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Blanco-Saiz I, Goñi-Gironés E, Ribelles-Segura MJ, Salvador-Egea P, Díaz-Tobarra M, Camarero-Salazar A, Rudic-Chipe N, Saura-López I, Alomar-Casanovas A, Rabines-Juárez A, García-Torres J, Anda-Apiñániz E. Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:35-44. [PMID: 37268356 DOI: 10.1016/j.endien.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.
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Blanco-Saiz I, Goñi-Gironés E, Ribelles-Segura MJ, Salvador-Egea P, Díaz-Tobarra M, Camarero-Salazar A, Rudic-Chipe N, Saura-López I, Alomar-Casanovas A, Rabines-Juárez A, García-Torres J, Anda-Apiñániz E. Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Loidi-Pascual L, Librero J, Córdoba-Iturriagagoitia A, Guarch-Troyas R, Montes-Díaz M, Ruiz de Azua-Ciria Y, Arozarena I, Goñi-Gironés E, Yanguas I. Sentinel node tumor burden in cutaneous melanoma. Survival with competing risk analysis and influence in relapses and non-sentinel node status: retrospective cohort study with long follow-up in a Spanish population. Arch Dermatol Res 2022; 314:369-378. [PMID: 33973061 DOI: 10.1007/s00403-021-02232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
Several authors have studied the potential of sentinel lymph node (SLN) tumor burden as prognostic factor but the microscopic classifications used in different study groups were variable. We examined the prognostic role of tumor burden in SLN on melanoma specific-survival and competing causes of death. We also analysed clinical and histological factors as predictors of disease relapses and additional non sentinel lymph node (NSLN) metastases. We included all patients with cutaneous melanoma that underwent SLN biopsy between 2002 and 2012 at Complejo Hospitalario de Navarra (Spain). The study end-points were death due to melanoma, melanoma relapse and involvement of NSLN. We used Fine-Gray test for competing risk analysis. A logistic regression model was performed to predict the risk of involvement of NSLN. Between 2002 and 2012, there were 348 patients who underwent SLN biopsy in our centre (308 were eligible for the study). 26.9% patients positive SLN. 88 patients died during the follow-up period and 66 (75%) died from melanoma. The 5-year cumulative incidence of melanoma death was 15.33% (95 % CI 15.25-15.42). The cumulative probability of death from melanoma was associated with gender, histological subtype, Breslow thickness, mitotic rate, ulceration and SLN tumor burden. In multivariable analysis, Breslow thickness and SLN tumor burden remained as independent prognostic factors. SLN tumor burden appears to be an important prognostic factor. It is very important reporting these characteristics in pathological reports. More prospective studies would be necessary to analyze these variables and to be able to make recommendations in management of melanoma patients.
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Affiliation(s)
- Leire Loidi-Pascual
- Dermatology Department of Complejo Hospitalario de Navarra, C/Irunlarrea., 31008, Pamplona, Navarra, Spain.
| | - Julián Librero
- Methodology Unit of Navarrabiomed Center-IDISNA, Pamplona, Spain
| | | | - Rosa Guarch-Troyas
- Pathology Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marta Montes-Díaz
- Pathology Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Imanol Arozarena
- Navarrabiomed, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Elena Goñi-Gironés
- Nuclear Medicine Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ignacio Yanguas
- Dermatology Department of Complejo Hospitalario de Navarra, C/Irunlarrea., 31008, Pamplona, Navarra, Spain
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Loidi-Pascual L, Librero J, Córdoba-Iturriagagoitia A, Guarch-Troyas R, Montes-Díaz M, Ruiz de Azua-Ciria Y, Arozarena I, Goñi-Gironés E, Yanguas I. Correction to: Sentinel node tumor burden in cutaneous melanoma. Survival with competing risk analysis and influence in relapses and non‑sentinel node status: retrospective cohort study with long follow‑up in a Spanish population. Arch Dermatol Res 2021; 314:379. [PMID: 34812922 DOI: 10.1007/s00403-021-02302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leire Loidi-Pascual
- Dermatology Department of Complejo Hospitalario de Navarra, C/Irunlarrea., 31008, Pamplona, Navarra, Spain.
