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Bran W, Sahli‐Vivicorsi S, Cadieu R, Alavi Z, Leclere J. Ultrasound-guided hookwire localization of non palpable cervical lymphadenopathy: A case-control study of operative time. Cancer Med 2023; 12:16054-16065. [PMID: 37317644 PMCID: PMC10469735 DOI: 10.1002/cam4.6257] [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: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE We aimed at evaluating the impact of ultrasound-guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. DESIGN AND METHODS Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H-) per operative US-guided hook-wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery-related adverse events data were collected. RESULTS Mean operative time was significantly shorter in H+ group versus H- group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H-, p = 0.1). No significant between group difference in surgery-related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). CONCLUSION US-guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H-.
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Affiliation(s)
- William Bran
- Radiology DepartmentBrest University HospitalBrestFrance
- ENT DepartmentBrest University HospitalBrestFrance
| | | | - Romain Cadieu
- Radiology DepartmentBrest University HospitalBrestFrance
| | - Zarrin Alavi
- INSERM, CIC 1412Brest University HospitalBrestFrance
| | - Jean‐Christophe Leclere
- Radiology DepartmentBrest University HospitalBrestFrance
- ENT DepartmentBrest University HospitalBrestFrance
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Weiser R, Manno GC, Cass SH, Chen L, Kuo YF, He J, Robinson AS, Posleman Monetto F, Silva HC, Klimberg VS. Fluoroscopic Intraoperative Breast Neoplasm and Node Detection. J Am Coll Surg 2023; 236:575-585. [PMID: 36728380 DOI: 10.1097/xcs.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preoperative localization is necessary for nonpalpable breast lesions. A novel procedure, fluoroscopic intraoperative neoplasm and node detection (FIND), obviates the preoperative painful and potentially expensive localization by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates. STUDY DESIGN This is an IRB-approved retrospective study (September 2016 to March 2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time, and axillary node localization rate. RESULTS We identified 459 patients, of whom 116 (25.3%) underwent FIND and 343 (74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1% (4 of 79) for FIND and 16.6% (41 of 247) for WL (p = 0.008). This difference lost statistical significance on multivariable logistic regression (p = 0.652). Re-excision rates were 7.6% and 14.6% for FIND and WL (p = 0.125), with an equivalent mean specimen weight (p = 0.502), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (mean ± SD; p = 0.022). FIND identified all (29 of 29) targeted axillary nodes, and WL identified only 80.1% (21 of 26) (p = 0.019). CONCLUSIONS FIND has lower positive margin rates and a trend towards lower re-excision rates compared with WL, proving its value in localizing nonpalpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.
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Affiliation(s)
- Roi Weiser
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Gabrielle C Manno
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Samuel H Cass
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Lu Chen
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Jing He
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Angelica S Robinson
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - Flavia Posleman Monetto
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - H Colleen Silva
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
| | - V Suzanne Klimberg
- From the Department of Surgery (Weiser, Cass, Silva, Klimberg), University of Texas Medical Branch, Galveston, TX
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Shaughnessy E, Vijapura C, Reyna C, Lewis J, Lewis K, Lee S, Sobel L, Wahab R, Rosen L, Brown A. Exploiting the advantages of a wireless seed localization system that differentiates between the seeds: Breast cancer resection following neoadjuvant chemotherapy. Cancer Rep (Hoboken) 2022; 6:e1690. [PMID: 35940632 PMCID: PMC9875611 DOI: 10.1002/cnr2.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/03/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most wireless localization methods utilize only one means of detection for the surgeon, sufficient to localize a single small breast lesion for excision. Complex cases requiring bracketing of a larger lesion or localization of two or more close lesions can superimpose the signal from separate "seeds" with such methods. The lack of discernment between the localization "seeds" can disorient the surgeon, risking a missed lesion on excision and longer operative times. with the use of neoadjuvant chemotherapy prior to breast surgery, the necessity of localizing both a breast lesion and an axillary lymph node previously biopsied is becoming frequent. CASE A 44 year-old woman underwent neoadjuvant chmotherapy for a breast cancer the did not express estrogen receptor, progesterone receptor, or HER2 receptor. In establishing the extent of disease, a suspicious ipsilateral lymph node was biopsied and found to contain metastatic disease. She had an excellent response to the chemotherapy, with decreased size of the primary tumor and the previously biopsied lymph node. The patient desired breast conservation. The primary tumor and associated calcifications were bracketed using two different Smartclips™, with a third localizing the lymph node biopsied. CONCLUSION This report illustrates how the use of three SmartClips™, within the EnVisioTM system, allowed for separate tracking of each "seed" throughout a complex surgery in a patient following neoadjuvant chemotherapy. This resulted in successful resection of both the tumor and the tagged lymph node.
