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e15229 Background: HPD is a new pattern of response consisting of accelerated tumor growth due to immunotherapy (5%-20% of pts on IO drugs). The tumor growth rate (TGR, Champiat et al.) estimates the differential increase in tumor volume over time, pre- and on IO drugs, to assess for HPD, but it is not easily calculated in practice. A comparison of the different methods to identify HPD is missing. Methods: Retrospective study of 182 consecutive pts treated in Phase 1 studies of IO drugs at START Madrid-CIOCC in 2017-8, comparing 3 HPD measurement criteria (Champiat, Matos -which does not use pre-baseline CT scans-, and Saâda-Bouzid). Cohen’s Kappa index was calculated as a measure of the agreement between the 3 methods, being those values closer to 1 the more concordant ones. Overall survival (OS) rates were calculated by Kaplan-Meier (p < 0.05 to be significant). Results: 99 (54%) of 182 pts had progressive disease at cycle 1 of treatment and in 62 (34%) pre-baseline CT scans were available to calculate TGR. The Champiat method identified 18 (9.9%) pts with HPD. Of 61 cases validated to comparison, the Matos criteria labeled 27 pts (14.8% of 182) with HPD, of whom only 10 pts coincided with those identified by Champiat with a low agreement (Kappa: 0.140, p:0.251). No significant differences in OS between pts with non-HPD vs HPD by Matos criteria were seen (p = 0.16). With Saâda-Bouzid method, of 59 cases validated to comparison, 17 pts (9.3% of 182) were labeled with HPD and 13 of them coincided with those identified by Champiat method with a high agreement (Kappa:0.706, p:0.000). Differences in OS between non-HPD vs HPD pts were statistically significant (p = 0.038). Conclusions: HPD might have a detrimental effect to 10% of pts on IO drugs, also in our series. Every effort should be done to obtain pre-baseline CT scans to identify HPD response to IO drugs, based on differential TGR. The use of Saâda-Bouzid method is preferred due to its practical application and its correlation with survival. [Table: see text]

Objetivo Aportar nuestra experiencia en la utilizacion de la via percutanea retrograda o transyeyunal como acceso a la via biliar en pa-cientes con hepato o coledocoyeyunostomia. Material y metodo Presentamos a seis pacientes en los que se uti-lizo la via percutanea retrograda con distintas finalidades: en seis casos para la dilatacion de estenosis biliares (cuatro pacientes con estenosis de la anastomosis bilioenterica, un paciente presentaba multiples este-nosis del arbol biliar y uno una estenosis del coledoco distal y de la pa-pila), en tres casos para extraer colelitiasis intrahepaticas y extrahepati-cas, en otro para extraer un tubo tutor migrado fuera de la hepatoyeyu-nostomia al asa yeyunal y, por ultimo, en un caso se utilizo para tratar una fuga biliar en la anastomosis bilioenterica. Ademas, describimos los detalles tecnicos del procedimiento. Resultados El tratamiento dilatador se realizo con exito en todos los pacientes, requiriendo una media de dos sesiones. No hubo compli-caciones inmediatas excepto un caso de hemofilia. Los pacientes lleva-ron colocados los tubos de drenaje transhepaticos durante un periodo de entre 12-30 dias, mientras que el tiempo de los tubos transyeyunales fue de 22 dias y cuatro meses. Conclusiones El acceso percutaneo retrogrado es una via de abor-daje al arbol biliar alternativa y complementaria a la transhepatica. Las principales ventajas de este procedimiento respecto al anterogrado son el acceso sencillo a los conductos biliares, tanto derechos como iz-quierdos, el menor riesgo de complicaciones y la menor severidad de estas, y la posibilidad de realizar el seguimiento de los drenajes de for-ma ambulatoria.

La propia historia natural de la arteriosclerosis posibilita el desarrollo de estudios y proyectos dirigidos a identificar y clasificar los sujetos con alto riesgo de presentar enfermedad coronaria. Han sido diversas las tecnicas radiologicas que han tratado de determinar la severidad de la afectacion de las arterias coronarias, con un exito relativo. En esta ultima decada, los continuos avances en tomografia computarizada (TC) han posibilitado la deteccion y cuantificacion de los depositos de calcio en las arterias coronarias, con una sensibilidad y especificidad practicamente superponibles a los datos obtenidos tras coronariografia. La cuantificacion total del calcio coronario, indicador inequivoco de arteriosclerosis, permite estratificar el riesgo cardiovascular de los pacientes de manera no invasiva y con mayor fiabilidad que con los metodos habituales. Hoy dia, las principales aplicaciones clinicas de la deteccion y cuantificacion de la ateromatosis coronaria incluyen: dolor toracico de caracteristicas atipicas; cribado del riesgo coronario en pacientes asintomaticos, y seguimiento de la progresion de la arteriosclerosis coronaria en los pacientes tratados.

