Interesting images
Use of 125I seeds in the surgical management of a complex oncological case
Uso de semillas de 125I en el manejo quirúrgico de un caso oncológico complejo
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Subsequent post-therapeutic monitoring images (B & D) of improved lung cancer, resolved bone metastasis and resolved muscle uptake.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.V. Khuong, B.D. Nguyen" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.V." "apellidos" => "Khuong" ] 1 => array:2 [ "nombre" => "B.D." 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Castillo-Simón, M. Tormo-Ratera, A. Ferrer-Fuertes, F.J. Cuesta-González, S. Vidal-Sicart" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A.G." "apellidos" => "Castillo-Simón" "email" => array:1 [ 0 => "gadeacassim@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Tormo-Ratera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ferrer-Fuertes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F.J." "apellidos" => "Cuesta-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Vidal-Sicart" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine, Hospital Clinic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Oral and Maxillofacial Surgery, Hospital Clinic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institut de investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de semillas de <span class="elsevierStyleSup">125</span>I en el manejo quirúrgico de un caso oncológico complejo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 476 "Ancho" => 1305 "Tamanyo" => 73728 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SPECT/CT axial and volumetric reconstruction images showing the localization of the <span class="elsevierStyleSup">125</span>I seeds placed, under ultrasound guidance, in the occipital and retroauricular lymph nodes the day before surgery, which also defined the suspected area of malignant tissue planned to be resected.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 65 year-old male patient diagnosed in march 2020 of a retroauricular superficial spreading malignant melanoma (MM) (Breslow 7.5<span class="elsevierStyleHsp" style=""></span>mm) with evidence of multiple skin metastases in the wide local excision; further systemic evaluation did not show evidence of distant metastases. In January 2021 lateral cervical lymphadenectomy was performed due to an increased tracer uptake in three cervical lymph nodes in a follow-up <span class="elsevierStyleSup">18</span>F-FDG PET/CT (not showed). Histopathology confirmed malignancy in 4 out of the 41 lymph nodes removed, resulting in a IIID pathologic stage. Consequently, a multidisciplinary committee decided to initiate adjuvant therapy with nivolumab.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Eight months later, disease progression was suspected; therefore neck CT was carried out which identified two enlarged lymph nodes (left retroauricular and occipital) and fat stranding between them; ultrasound-guided fine needle aspiration (FNA) biopsy of one of the nodes was malignant. Afterwards, a <span class="elsevierStyleSup">18</span>F-FDG PET/CT confirmed the increased metabolism of the previously described lymph nodes and a mild uptake in surrounding tissue between them, but without and overt evidence of other FDG avid lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">As a result of these findings, nivolumab treatment was stopped and surgical treatment was considered. Thus, the patient was referred to our department in order to carry out a radioguided excision of the impalpable nodes using <span class="elsevierStyleSup">125</span>I seeds, which also helped to define and resect the suspected area of malignant tissue between them (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Nowadays, it is well known the use of <span class="elsevierStyleSup">125</span>I seeds for the localization of impalpable breast lesions, as well as in targeted axillary dissection (TAD) after neoadjuvant chemotheraphy in breast cancer patients with lymph node positivity, among others.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a> However, the use of this novel technique is exponentially increasing, becoming a very reliable tool helping surgeons to effectively identify and resect targeted lesions in various oncologic cases. This new role could be explained by the increasing use of sophisticated imaging techniques (such as PET/CT), which are able to more frequently detect small or occult lesions.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> As a result, the surgeon is placed at the center of clinical enigmas regarding the management of these patients, sometimes requiring preoperative image-guided localization and/or radioguided surgical excision. The use of <span class="elsevierStyleSup">125</span>I seeds in the surgical management of the complex oncological cases could become a key technique due to the fact that its use can define not only the targeted lesion but also a potential involved area to be resected (bracketing).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1190 "Ancho" => 1175 "Tamanyo" => 145122 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET/CT axial images (a–c) and emission-based attenuation correction PET axial image (d) performed after a positive FNA biopsy of an enlarged lymph node identified on neck CT. (a) Increased metabolism of the occipital lymph node; (b) increased metabolism of the retroauricular lymph node; (c, d) increased uptake of the tissue surrounding the two lymph nodes, which correlates with the area of fat stranding showed in the previous neck CT.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 476 "Ancho" => 1305 "Tamanyo" => 73728 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SPECT/CT axial and volumetric reconstruction images showing the localization of the <span class="elsevierStyleSup">125</span>I seeds placed, under ultrasound guidance, in the occipital and retroauricular lymph nodes the day before surgery, which also defined the suspected area of malignant tissue planned to be resected.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1746 "Ancho" => 1305 "Tamanyo" => 337186 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a, b) Gamma probe guiding the position of the <span class="elsevierStyleSup">125</span>I retroauricular seed during the surgical procedure, helping the surgeon to decide the proper skin incision (a) and localizing the retroauricular node (b). (c) Visualization of the <span class="elsevierStyleSup">125</span>I occipital seed in the surgical field after localization with the gamma probe. (d) Dissection of the retroauricular node in the Pathology department that shows the <span class="elsevierStyleSup">125</span>I seed, before collecting the seeds back to the Nuclear Medicine department.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioactive seed localisation to guide removal of impalpable lymph nodes (Radioguided Occult Lesion Localisation using Iodine-125 seeds “ROLLIS”)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Jackson" 1 => "A.G. Bourke" 2 => "F. Abdul Aziz" 3 => "D. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2013-203267" "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2014" "volumen" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioguided surgery of non palpable lesions: we have much to sow" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Goñi" 1 => "P. Paredes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2019.09.006" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "341" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31767162" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radio-guided occult lesion localisation using iodine 125 Seeds “ROLLIS” to guide surgical removal of an impalpable posterior chest wall melanoma metastasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Dissanayake" 1 => "D. Dissanayake" 2 => "D.B. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jmrs.125" "Revista" => array:7 [ "tituloSerie" => "J Med Radiat Sci" "fecha" => "2015" "volumen" => "62" "paginaInicial" => "230" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26451246" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673606690107" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004200000002/v2_202311010503/S2253808922000283/v2_202311010503/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004200000002/v2_202311010503/S2253808922000283/v2_202311010503/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808922000283?idApp=UINPBA00004N" ]