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Affiliation(s)
- Elizabeth Shaughnessy
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Charmi Vijapura
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Chantal Reyna
- Department of SurgeryCrozer Health SystemSpringfieldPennsylvaniaUSA
| | - Jaime Lewis
- Department of Surgery, Section of Breast Surgery within Division of Surgical OncologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Kyle Lewis
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Su‐Ju Lee
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lawrence Sobel
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Rifat Wahab
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
| | - Lauren Rosen
- Department of Pathology, Section of Surgical Pathology within Division of Anatomic PathologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Ann Brown
- Department of Radiology, Division of Breast ImagingUniversity of CincinnatiCincinnatiOhioUSA
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Dhamija E, Singh R, Mishra S, Hari S. Image-Guided Breast Interventions: Biopsy and Beyond. Indian J Radiol Imaging 2021; 31:391-399. [PMID: 34556924 PMCID: PMC8448213 DOI: 10.1055/s-0041-1734223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Breast interventions primarily comprise of biopsy of the suspicious breast lesions to obtain accurate pathological diagnosis. Generally, image-guided breast biopsy is required for nonpalpable lesions, however, even in palpable lesions, image-guided biopsy should be performed as it improves the accuracy of diagnosis. Image-guided breast interventions have progressed well beyond biopsy, making the radiologist an important part of the multidisciplinary management of breast cancer. Preoperative localization of nonpalpable abnormalities guides optimal surgical excision to obtain negative margins without sacrificing the normal tissue. Ablative procedures for breast cancer treatment such as radiofrequency ablation (RFA) and high-intensity focused ultrasound ablation can sometimes replace surgery in older patients with comorbidities. This article enumerates and describes the expanding spectrum of image-guided interventions performed by breast radiologist.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Department of Radiodiagnosis, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Oncoanaesthesia & Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Ultrasound-Guided Hook-Wire Localization for Surgical Excision of Non-Palpable Superficial Inguinal Lymph Nodes in Dogs: A Pilot Study. Animals (Basel) 2020; 10:ani10122314. [PMID: 33297352 PMCID: PMC7762221 DOI: 10.3390/ani10122314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022] Open
Abstract
The evaluation of loco-regional lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients. Excision of non-palpable LN can be challenging. The aim of the study was to evaluate surgical time, successful excision rate and surgical complications associated with the use of an ultrasound-guided hook-wire (UGHW) LN localization method for non-palpable superficial inguinal LN (SILN) in dogs. Dogs that presented for excision of non-palpable SILN, performed with the aid of an UGHW placement, were enrolled. Information including signalment, SILN width, UGHW placement and surgical procedure time, hook-wire position, successful excision and intra- and post-operative complications were reviewed. Seventeen dogs were enrolled. Median LN width was 3 mm (range 2-11). Median time of preoperative UGHW placement and surgical LN excision was 8 min and 15 min, respectively. Successful SILN excision was achieved in all cases. Two minor intra-operative (hook migration and wire fragmentation) and one minor post-operative complications (seroma) were observed. No major intraoperative or post-operative complications occurred. The UGHW LN localization method is safe and effective and may allow a high rate of successful SILN excisions in dogs. This method has the potential to facilitate LN excision for other superficial LN locations.
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Khare S, Singh T, Santosh I, Laroiya I, Singh G. Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420938068. [PMID: 32669849 PMCID: PMC7336821 DOI: 10.1177/1178223420938068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Abstract
Background: Excision of nonpalpable breast lesions requires intraoperative guidance.
Wire-guided localization and intraoperative ultrasounds have been used
successfully but suffer from some disadvantages. We describe a new
modification of the standard technique using a combination of preoperative
ultrasound in conjunction with standard wire-guided localization. Methods: Wire and ultrasound-guided localization (WUGL) technique was used for the
excision of nonpalpable breast lesions. Results: Sixty-nine patients with nonpalpable breast lesions were subjected to
excision using WUGL, out of whom 63 patients had a preoperative diagnosis of
invasive/noninvasive breast cancer. Six patients had a preoperative
diagnosis of benign lesions, out of which 3 patients were converted to
invasive breast cancer on final pathology. Only 1 patient had positive
margin. Conclusions: WUGL is a technique that uses a combination of well-accepted and easily
available techniques. It has given good results and has the potential for
widespread acceptance in resource-constrained situations.
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Affiliation(s)
- Siddhant Khare
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Tulika Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India.,Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Irrinki Santosh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Ishita Laroiya
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Gurpreet Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
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Digital Breast Tomosynthesis as a Tool in Confirming Negative Surgical Margins in Non-palpable Breast Lesions. Indian J Surg Oncol 2019; 10:624-628. [PMID: 31857754 DOI: 10.1007/s13193-019-00956-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022] Open
Abstract
Breast cancer is one of the leading killers among women the world over. Widespread mammographic screening programs have led to almost 20% of breast cancers being detected when they are radiologically visible but clinically impalpable. For the localization of these cancers before surgical excision, the Kopan hook wire is the standard technique, but the extent of margins excised still needs to be determined. In this study, we have evaluated the accuracy of specimen mammogram (SM) with digital breast tomosynthesis (DBT) for margin assessment by comparing it to the excised margins as measured in final histopathology. This is a prospective observational study of patients with radiologically suspicious impalpable breast lesions. The patients underwent ultrasound-guided hook wire placement followed by excision of the lesion, subjected to digital tomosynthesis mammogram, and margins were revised on table when indicated. These findings were correlated with final histopathological margin. Our study included 30 patients and out of the 6 lesions, which showed positive margins on specimen mammography, 4 were histologically confirmed to have tumour at the surgical margin and 2 were confirmed to be tumour free. All DBT-positive margins were re-excised at the time of primary surgery. Individual comparison of the margins revealed a good agreement and high level of correlation between DBT and histopathology margins. None of the cases required a second surgery for margin revision. It can be concluded that specimen mammogram with DBT can be used as a reliable tool for intraoperative surgical margin assessment in non-palpable breast lesions to reduce rate of margin revision as well as reduce the volume of breast excised without compromising the oncological safety of the procedure.
