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Resumen Objetivo Presentar nuestra experiencia inicial en el procedimiento combinado de deteccion intraoperatoria del ganglio axilar positivo biopsiado marcado con semilla de 125I (GM) y biopsia del ganglio centinela (GC) despues de quimioterapia neoadyuvante, en pacientes con cancer de mama. Material y metodos Estudio prospectivo, enero de 2017 - marzo de 2019, 16 pacientes con cancer de mama T1-3N1. Estadio TNM: II-A: 3, II-B: 10, III-A: 3. Tipo histologico ductal infiltrante: 14. Subtipos moleculares: luminal-A: 3, luminal-B: 9, HER2: 3, triple negativo: 1. El GM se marco 227±36 dias antes de iniciar la quimioterapia neoadyuvante (n: 10), o 1-6 dias antes de la cirugia, sobre el ganglio previamente identificado con un marcador ecovisible tipo hidrogel (n: 3) o tridimensional-3D (n: 3). En 10 pacientes se realizo linfadenectomia axilar. Resultados GM y GC se identificaron en la cirugia en el 93,7% (15/16) de los casos, en 33,3% (5/15) GM no se encontraba entre los GC, y solo en una enferma (1/5) existio discrepancia entre el resultado de GM y GC (macrometastasis y negativo 0/2). Numero medio ganglios GC: 2,2±0,9 (rango 1-3) y linfadenectomia axilar: 13,5±5,2 (rango 7-23). En todos los casos, el analisis anatomopatologico del GM, con semilla de 125I y/o marcador, predijo correctamente el estatus axilar posneoadyuvancia. En todas las pacientes se recupero la semilla radiactiva de 125I. Conclusiones La colocacion de semillas de 125I es una tecnica factible para la localizacion intraoperatoria del ganglio positivo biopsiado en combinacion con la biopsia del ganglio centinela. El resultado anatomopatologico del GM permite determinar el estatus axilar posneoadyuvancia.

Resumen Objetivo El marcaje de lesiones no palpables en cancer de mama mediante semillas de 125I es una alternativa al arpon quirurgico. El objetivo de este trabajo es presentar los resultados obtenidos con el uso de semillas de 125I frente a la que era la tecnica de referencia en nuestro centro, el arpon quirurgico. Material y metodo Estudio longitudinal prospectivo en el que se incluyen pacientes con diagnostico anatomopatologico de cancer de mama, con lesiones no palpables, candidatas a tratamiento quirurgico primario en las que se realizo marcaje con semilla de 125I (2016-2018) y con arpon (2015-2016). Se realizo analisis histopatologico de la pieza quirurgica determinando la existencia de bordes afectos. Se calculo el volumen de la pieza quirurgica. Resultados Se incluyeron un total de 146 pacientes, 95 a las que se les realizo tumorectomia guiada con semilla de 125I y 51 con arpon. El volumen cubo medio de las piezas resecadas fue de 135,67 cm3 vs. 190,77 cm3 (p = 0,017). El volumen ortoedro fue de 58,75 cm3 vs. 80,60 cm3 (p = 0,003). Once de las pacientes marcadas con semillas presentaron afectacion de bordes (11,6%) frente a 7 (13,2%) del grupo arpon (p = 0,084). Se realizo reescision en 9 de las pacientes marcadas con semillas y en 7 del grupo arpon (p = 0,49). Conclusion El uso de semillas de 125I es factible en la localizacion de lesiones no palpables de mama, con una baja tasa de reintervencion y volumenes de piezas quirurgicas significativamente inferiores a los obtenidos con arpon.

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with 99mTC-HDP bone scintigraphy and 18F-FDG PET/CT, which helped to obtain the definitive pathological diagnosis of osteopoikilosis (OP) co-existing with gastric cancer bone metastases. Of the different imaging scans performed, bone scintigraphy was particularly relevant due to its ability to discriminate between benign and metastatic bone disease.

