RESUMEN
OBJECTIVES: This study was designed to evaluate the detection rate (DR) and sensitivity of sentinel lymph node (SLN) mapping in patients with endometrial cancer using TC99m colloid and blue dye and to evaluate the contribution of preoperative planar lymphoscintigraphy (PLSG) and SPECT/CT. METHODS: A retrospective analysis of patients who underwent SLN mapping as part of their primary surgery for endometrial cancer. Patients underwent preoperative PLSG and later with additional SPECT/CT. Intraoperative detection was performed using TC99m colloid and blue dye by cervical injections. SLNs were sent separately for pathologic evaluation with ultrastaging. RESULTS: Fifty-three patients were included in this study. Successful preoperative mapping was achieved in 31 of 37 patients (84 %) who underwent SPECT/CT compared with only 30 of 45 patients (67 %) who underwent PLSG. SPECT/CT localizations of SLNs were anatomically accurate in 91 % of cases. Intraoperative DR of at least one SLN was 77 %, whilst the bilateral DR was 49 %. DR was significantly better using combined blue dye and TC99m colloid injections compared with blue dye alone: 81 versus 57 % for unilateral and 54 versus 28 % for bilateral mapping (P = 0.01, 0.009, respectively). Six cases of nodal metastasis were diagnosed: four by positive SLNs, and two cases were diagnosed using side-specific full dissection according to the SLN algorithm when SLN detection failed. There were no cases of false-negative results. CONCLUSIONS: SLN detection using cervical injections of TC99m colloid and blue dye is feasible and sensitive for patients with endometrial cancer. SPECT/CT aids to accurate locating of the SLN.
Asunto(s)
Ganglios Linfáticos/patología , Linfocintigrafia , Neoplasias Ováricas/patología , Biopsia del Ganglio Linfático Centinela , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos X/métodos , Adenocarcinoma de Células Claras/diagnóstico por imagen , Adenocarcinoma de Células Claras/patología , Adenocarcinoma de Células Claras/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Cistadenocarcinoma Seroso/diagnóstico por imagen , Cistadenocarcinoma Seroso/patología , Cistadenocarcinoma Seroso/cirugía , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Pronóstico , Radiofármacos , Estudios Retrospectivos , Azufre Coloidal Tecnecio Tc 99mRESUMEN
UNLABELLED: The aim of this study was to assess the value of 99mTc-hexakis2-methoxyisobutylisonitrile (MIBI) scintigraphy in patients with clinical and radiologic features of primary or metastatic musculoskeletal tumors. METHODS: The scintigraphic findings for 84 patients were compared with the surgical and histologic findings. Each patient underwent three-phase bone scanning with 99mTc-methylene diphosphonate (MDP) and dynamic and static MIBI scintigraphy. The MIBI scans were evaluated by visual and quantitative analysis. The count ratio of the lesion to the adjacent or contralateral normal area (L/N) was calculated from the region of interest drawn on the MIBI scan. The Mann-Whitney test was used to determine the differences between the uptake ratios of malignant and benign lesions. RESULTS: Although increased MDP uptake was not specific for bone malignancy, a significant difference was found between benign tumors (L/N = 1.22 +/- 0.43) and malignant tumors (L/N = 2.25 +/- 1.03) on MIBI scans. Sensitivity and specificity were 81% and 87%, respectively. Forty-six of 53 proven benign lesions did not show significant MIBI uptake. The negative predictive value was 88%. In all seven sites of pathologic fracture, significant uptake was seen. However, three malignant lesions were not detected by MIBI scintigraphy, whereas seven benign lesions showed false-positive results. CONCLUSION: The major diagnostic worth of MIBI scintigraphy is its high negative predictive value. Although not capable of replacing tissue biopsy as a definitive diagnostic modality for musculoskeletal neoplasms, MIBI scintigraphy does appear to have a role in better preoperative assessment and in distinguishing between pathologic and simple fractures.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias de los Músculos/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Neoplasias Óseas/secundario , Diagnóstico Diferencial , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/etiología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/secundario , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Medronato de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
A retrospective study was carried out to determine the diagnostic value of OncoScint CR/OV immunoscintigraphy in assessing patients with suspected recurrence of carcinoma of the colon and ovary. The scintigraphic results of 31 patients were compared with surgical and histopathological findings, conventional radiological examinations and clinical disease outcome over an average 3-year follow-up. Detected lesions were divided by location into hepatic or extrahepatic and the latter group was classified as local recurrence at the resection site, pelvic or abdominal regional lymph node involvement and distant metastatic disease. The combined sensitivity and accuracy of immunoscintigraphy in the detection of extra-hepatic disease was significantly higher than that of cross-sectional radiological imaging (87% and 83% vs 44% and 53% respectively) with equal specificity of 74%. Scintigraphy identified 14 (36%) of 39 extra-hepatic malignant lesions not diagnosed by conventional radiological techniques and influenced therapeutic planning in 8 (26%) of 31 patients studied. In the liver, conventional imaging had a significantly higher detection rate than immunoscintigraphy (sensitivity 93% vs 28%). In conclusion, these results show that OncoScint scintigraphy is a sensitive method for the detection of local recurrence and extra-hepatic metastases in colorectal and ovarian carcinoma and has an important role in the therapeutic decision-making process.