Las fistulas ureteroarteriales se asocian con una alta mortalidad, lo que se ha relacionado a un retraso en el diagnostico y tratamiento. A pesar de que se conocen diversos factores predisponentes y de que existe una manifestacion inicial muy concreta (hematuria), la fistula ureteroarterial es de dificil diagnostico. Clasicamente, el tratamiento de dicha fistula ha consistido en la cirugia abierta y en la embolizacion vascular percutanea. Hoy en dia, las endoprotesis vasculares se perfilan como alternativa terapeutica en el tratamiento de las fistulas ureteroarteriales. Se presenta el caso de una paciente con una probable fistula ureteroarterial tratada mediante embolizacion ureteral y colocacion de endoprotesis vascular cubierta.

Lung cancer is the neoplasia with the highest worldwide mortality rate. During recent decades, several programs for early detection of lung cancer have been initiated with none having demonstrated a significant reduction in mortality. Recent technological advances (spiral CT) have rekindled an interest in screening programs and results have been encouraging. Nevertheless, the initial question remains: would programs for the early detection of lung cancer be able to significantly decrease mortality rates?

Among the broad spectrum of tumoral bone lesions that affect the sacrum are chondrosarcoma, chondroma, aneurysmal bone cyst, Ewing sarcoma, giant cell tumor, lymphoma, Paget disease, osteosarcoma, plasmacytoma, and neurogenic tumors. The clinical onset may be insidious, and sacral bone tumors may be

We describe a novel technique for marking non-palpable breast lesions with the aim of selecting the best approach prior to performing a biopsy. The technique employs a new coil, specifically designed for breast localization, guided by stereotaxy. This technique is reserved for selected cases in which the lesion is seen peripherally in only one mammographic view with negative or non-conclusive ultrasonographic results, and deeply seated after a stereotactic study. Once the coil is released beside the lesion, the shortest approach from the skin may be employed to perform the biopsy. To our knowledge, this is the first report of this technique.

We present two cases of suspicious mammographic images that remained stable over long periods of time (44 and 24 months). The biopsies revealed infiltrating ductal carcinoma and ductal carcinoma in situ. In one case, the lesion consisted of a cluster of microcalcifications, while the other was characterized by architectural distortion. There are very few references to this subject in the literature. We conclude that all suspicious mammographic lesions should be biopsied, despite previous evidence suggesting their stability, even over long periods of time.

Background Surgical resection remains the gold standard for the treatment of localized adenocarcinoma of the extrahepatic bile ducts. Yet, treatment of loco-regional recurrences is not well defined. Case Presentation We present an unusual case of distal adenocarcinoma of the extrahepatic bile ducts that was treated with surgery and relapsed two years later with a solitary recurrence on the tract of a previous Redon drain. In addition, a review of the literature on management of loco regional relapses is presented. Conclusions The ideal management of these patients still remains undefined. Decisions are made based on clinical parameters from retrospective series, such as tumor grade, surgical margins or lymph node involvement. Prospective studies, that include molecular and genetic markers, are needed to improve patient selection and outcomes on this population.

Cystic dystrophy of heterotopic pancreas is a rare condition that means cystic changes of normal pancreatic tissue, placed in unusual locations, commonly in the duodenal wall. We report a case of CDHP in stomach, histologically confirmed after surgery. We show the correlation between radiological and anatomopathological findings, and also review the current literature about reported cases of this exceptional disease.

We report an infrequent mammographic case in which a gross-calcified lipid cyst evolved spontaneously to form a cluster of pleomorphic microcalcifications which were indistinguishable from those seen in breast cancer. The biopsy performed was consistent with fat necrosis. Ultrasonography of the specimen showed a nodule with mixed echogenicity surrounded by a hypoechoic rim. To our knowledge, this behavior is extremely rare, with only one similar case reported in the literature.

Presentamos un caso de tumor mucinoso de mama, cuya unica manifestacion mamografica consistio en una agrupacion de microcalcificaciones polimorficas de 4 mm de diametro maximo. El tumor correspondio histologicamente a un subtipo mucinoso puro. La revision bibliografica realizada nos confirma que esta presentacion es francamente atipica por lo que creemos que es de interes para el radiologo.