaboracion entre clinicos, radiologos y patologos.

Histological diagnosis of thyroid disease using ultrasound-guided core biopsies.

Background: Thyroid core biopsies obtained with ultrasound (US)-guided needles are an alternative to conventional fine-needle aspiration and, according to various authors, have greater sensitivity and specificity. The technique is inexpensive, rapid and reliable with a low rate of complications, similar to conventional fine-needle aspiration procedures. Objectives: This paper critically reviews the methodology for obtaining samples and processing them in the pathology laboratory. Methods: Accumulated experience with 1,065 cases of US-guided core biopsy of the thyroid gland in a 15-year period. Results: US-guided core biopsy is a useful, inexpensive and safe method in the histological diagnosis of thyroid gland pathology. Thyroid samples obtained this way are not a substitute for fine-needle aspiration cytology. Indeed, some authors assert that the best results are obtained by combining the two approaches, the methods being complementary. Conclusions: To take best advantage of the findings from these techniques, pathologists must know which types of diagnoses can be made and the fundamentals of how and, lastly, what cannot be diagnosed and the reasons why. Best results are obtained with a multidisciplinary approach in a hospital committee composed of endocrinologists, surgeons, radiologists and pathologists, who analyse and provide a background on each case.

El diagnóstico histológico de la patología tiroidea en biopsias guiadas por control ecográfico

Resumen La biopsia de tiroides obtenida con aguja guiada por control ecografico es una alternativa a la puncion aspiracion con aguja fina que, segun multiples autores, ofrece mayor sensibilidad y especificidad diagnostica que esta. Este trabajo revisa de una manera critica la metodologia de obtencion de la muestra, su manipulacion optima en el Laboratorio de Anatomia Patologica, lo que se puede diagnosticar, como hacerlo, y lo que no, y por que no. El rendimiento optimo de este procedimiento se obtiene en el contexto de un comite multidisciplinario en el que los diversos especialistas implicados discuten los casos complejos.

Sclerosing mucoepidermoid carcinoma of the thyroid gland: cytohistological findings of a case

Hematol Oncol Stem Cell Ther 1(1) January 2008 hemoncstem.edmgr.com 62 Mucoepidermoid carcinoma is an extremely rare thyroid neoplasm with only a handful of cases reported so far.3,4,23,25,26 Although it has been considered a lowsgrade carcinoma, rare highsgrade cases have also been described.4,25 A sclerosing variant of thyroid mucoepidermoid carcinoma associated with eosinophilia (SMEC) has also been reported.1s3,7s9,11,19s22 Overall, the histogenesis of mucoepidermoid carcinos mas in the thyroid is unclear and remains under debate. Authors hypothesize whether they originate from solid cell nests, the ultimobranchial body remnants, or from follicular cells. The first option is favored by most,3,11,13,20 based upon the histological and immunohistochemical similarities between these neoplasms and ultimobrans chial body remnants. The cytological and histological features of a new case of SMEC diagnosed on core bis opsy (CB) and treated with radical surgery are reported here. The tumor showed the expected mucoepidermoid histology, but showed intense atypia, prominent inflams matory infiltrate and extensive desmoplasia. To the best of our knowledge, there are very few reports describing the cytological findings of this entity.5,11

Indicación de las técnicas de diaagnóstico por la imagen en la sospecha de apendicitis aguda: propuesta de protocolo diagnostic*

objetivos Estudiar la eficiencia de la ecografia y la tomografia computarizada (TC) en la sospecha de apendicitis. Comprobar su rentabilidad ante distintos contextos clinicos y caracteristicas de los pacientes. Estudiar el coste y los beneficios de incorporar estas tecnicas y proponer un protocolo para su utilizacion. Material y metodos Se compararon apendicectomias negativas, complicaciones y estancia hospitalaria de un grupo de 152 pacientes con sospecha de apendicitis estudiado mediante ecografia y TC y los 180 pacientes operados de apendicitis vistos en las mismas fechas que los primeros pero no seleccionados para ser incluidos en el primer grupo y manejados segun criterio de los cirujanos, calculandose los costes asistenciales para cada grupo. En los primeros se valoro la eficacia diagnostica de los signos clinicos. Resultados Los signos clinicos fueron poco fiables mientras que la ecografia y la TC obtenian excelentes resultados. La proporcion de apendicectomias negativas fue 9,6% en el grupo estudiado y 12,2% en el grupo control, con menores complicaciones y tiempo de hospitalizacion en el primer grupo. En los varones, sin embargo, la proporcion de apendicectomias negativas fue menor en el grupo control. El coste por apendicitis en el grupo con ecografia y TC fue solo ligeramente superior al del grupo control. Conclusiones Aunque ante casos de baja probabilidad o varones con clinica clara no son necesarias, las pruebas de imagen estan indicadas en todos los demas casos de sospecha de apendicitis. En ninos la ecografia seria la tecnica de eleccion. En el resto, es conveniente usar la tecnica alternativa en caso de diagnostico negativo con la que se utilice inicialmente.

Comparación de la ecografía y la tomografía computarizada en el diagnóstico de la apendicitis aguda

Resumen Objetivos Comparar la eficacia de la ecografia y la tomografia computarizada (TC) ante una sospecha de apendicitis. Estudiar en que medida la edad, el sexo y el habito del paciente, asi como el contexto clinico influyen en el rendimiento diagnostico de ambas. Material y metodos Durante un ano, se estudiaron mediante eco-grafia y TC 152 pacientes con sospecha clinica de apendicitis. Las ex-ploraciones fueron realizadas independientemente, sin conocimiento del resultado de la otra, emitiendose en cada caso un diagnostico posi-tivo o negativo para apendicitis. Los diagnosticos finales se establecie-ron por cirugia o seguimiento clinico. Resultados La TC obtuvo para el diagnostico de apendicitis una sensibilidad del 82%, especificidad del 95%, valor predictivo positivo del 93%, valor predictivo negativo del 87% y fiabilidad del 90%, mien-tras que la ecografia, una sensibilidad del 83%, especificidad del 97%, valor predictivo positivo del 95%, valor predictivo negativo del 88% y fiabilidad del 91%. La ecografia obtuvo mejores resultados en pacien-tes con alta sospecha clinica y en ninos, y la TC en pacientes con clini-ca dudosa. Con la ecografia se emitieron mas diagnosticos alternativos, mientras que la TC fue capaz de visualizar un apendice normal con mas frecuencia. Sexo y habito corporal no influyeron en las respectivas eficacias, aunque la ecografia se vio facilitada en pacientes delgados y la TC en obesos. Conclusiones Ecografia y TC son altamente fiables en la apendici-tis, especialmente cuando la confirman. La ecografia debe ser la tecni-ca de eleccion en ninos y en pacientes con clinica clara. En pacientes con cuadros dudosos, el rendimiento de la TC es algo superior. Sin embargo, la eficacia de ambas tecnicas dependera en ultima instancia de la preparacion del especialista que las interpreta.