P. Navarro

Indicación del rastreo óseo en la estadificación del cáncer de mama de inicio

OBJECTIVE Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. MATERIAL AND METHODS The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y <or=5 cm (T2) were analyzed in two groups stratified by tumor size, <or=3 cm or >3 cm, and pre-treatment clinical stage. RESULTS Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and <or=5 cm (T2) were diagnosed in 84 patients (34%), of which 3.6% had bone metastasis. There were no differences in the rate of bone metastases in patients with stage T2 disease and lesions <or=3 cm vs. >3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. CONCLUSIONS Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor <or=2 cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease.

Physiological expression of pancreatic somatostatin receptors in 99mTc-HYNIC-TOC scintigraphy

PurposeTo describe the frequency of head and/or pancreas uncinate process uptake of 99mTc-HYNIC-TOC, to study its nature, and analyze its diagnostic value.Materials and methodsRetrospective evaluation of 47 consecutive 99mTc-HYNIC-TOC examinations was conducted. Head and/or pancreas uncinate process uptake was considered to be physiological in patients with normal CT at the same episode and in follow-up. It was analyzed if age or diabetes mellitus was justifying the existence or not of uptake.Results32.5% patients showed uptake; 73% of them were mild. 84.6% patients with uptake have no pathology and 4% had neuroendocrine pancreatic disease at CT. Neither the age nor the diabetes mellitus established differences in patients without lesion.ConclusionsNear one-third of patients show physiological uptake by head and/or pancreas uncinate process at 99mTc-HYNIC-TOC scintigraphy. It seems that neither the diabetes nor the ages are factors that determine this physiological uptake.

Indication of bone scans in early breast cancer staging

OBJECTIVE: Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness. MATERIAL AND METHODS: The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y 3 cm, and pre-treatment clinical stage. RESULTS: Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions 2 cm and 3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis. CONCLUSIONS: Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor <or=2 cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease.

Enfermedad de Gorham: hallazgos en la gammagrafía ósea con 99mTc–HMDP

Hombre de 45 años que acude a Urgencias por dolor en homro izquierdo tras esfuerzo, cuya exploración física no presenta ignos de limitación funcional y con radiología normal. Consulta meses después por dolor y edema en hombro izquierdo. En Rx imple se aprecia destrucción completa de la cabeza humeral, con alcificaciones periarticulares (fig. 1a) por lo que se solicita RM e hombro que se informa como extensa tumoración centrada en rticulación glenohumeral de contornos mal definidos, a descartar arcoma sinovial (fig. 1b). Ante la sospecha de lesión tumoral se olicita gammagrafía ósea para valorar extensión. La gammagrafía ósea realizada con 740 MBq de 99mTc–HMDP uestra hipercaptación ósea en cuello humeral, escápula, acroion y cavidad glenoidea izquierda. Además aumento de la ctividad en fase vascular y ósea en los tejidos blandos del tercio uperior de la extremidad superior izquierda (fig. 2a y b). La SPECTAC de baja dosis demostró que estas lesiones correspondían a diversas calcificaciones localizadas en estructuras musculares contiguas e importante edema sin visualizarse la cabeza humeral izquierda (fig. 2c). La impresión diagnóstica fue infiltración neoplásica sin poder descartar lesión pseudotumoral (osteolisis masiva de la cabeza humeral), recomendando estudio anatomopatológico.La biopsia de hueso confirma tejido óseo con presencia de tejido fibroconectivo adyacente con hipervascularización y proliferación vascular hemangiomatosa, sin signos de malignidad (fig. 3a y b), compatible en su adecuado contexto clínico y radiológico con enfermedad de Gorham. Una vez diagnosticado se inicia tratamiento con ácido zoledrónico y calcio más vitamina D. La evolución clínica fue favorable, manteniéndose el paciente asintomático y con un rango de movilidad aceptable. Se propuso realizar artroplastia invertida de hombro pero el paciente está satisfecho con su movilidad actual.