To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked withProspective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients.ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML,Placing of

Leiomyomas are benign tumors derived from smooth muscle tissue that rarely present outside the uterus. These tumors do not usually show FDG uptake. We present the case of a patient with hypertension refractory to treatment and a lesion arising from inferior vena cava, that shows intense FDG uptake in PET/CT scan, suggestive of paraganglioma, with a final histological diagnosis of leiomyoma.

a b s t r a c t The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass. Objective: To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI. Material and methods: We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters 2 ), LMI (lean in kg/height in meters 2

Resumen Objetivo Valorar la utilidad de la biopsia selectiva del ganglio centinela (BGC) despues de la quimioterapia neoadyuvante (QTN) en pacientes con cancer de mama operable y axila positiva al diagnostico. Material y metodos Estudio prospectivo entre enero de 2008 y diciembre de 2012 en 52 pacientes, con una edad media de 50,7 anos y con cancer de mama infiltrante T1-3, N1, M0 (uno bilateral, 7 multifocales), tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en HER-2/neu positivas. El estatus axilar se establecio por la exploracion fisica, la ecografia axilar y la puncion ecoguiada de ganglios sospechosos. El dia antes de la cirugia se inyecto periareolarmente 74-111 MBq de 99mTc-nanocoloide de albumina. En todas se realizo una cirugia mamaria, una BGC y una linfadenectomia axilar. El GC se analizo por cortes de congelacion, hematoxilina-eosina, inmunohistoquimica u OSNA. Resultados Tamano medio del tumor: 3,5 cm. Tipo histologico: 81,1% carcinoma ductal infiltrante. Respuesta completa al tumor primario: clinica 43,4%, patologica 41,5%. Ninguna de las pacientes presento adenopatias axilares palpables despues del tratamiento. Respuesta completa patologica axilar: 42,2%. El porcentaje de identificacion del GC fue de 84,9%. En 6 de las 8 pacientes sin migracion del nanocoloide la axila resulto positiva en el estudio anatomopatologico. En el 95,5% de los casos el GC determino correctamente el estatus axilar. La tasa de falsos negativos fue de 8,3%. En el 68,2% de los casos el GC fue el unico afectado de la axila. El numero medio de GC identificados fue de 1,9 y el de ganglios axilares extirpados fue de 13,2. Conclusion La BGC post-QTN es una tecnica segura y factible en pacientes con cancer de mama operable T1-3, N1 y axila clinicamente negativa despues del tratamiento.

Some patients use complementary medicine. We present a patient with Hodgkin's lymphoma, scanned with

The coexistence of different bone diseases in the same patient involves a complex differential diagnosis. A patient is presented who was studied due to a renal mass that showed many sclerotic lesions in spine and limbs in conventional radiology and CT. These lesions were evaluated with

Resumen El edema de extremidades constituye un motivo frecuente de consulta medica, considerandose la linfogammagrafia un metodo fiable para su diagnostico diferencial. Objetivo Valorar la utilidad del estudio isotopico en el diagnostico diferencial del edema y el rendimiento diagnostico de diferentes patrones gammagraficos encontrados. Material y Metodos Se consideraron 61 pacientes remitidos a nuestro Servicio en los ultimos tres anos por sospecha de linfedema, descartandose uno por falta de diagnostico. La media de edad fue de 43 anos. Cincuenta y seis pacientes presentaban edema en miembros inferiores y 4 en superiores. Tras inyeccion intradermica de dos dosis de 99mTc-nanocoloide, se realizaron rastreos gammagraficos de extremidades a los 30 y 120 minutos de su administracion. El diagnostico definitivo se baso en pruebas de imagen, evolucion clinica y respuesta a tratamiento. Se calculo el rendimiento diagnostico de cuatro diferentes patrones gammagraficos (presencia de flujo dermico, asimetria-alteracion en ganglios inguinales/axilares, presencia de vias colaterales y visualizacion de ganglios intermedios) considerandose de manera individual y conjunta. Resultados El mayor rendimiento diagnostico se alcanzo considerando el flujo dermico y la asimetria en ganglios inguinales/axilares (exactitud 88,9%, especificidad 96,4%, VPP 95,5%). La valoracion de ganglios intermedios y presencia de vias colaterales aporto escaso rendimiento diagnostico, con baja sensibilidad y elevada tasa de falsos positivos. Conclusion La linfogammagrafia presento un alto rendimiento diagnostico, permitiendo un tratamiento precoz del linfedema. El flujo dermico y asimetria en ganglios inguinales/axilares mostraron la mayor exactitud diagnostica. La valoracion de ganglios intermedios y visualizacion de vias colaterales no aportaron mejoria al diagnostico.