| | - Julián Librero
- Methodology Unit of Navarrabiomed Center-IDISNA, Pamplona, Spain
| | | | - Rosa Guarch-Troyas
- Pathology Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marta Montes-Díaz
- Pathology Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Imanol Arozarena
- Navarrabiomed, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Elena Goñi-Gironés
- Nuclear Medicine Department of Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ignacio Yanguas
- Dermatology Department of Complejo Hospitalario de Navarra, C/Irunlarrea., 31008, Pamplona, Navarra, Spain
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Goñi-Gironés E, Fuertes-Cabero S, Blanco-Sáiz I, Casáns-Tormo I, García-Talavera San Miguel P, Martín-Gil J, Sampol-Bas C, Abreu-Sánchez P, Díaz-Expósito R, Vidal-Sicart S. Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. Rev Esp Med Nucl Imagen Mol 2020; 40:57-66. [PMID: 33386282 DOI: 10.1016/j.remn.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.
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Affiliation(s)
- E Goñi-Gironés
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - S Fuertes-Cabero
- Servicio de Medicina Nuclear, Hospital Universitario Quirónsalud Madrid, Madrid, España
| | - I Blanco-Sáiz
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - I Casáns-Tormo
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España
| | | | - J Martín-Gil
- Servicio de Cirugía General, Hospital Quirónsalud San José, Madrid, España
| | - C Sampol-Bas
- Servicio de Medicina Nuclear, Hospital Universitari Son Espases, Mallorca, España
| | - P Abreu-Sánchez
- Servicio de Medicina Nuclear, Hospital Universitario Doctor Peset, Valencia, España
| | - R Díaz-Expósito
- Servicio de Medicina Nuclear, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - S Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clinic Barcelona, Barcelona, España
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Loidi-Pascual L, Lecumberri-Biurrun MJ, Arozarena-Martinicorena I, Goñi-Gironés E, Yanguas-Bayona JI. Study of cutaneous melanoma recurrences after sentinel node biopsy: Patterns of dissemination and use of complementary test in follow-up. Eur J Cancer Care (Engl) 2020; 30:e13344. [PMID: 33089896 DOI: 10.1111/ecc.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the patterns of melanoma recurrence in the local population, including factors that may influence in this event and timing of relapse, and to determine the mode of detection of them. METHODS This is a retrospective cohort study of patients with melanoma who underwent sentinel lymph node biopsy at the Complejo Hospitalario de Navarra (Spain) from 2002 to 2012. The following data were collected of each patient: age, gender, date of diagnosis, location of melanoma, histological subtype, Breslow thickness, ulceration, mitosis, sentinel node status, AJCC 8th edition stage, site of first diagnosed metastasis, mode of relapse, date of first relapse and time of death. RESULTS Of 308 patients, 30% people suffered metastasis. The mean follow-up time was 68.63 months. 51.1% of relapses were locoregional and 48.9% haemato-visceral. Sentinel node status was the only variable associated with higher risk of haemato-visceral metastasis (p < 0.001). The mean time between diagnosis of melanoma and recurrence was 2.7 years. Most recurrences were detected by the patient himself or had any type of symptoms and were consequently selected for a complementary test. CONCLUSION It is important to follow-up all patients with diagnosis of cutaneous melanoma, essentially during the first 5 years after diagnosis.
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Affiliation(s)
| | | | | | - Elena Goñi-Gironés
- Nuclear Medicine Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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Reyes-Pérez M, Rodrigo-Rincón MI, Martínez-Lozano ME, Goñi-Gironés E, Camarero-Salazar A, Serra-Arbeloa P, Estébanez-Estébanez C. [Assessment of the patient satisfaction with a Nuclear Medicine Service]. Rev Esp Med Nucl Imagen Mol 2012; 31:192-201. [PMID: 23067688 DOI: 10.1016/j.remn.2011.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 10/28/2022]
Abstract
GOAL To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). METHODS A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. RESULTS A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. CONCLUSION This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective.
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Affiliation(s)
- M Reyes-Pérez
- Servicio de Medicina Preventiva y Gestión de Calidad, Antiguo Hospital de Navarra, Complejo Hospitalario de Navarra, Pamplona, España
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Reyes-Pérez M, Rodrigo-Rincón M, Martínez-Lozano M, Goñi-Gironés E, Camarero-Salazar A, Serra-Arbeloa P, Estébanez-Estébanez C. Assessment of the patient satisfaction with a Nuclear Medicine Service. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2012.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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