We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, ...melanoma, and pelvic tumors.
From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.
Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.
SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.
OBJETIVO: descrever as complicações maternas decorrentes dos procedimentos endoscópicos terapêuticos em Medicina fetal, realizados em um centro universitário no Brasil. MÉTODOS: estudo observacional ...retrospectivo que incluiu gestantes atendidas no período de Abril de 2007 a Maio de 2010. Esses casos foram submetidos aos seguintes procedimentos: ablação vascular placentária com laser (AVPL) por síndrome de transfusão feto-fetal (STFF) grave; oclusão traqueal fetal (OTF) e retirada de balão traqueal por via endoscópica por hérnia diafragmática congênita (HDC) grave e AVPL, com ou sem cauterização bipolar do cordão umbilical, por síndrome da perfusão arterial reversa (SPAR) em gêmeo acárdico. As principais variáveis descritas para cada condição clínica/tipo de cirurgia foram as complicações maternas e a sobrevida (alta do berçário) do neonato/lactente. RESULTADOS: cinquenta e seis gestantes foram submetidas a 70 procedimentos: STFF grave (34 pacientes; 34 cirurgias); HDC grave (16 pacientes; 30 cirurgias) e SPAR (6 pacientes; 6 cirurgias). Entre as 34 gestantes tratadas com AVPL por STFF, duas (2/34=5,9%) apresentaram perda de líquido amniótico para a cavidade peritoneal e sete (7/34=20,6%) tiveram abortamento após os procedimentos. A sobrevida de pelo menos um gêmeo foi de 64,7% (22/34). Entre as 30 intervenções realizadas para HDC, houve perda de líquido amniótico para a cavidade peritoneal materna em um caso (1/30=3,3%) e rotura prematura pré-termo de membranas após três (3/30=30%) fetoscopias para retirada do balão traqueal. A sobrevida com alta do berçário foi de 43,8% (7/16). Entre os seis casos de SPAR, houve sangramento materno para a cavidade peritoneal após uma cirurgia (1/6=16,7%) e a sobrevida com alta do berçário foi de 50% (3/6). CONCLUSÕES: em concordância com os dados disponíveis na literatura, em nosso centro, os benefícios relacionados às intervenções endoscópicas terapêuticas em casos de STFF, HDC e SPAR parecem superar os riscos de complicações maternas que, raramente, foram consideradas graves.
To describe the maternal complications due to therapeutic endoscopic procedures in fetal Medicine performed at an university center in Brazil.
Retrospective observational study including patients ...treated from April 2007 to May 2010 who underwent laser ablation of placental vessels (LAPV) for severe twin-twin transfusion syndrome (TTTS); fetal tracheal occlusion (FETO) and endoscopic removal of tracheal balloon in cases of severe congenital diaphragmatic hernia (CDH); LAPV with or without bipolar coagulation of the umbilical cord in cases of twin reversed arterial perfusion (TRAP) sequence. The main variables described for each disease/type of surgery were maternal complications and neonatal survival (discharge from nursery).
Fifty-six patients underwent 70 procedures: Severe TTTS (34 patients; 34 surgeries); severe CDH (16 patients; 30 surgeries), and TRAP sequence (6 patients; 6 surgeries). Among 34 women who underwent LAPV for TTTS, two (2/34=5.9%) experienced amniotic fluid leakage to the peritoneal cavity and seven (7/34=20.6%) miscarried after the procedure. Survival of at least one twin was 64.7% (22/34). Among 30 interventions performed in cases of CDH, there was amniotic fluid leakage into the maternal peritoneal cavity in one patient (1/30=3.3%) and premature preterm rupture of membranes after three (3/30=30%) fetoscopies for removal of the tracheal balloon. Infant survival with discharge from nursery was 43.8% (7/16). Among six cases of TRAP sequence, there was bleeding into the peritoneal cavity after surgery in one patient (1/6=16.7%) and neonatal survival with discharge from nursery was 50% (3/6).
In agreement with the available data in literature, at our center, the benefits related to therapeutic endoscopic interventions for TTTS, CDH and TRAP sequence seem to overcome the risks of maternal complications, which were rarely considered severe.
