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Fuertes Manuel J, Kohan S, Jordà Solé M, Mateu Hidalgo I, Miralles Curto M, Aguiló Sagristà O, Aguilar Alomá E, Peña González K, Lafuerza Torres A, Melé Olivé M, Repkova J, Montero Jaime M, Gumà Padró J. Pacientes con afectación ganglionar inicial por cáncer de mama que han recibido quimioterapia neoadyuvante: técnica combinada ganglio centinela-cirugía radioguiada del ganglio patológico. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Fuertes Manuel J, Kohan S, Jordà Solé M, Mateu Hidalgo I, Miralles Curto M, Aguiló Sagristà O, Aguilar Alomá E, Peña González K, Lafuerza Torres A, Melé Olivé M, Repkova J, Montero Jaime MJ, Gumà Padró J. Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node. Rev Esp Med Nucl Imagen Mol 2022; 41:284-291. [PMID: 35597764 DOI: 10.1016/j.remnie.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.
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Affiliation(s)
- J Fuertes Manuel
- Medicina Nuclear-Diagnóstico por Imagen, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - S Kohan
- Radiodiagnóstico-Diagnóstico por Imagen, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - M Jordà Solé
- Ginecología y Obstetricia, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - I Mateu Hidalgo
- Ginecología y Obstetricia, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - M Miralles Curto
- Ginecología y Obstetricia, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - O Aguiló Sagristà
- Ginecología y Obstetricia, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - E Aguilar Alomá
- Ginecología y Obstetricia, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - K Peña González
- Anatomía Patológica, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - A Lafuerza Torres
- Oncología Radioterápica, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - M Melé Olivé
- Oncología Médica, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - J Repkova
- Oncología Médica, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
| | - M J Montero Jaime
- Radiodiagnóstico-Diagnóstico por Imagen, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - J Gumà Padró
- Oncología Médica, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Universitat Rovira i Virgili (URV), Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain; Institut d'Oncologia de la Catalunya Sud (IOCS), Reus, Tarragona, Spain
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Garganese G, Bove S, Fragomeni S, Moro F, Triumbari EKA, Collarino A, Verri D, Gentileschi S, Sperduti I, Scambia G, Rufini V, Testa AC. Real-time ultrasound virtual navigation in 3D PET/CT volumes for superficial lymph-node evaluation: innovative fusion examination. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:766-772. [PMID: 33587289 DOI: 10.1002/uog.23613] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the feasibility and clinical application of fusion imaging with virtual navigation, combining 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) with real-time ultrasound imaging, in assessing superficial lymph nodes in breast-cancer and gynecological-cancer patients. METHODS This was a pilot study of breast- and gynecological-cancer patients with abnormal uptake of 18 F-FDG by axillary or groin lymph nodes on PET/CT scan, examined at our institution between January 2017 and May 2019. Fusion imaging was performed, uploading preacquired PET/CT DICOM images onto the ultrasound machine and synchronizing them with real-time ultrasound scanning performed at the lymph-node site. In the first phase, we assessed the feasibility and reliability of fusion imaging in a series of 10 patients with suspicious lymph nodes on both PET/CT and ultrasound, and with full correspondence between both techniques in terms of size, shape and morphology of the lymph nodes (Group A). In the second phase, we included 20 patients with non-corresponding findings between PET/CT and ultrasound: 10 patients with lymph nodes that were suspicious or pathological on PET/CT scan but not suspicious on ultrasound assessment (Group B), and 10 patients with suspicious or pathological lymph nodes on both PET/CT and ultrasound but with no correspondence between the two techniques in terms of number of affected lymph nodes (Group C). RESULTS In the 30 selected patients, fusion imaging was assessed at 30 lymph-node sites (22 inguinal and eight axillary nodes). In the first phase (Group A), the fusion technique was shown to be feasible in all 10 lymph-node sites evaluated. In the second phase, fusion imaging was completed successfully in nine of 10 cases in Group B and in all 10 cases in Group C. In all groups, fusion imaging was able to identify the target lymph node, guiding the examiner to perform a core-needle aspiration biopsy or to inject radiotracer for selective surgical nodal excision, according to the radio-guided occult lesion localization technique. CONCLUSION Fusion imaging with virtual navigation, combining PET/CT and real-time ultrasound imaging, is technically feasible and able to detect target lymph nodes even when PET/CT and ultrasound findings are inconsistent. Fusion imaging can also be used to guide the performance of core-needle aspiration biopsy, avoiding further surgical diagnostic procedures, or the injection of radiotracer for selective surgical nodal excision, enabling more sparing, selective surgery. This innovative technique could open up multiple diagnostic and therapeutic opportunities in breast and gynecological oncology. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - E K A Triumbari
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Collarino
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - D Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - S Gentileschi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Sperduti