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Park SY, Kim HJ, Kim WH, Cheon HJ, Lee H, Park HY, Jung JH, Park JY. Feasibility of ultrasound-guided absorbable retaining thread needle localization for nonpalpable breast lesions. Ultrasonography 2019; 38:272-276. [PMID: 31104457 PMCID: PMC6595124 DOI: 10.14366/usg.18059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/08/2019] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Absorbable retaining thread (ART) needle localization utilizes a guiding needle with a thread; this technique was invented to reduce patient discomfort and wire migration. We investigated the feasibility of ultrasound (US)-guided ART needle localization for nonpalpable breast lesions. METHODS ART needle localization was performed for 26 nonpalpable breast lesions in 26 patients who were scheduled to undergo surgical excision the day after localization. Seventeen breast lesions were initially diagnosed as invasive ductal carcinoma, six as ductal carcinomas in situ, and one as fibrocystic change. The other two cases without an initial pathologic diagnosis had suspicious US features, and excision was planned concomitantly with contralateral breast cancer surgery. The primary outcome was the technical success rate of ART needle localization confirmed by US immediately after the procedure, and the secondary outcomes were the percentage of clear margins on pathology and the complication rate of ART needle localization. RESULTS The technical success rate of ART needle localization was 96.2% (25 of 26 patients), and the ART was located 1 cm away from the mass in one patient (3.8%). The lesions were successfully removed with clear margins in all 26 patients. No significant complications related to ART needle localization were observed. CONCLUSION ART needle localization can be an alternative to wire needle localization for nonpalpable breast lesions.
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Affiliation(s)
- Seo Young Park
- Department of Radiology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye Jin Cheon
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Hoseok Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Pinilla-Pagnon I, Pérez-Mies B, Reguero ME, Martinez MT, Chiva M, Pérez-Rodrigo S, Illarramendi OA, Martin MER, Collado MV, Sanchez MC, Rosa-Rosa JM, Palacios J. Histological changes secondary to wire coil placement in breast tissue and lymph nodes. Virchows Arch 2018; 473:285-291. [PMID: 29984379 DOI: 10.1007/s00428-018-2399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/04/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022]
Abstract
We describe the histological and immunohistochemical features of the changes produced by spiral coil localization wires in the breast parenchyma and lymph nodes of a total of 100 patients undergoing surgery for different breast lesions. Coil wires produced cystic lesions containing a hyaline, mucous-like, PAS-negative fluid. Cavities were lined by cells of variable morphology ranging from synovial-like cells (with a conspicuous epithelial appearance) to mononuclear or multinucleate histiocytic cells that expressed CD68, but were negative for keratins. CD3-positive/CD8-positive T lymphocytes predominated in the inflammatory reaction. Pathologists should be aware of these changes in order to differentiate coil-related lesions from other granulomatous or epithelial lesions, including mucocele-like and ductal carcinoma in situ lesions.
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Affiliation(s)
| | - Belén Pérez-Mies
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Eugenia Reguero
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Miguel Chiva
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Silvia Pérez-Rodrigo
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Maria Eugenia Rioja Martin
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Nuclear Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria Vicenta Collado
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- General Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria Concepción Sanchez
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Manuel Rosa-Rosa
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - José Palacios
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.
- IRyCIS, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Universidad de Alcalá de Henares, Madrid, Spain.
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PSMA-PET guided hook-wire localization of nodal metastases in prostate cancer: a targeted approach. World J Urol 2018; 37:1251-1254. [PMID: 29616296 DOI: 10.1007/s00345-018-2282-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 12/17/2022] Open
Abstract
Prostate Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (PSMA-PET/CT) has increased the sensitivity and specificity of imaging to identify metastatic prostate cancer in the group of patients with early biochemical recurrence when compared to conventional imaging. In patients who develop biochemical recurrence of prostate cancer following surgical resection, salvage lymph node dissection may reduce prostate specific antigen (PSA) levels and delay the time for commencement of systemic therapies. However, PLND may be an anatomically and technically difficult procedure, particularly with small metastatic diseases which can be problematic for intra-operative identification. We describe the technique using PSMA-PET imaging to pre-operatively localise areas of low-volume nodal metastatic disease with hookwire to allow targeted lymph node dissection with direct visualisation and palpation to ensure adequate clearance of involved nodes.
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