OBJETIVO: descrever as complicações maternas decorrentes dos procedimentos endoscópicos terapêuticos em Medicina fetal, realizados em um centro universitário no Brasil. MÉTODOS: estudo observacional ...retrospectivo que incluiu gestantes atendidas no período de Abril de 2007 a Maio de 2010. Esses casos foram submetidos aos seguintes procedimentos: ablação vascular placentária com laser (AVPL) por síndrome de transfusão feto-fetal (STFF) grave; oclusão traqueal fetal (OTF) e retirada de balão traqueal por via endoscópica por hérnia diafragmática congênita (HDC) grave e AVPL, com ou sem cauterização bipolar do cordão umbilical, por síndrome da perfusão arterial reversa (SPAR) em gêmeo acárdico. As principais variáveis descritas para cada condição clínica/tipo de cirurgia foram as complicações maternas e a sobrevida (alta do berçário) do neonato/lactente. RESULTADOS: cinquenta e seis gestantes foram submetidas a 70 procedimentos: STFF grave (34 pacientes; 34 cirurgias); HDC grave (16 pacientes; 30 cirurgias) e SPAR (6 pacientes; 6 cirurgias). Entre as 34 gestantes tratadas com AVPL por STFF, duas (2/34=5,9%) apresentaram perda de líquido amniótico para a cavidade peritoneal e sete (7/34=20,6%) tiveram abortamento após os procedimentos. A sobrevida de pelo menos um gêmeo foi de 64,7% (22/34). Entre as 30 intervenções realizadas para HDC, houve perda de líquido amniótico para a cavidade peritoneal materna em um caso (1/30=3,3%) e rotura prematura pré-termo de membranas após três (3/30=30%) fetoscopias para retirada do balão traqueal. A sobrevida com alta do berçário foi de 43,8% (7/16). Entre os seis casos de SPAR, houve sangramento materno para a cavidade peritoneal após uma cirurgia (1/6=16,7%) e a sobrevida com alta do berçário foi de 50% (3/6). CONCLUSÕES: em concordância com os dados disponíveis na literatura, em nosso centro, os benefícios relacionados às intervenções endoscópicas terapêuticas em casos de STFF, HDC e SPAR parecem superar os riscos de complicações maternas que, raramente, foram consideradas graves.PURPOSE: to describe the maternal complications due to therapeutic endoscopic procedures in fetal Medicine performed at an university center in Brazil. METHODS: retrospective observational study including patients treated from April 2007 to May 2010 who underwent laser ablation of placental vessels (LAPV) for severe twin-twin transfusion syndrome (TTTS); fetal tracheal occlusion (FETO) and endoscopic removal of tracheal balloon in cases of severe congenital diaphragmatic hernia (CDH); LAPV with or without bipolar coagulation of the umbilical cord in cases of twin reversed arterial perfusion (TRAP) sequence. The main variables described for each disease/type of surgery were maternal complications and neonatal survival (discharge from nursery). RESULTS: fifty-six patients underwent 70 procedures: Severe TTTS (34 patients; 34 surgeries); severe CDH (16 patients; 30 surgeries), and TRAP sequence (6 patients; 6 surgeries). Among 34 women who underwent LAPV for TTTS, two (2/34=5.9%) experienced amniotic fluid leakage to the peritoneal cavity and seven (7/34=20.6%) miscarried after the procedure. Survival of at least one twin was 64.7% (22/34). Among 30 interventions performed in cases of CDH, there was amniotic fluid leakage into the maternal peritoneal cavity in one patient (1/30=3.3%) and premature preterm rupture of membranes after three (3/30=30%) fetoscopies for removal of the tracheal balloon. Infant survival with discharge from nursery was 43.8% (7/16). Among six cases of TRAP sequence, there was bleeding into the peritoneal cavity after surgery in one patient (1/6=16.7%) and neonatal survival with discharge from nursery was 50% (3/6). CONCLUSIONS: in agreement with the available data in literature, at our center, the benefits related to therapeutic endoscopic interventions for TTTS, CDH and TRAP sequence seem to overcome the risks of maternal complications, which were rarely considered severe.
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