Asunto(s)
Anticuerpos Monoclonales , Neoplasias Colorrectales/diagnóstico por imagen , Radioisótopos de Indio , Recurrencia Local de Neoplasia/diagnóstico por imagen , Oligopéptidos , Neoplasias Ováricas/diagnóstico por imagen , Ácido Pentético/análogos & derivados , Radioinmunodetección , Adulto , Anciano , Errores Diagnósticos , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
It is often difficult to assess accurately the nature of a skeletal lesion. Problems include differentiating a malignant from a benign bone tumor, as well as determining the cause of a pathologic fracture. Such fractures may occur through osteoporotic bone as well as through neoplasm-affected bone. Thus, development of an imaging modality capable of distinguishing between such lesions is of importance. During 1996, we ran a prospective study in which results of Tc-99m-methyl-diphosphate (MDP) bone scans were compared with those of sestamibi (MIBI) bone scans and with subsequent biopsy and clinical course. The results of the bone scans were assessed by 2 independent "blinded" observers, and the ratios of counts in lesions to those in normal tissue (L/N ratios) were calculated. In cases of malignant (7) and benign (8) tumors, intensity of uptake in MDP scans were not predictive of degree of aggressiveness. On the other hand, MIBI bone scans demonstrated significant difference in intensity of uptake between benign and malignant bone tumors (L/N ratios 2.05 vs 2.75). In 5 of 8 benign lesions the L/N ratio was 1. In the others, increased uptake was minimal. In 2 patients changes in uptake in MIBI bone scan following chemotherapy appeared to be related to the degree of tumor necrosis achieved. While the MIBI bone scan cannot replace tissue biopsy as a definitive diagnostic modality in bone neoplasms, it does appear to allow better preoperative assessment and prognosis.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias de los Músculos/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Neoplasias Óseas/patología , Diagnóstico Diferencial , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/patología , Cintigrafía , Medronato de Tecnecio Tc 99mAsunto(s)
Duodeno/diagnóstico por imagen , Trasplante de Riñón/diagnóstico por imagen , Trasplante de Páncreas/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/cirugía , Humanos , Masculino , Cintigrafía , Pentetato de Tecnecio Tc 99mRESUMEN
Studies of rates of Sr transport from nutrient solutions containing 8 concentrations of Sr indicate a definite trend towards higher rates of Sr transport by roots of intact 12-day-old Regal barley (Hordeum vulgare, L.) seedlings as compared with Tregal. Differences in rates of Sr transport between the 2 varieties were also indicated by higher concentrations of Sr in fluids exuding from decapitated Regal roots as compared to fluids exuding from decapitated Tregal roots.No differences between Regal and Tregal were found in the physical factors of distance from epidermis to endodermis, number of cortical cell layers, or transpiration rate. Furthermore, no relationship was observed between transpiration rate and rate of Sr accumulation.Dependence of Sr transport on metabolic processes was indicated by marked effects of temperature, cyanide, and dinitrophenol on rates of Sr transport. Q(10) values for Sr transport by Regal and Tregal approached 2, thereby indicating that metabolic reactions were associated with this process. Strontium transport by both Regal and Tregal was markedly depressed in the presence of either cyanide or dinitrophenol. These results led to the conclusion that the Sr transport process is dependent on metabolic energy derived from respiration.