- Department of Biostatistics, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Rufini
- Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Hellingman D, Donswijk ML, Winter-Warnars GAO, de Koekkoek-Doll P, Pinas M, Budde-van Namen Y, Westerga J, Vrancken Peeters MJTFD, Kimmings N, Stokkel MPM. Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy. EJNMMI Res 2019; 9:94. [PMID: 31650284 PMCID: PMC6811805 DOI: 10.1186/s13550-019-0560-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background Selective removal of initially tumor-positive axillary lymph nodes in breast cancer patients who underwent neoadjuvant systemic treatment (NST) improves the accuracy of nodal staging and provides the opportunity for more tailored axillary treatment. This study evaluated whether radioguided occult lesion localization (ROLL) of clip-marked lymph nodes is feasible in clinical practice. Methods Prior to NST, a clip marker was placed inside a proven tumor-positive lymph node in all breast cancer patients (cTis-4N1-3 M0). After NST, technetium-99m-labeled macroaggregated albumin was injected in the clip-marked lymph nodes. The next day, these ROLL-marked nodes were selectively removed at surgery to evaluate the pathological response of the axilla. Results Thirty-seven patients (38 axillae) underwent clip insertion. After NST, the clip was visible by ultrasound in 36 procedures (95%). In the other two patients, the ROLL-node injection was performed in a sonographically suspicious unclipped node (1), and near the clip under computed tomography guidance (1). Initial surgery successfully identified the ROLL-marked node with clip in 33 procedures (87%). Removed specimens in the other five procedures contained only the sonographically suspicious tumor-positive unclipped node (1), a node with signs of complete response but no clip (2), a clip without node (1), and tissue without node nor clip, and a second successful ROLL-node procedure was performed (1). Overall, 10 ROLL-marked nodes had no residual disease. Conclusions This study demonstrates that the ROLL procedure to identify clip-marked lymph nodes is feasible. This facilitates selective removal at surgery and may tailor axillary treatment in patients treated with NST.
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Affiliation(s)
- Daan Hellingman
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Postbus 90203, 1006, BE, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Postbus 90203, 1006, BE, Amsterdam, The Netherlands
| | - Gonneke A O Winter-Warnars
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Postbus 90203, 1006, BE, Amsterdam, The Netherlands
| | - Petra de Koekkoek-Doll
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Postbus 90203, 1006, BE, Amsterdam, The Netherlands
| | - Marilyn Pinas
- Department of Radiology, Slotervaart hospital, Postbus 90440, 1006, BK, Amsterdam, The Netherlands.,Department of Radiology, Haaglanden Medical Center, Postbus 432, 2501, CK, The Hague, The Netherlands
| | - Yvonne Budde-van Namen
- Department of Radiology, Slotervaart hospital, Postbus 90440, 1006, BK, Amsterdam, The Netherlands
| | - Johan Westerga
- Department of Pathology, Slotervaart hospital, Postbus 90440, 1006, BK, Amsterdam, The Netherlands
| | | | - Nikola Kimmings
- Department of Surgical Oncology, Slotervaart hospital, Postbus 90440, 1006, BK, Amsterdam, The Netherlands.,Department of Surgical Oncology, Alexander Monro hospital, Postbus 181, 3720, AD, Bilthoven, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Postbus 90203, 1006, BE, Amsterdam, The Netherlands.
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Aydogan F, Mallory MA, Tukenmez M, Sagara Y, Ozturk E, Ince Y, Celik V, Akca T, Golshan M. A low cost training phantom model for radio-guided localization techniques in occult breast lesions. J Surg Oncol 2015; 112:449-51. [PMID: 26250621 DOI: 10.1002/jso.23984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 12/29/2022]
Abstract
Radio-guided localization (RGL) for identifying occult breast lesions has been widely accepted as an alternative technique to other localization methods, including those using wire guidance. An appropriate phantom model would be an invaluable tool for practitioners interested in learning the technique of RGL prior to clinical application. The aim of this study was to devise an inexpensive and reproducible training phantom model for RGL. We developed a simple RGL phantom model imitating an occult breast lesion from inexpensive supplies including a pimento olive, a green pea and a turkey breast. The phantom was constructed for a total cost of less than $20 and prepared in approximately 10 min. After the first model's construction, we constructed approximately 25 additional models and demonstrated that the model design was easily reproducible. The RGL phantom is a time- and cost-effective model that accurately simulates the RGL technique for non-palpable breast lesions. Future studies are warranted to further validate this model as an effective teaching tool.
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Affiliation(s)
- Fatih Aydogan
- Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Breast Division, Department of Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Melissa Anne Mallory
- Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mustafa Tukenmez
- Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Yasuaki Sagara
- Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erkan Ozturk
- Department of Surgery Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | | | - Varol Celik
- Breast Division, Department of Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Tamer Akca
- Department of General Surgery, Mersin University Medical Faculty, Mersin, Turkey
| | - Mehra Golshan
- Women's Cancer Center, Dana-Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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