Ga-citrate Osteomyelitis abstract Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diag- nostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with 99m Tc-HDP

Background Scintigraphy with iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if 123 I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with 123 I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Material and methods Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent 123 I-MIBG to assess CSI (heart-to-mediastinum ratio – HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of 123 I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. Results During a mean follow-up of 19.5 [9.3–29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p = 0.014). Late HMR ≤ 1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p = 0.012) and non-diabetic patients (hazard ratio 12.31; p = 0.023). Conclusions Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless 123 I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients.

Resumen El sindrome de Sjogren es una enfermedad autoinmune sistemica y cronica que muestra mayor riesgo de desarrollar linfomas no Hodgkin. En estos pacientes es rara tanto la afectacion neoplasica pulmonar como la coexistencia de diferentes tipos histologicos de linfoma. Frecuentemente los enfermos presentan procesos infecciosos asociados, la mayoria por candidiasis oral. En situaciones de inmunodeficiencia, la diseminacion hematogena del hongo puede causar afectacion pulmonar. Presentamos el caso de una paciente diagnosticada de linfoma no Hodgkin folicular en el contexto clinico de un sindrome de Sjogren de larga evolucion, en el que el estudio PET-TAC mostro, ademas del proceso neoplasico a nivel ganglionar y esplenico, extensa afectacion pulmonar. Ante la sospecha de un resultado falso positivo por infeccion candidiasica pulmonar se inicio tratamiento antifungico, sin obtener respuesta. Posteriormente un estudio histologico mostro la presencia de un segundo tipo de linfoma.

To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC).A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA).Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2.SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.

The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass.To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI.We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters(2)), LMI (lean in kg/height in meters(2)) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters(2)) were calculated.Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players.Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose.

Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis.To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns.A total of 61 patients, mean age 43 years, referred to our Department in the last three years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of (99m)Tc-nanocolloid, scintigraphic scans were made at 30 and 120minutes. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly.The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates.The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis.

Spondylodiscitis affects a small proportion of all patients with locomotor system infections, however its early diagnosis is important due to its potential morbidity. Magnetic resonance imaging is the diagnostic method of choice. Nonetheless, it has certain limitations and is not suitable for all patients. The conventional scintigraphic studies for evaluating spondylodiscitis are those performed with (99m)Tc-HDP and (67)Ga-citrate. However, their poor image resolution is a disadvantage of these techniques. The use of hybrid Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) improves detection of the disease by combining functional and anatomical images. We present 9 patients with suspicion of spondylodiscitis who underwent sequential bone scintigraphy with (99m)Tc-HDP and SPECT-CT with (67)Ga-citrate, with positive findings confirmed by clinical monitoring for at least 6 months.

Sjögren syndrome is a chronic systemic autoimmune disease in which there is an increased risk of developing non-Hodgkin's lymphoma. Neoplastic lung involvement and the coexistence of different histological types of lymphoma are uncommon in these patients. These patients frequently have associated infectious processes, most of them due to oral candidiasis. When there is immunodeficiency, the hematogenous spread of the fungus may affect the lungs. We present the case of a female patient diagnosed with follicular non- Hodgkin lymphoma within the context of long-term Sjögren syndrome. In addition to the neoplastic nodal and splenic disease, the PET-CT study showed extensive lung involvement. Due to suspicion of a false positive result for pulmonary Candida infection, antifungal treatment was initiated, with no response. A further histological study showed the presence of a second and different type of lymphoma.