M.T. Bajén

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.

Localización simultánea de neoplasias de mama no palpables y estudio del ganglio centinela (GC) mediante técnicas radioisotópicas

OBJECTIVE: To obtain correct location of non-palpable breast lesions, with high suspicion of malignancy and detection of SN by radiosotopic techniques. MATERIAL AND METHODS: Thirty-one patients whose ages ranged from 35 to 79 years, with non-palpable breast lesions detected by mammography and/or ultrasonography were studied. All the patients were diagnosed of breast cancer and treated with primary chemotherapy. All the patients underwent total axillary dissection. At 24 hours of the intervention, all patients received one dose of 37 MBq (1 mCi) of 99mTc labeled macroaggregated albumin (MAA) in the center of the lesion by ultrasonographic guide. Scintigraphic images were performed in anterior and lateral projections (in prone decubitus with hanging breast) to verify the correct location of the radiopharmaceutical. After, a study of the SN was performed by subdermal administration of an 18 MBq (0.5 mCi) dose of 99mTc labeled nanocolloid. The SN site was labeled on the skin with indelible ink. The intrasurgical site of the breast lesion and SN was performed using a gamma detector probe. Correct placement of the intralesional radiopharmaceutical, existence of disease free borders and histological study of SN were performed by the pathologist in the surgical act. The differed pathology study was performed with hematoxilin-eosin and immunohistochemistry. RESULT: In 29 of the 31 lesion sites, there was good placement of the radiotracer (93.5 %). There was 1 case of contamination of the needle pathway and another that did not coincide with the lesion, due to poor placement. Location of the SN was 96 % in the axilla and 4 % in axilla and internal mammary chain. The SN was located in surgery in 28/31 patients (90 %). CONCLUSION: Simultaneous radioguided location of the hidden breast lesions and sentinel node is a simple method, which is well tolerated by the patients and can be done in a single operation act.

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.

Influencia de la localización del cáncer de mama en la detección del ganglio centinela

Resumen Objetivo Valorar la influencia del cuadrante de localizacion del cancer de mama en la deteccion del ganglio centinela (GC) y en la visualizacion del drenaje a mamaria interna mediante tecnicas radioisotopicas. Se estudiaron 376 pacientes con cancer de mama; edad media: 57 anos (rango 29-88). A todas se les inyecto peritumoralmente 37-74 MBq de 99m Tc-nanocoloide, en 2 ml. El tumor se localizo en cuadrante superoexterno (CSE) en 189 pacientes, en inferoexterno (CIE) en 57, en superointerno en 57 (CSI), en 55 en inferointerno (CII) y en 18 en el central. Se obtuvieron imagenes gammagraficas en proyecciones anterior y lateral a las 2 horas postinyeccion del trazador. Se realizo marcaje cutaneo del GC para facilitar su localizacion quirurgica. Se utilizo una sonda gammadetectora para la deteccion intraquirurgica. Se realizo impronta del GC extirpado. El estudio histopatologico diferido se realizo mediante tecnicas de hematoxilina-eosina, inmunohistoquimia (CAM 19-2) y PCR. Resultados La deteccion gammagrafica y quirurgica del GC fue respectivamente 90% y 93% en CSE, 91% y 95 % en CIE, 93% y 95 % en CSI, 87% y 95 % en CII y 94% y 83 % en el central. El drenaje linfatico a mamaria interna fue de 6% en CSE, 5% en CIE, 12 % en CSI, 20 % en CII y ningun caso en el central. Conclusiones Estos resultados sugieren que la deteccion tanto gammagrafica como quirurgica del GC es independiente del cuadrante de localizacion del cancer. Los tumors localizados en los cuadrantes internos muestran un mayor porcentaje de drenaje linfatico a la cadena mamaria interna.

[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.