Introdução: A incidência do melanoma cutâneo (MC) está crescendo mais rapidamente que a de qualquer outro câncer. Devido ao seu potencial para metástases e à falta de terapias efetivas para a maioria dos pacientes em estágio avançado, o diagnóstico precoce do MC é crucial. Alguns dos fatores prognósticos mais importantes no MC são a espessura de Breslow e a presença de metástase linfonodal. O Tecnécio-99m-sestamibi (MIBI) é um radiofármaco usado rotineiramente em cintilografias miocárdicas e tem conhecidas propriedades para detecção de tumores malignos, incluindo câncer de mama, tumores cerebrais e melanomas primários e metastáticos. Objetivo: Avaliar a correlação entre a espessura de Breslow e a intensidade da captação de MIBI (IC-MIBI) em lesões primárias de MC. Métodos: Foram selecionados pacientes com lesões clinica e dermatoscopicamente suspeitas de MC. Os pacientes receberam uma injeção intravenosa de 740 – 1110 MBq (20 mCi) de MIBI. Após 10 minutos, o equipamento gamma-probe foi usado para detectar a IC-MIBI na lesão cutânea e em 2 pontos equidistantes na pele normal. A razão entre as contagens radioativas na lesão e a média da pele normal foi considerada a IC-MIBI. A seguir, pacientes realizaram SPECT (Single Photon Emission Computed Tomography) do local da lesão e da região linfonodal correspondente. Exérese da lesão cutânea e exame anatomopatológico foram então realizados. Pacientes portadores de lesões com Breslow > 1 mm ou < 1mm com ulceração/regressão espontânea realizaram biópsia do linfonodo sentinela. Resultados: Dezesseis pacientes com 20 lesões foram estudados (8 homens, 8 mulheres, de 34 – 81 anos, média 61 anos). Quatorze lesões eram melanomas e 6 eram nevos melanocíticos (NM). Cinco lesões eram melanomas in situ. A média da espessura de Breslow foi de 0,45 mm (variação: 0,30 – 14,90 mm). A média da IC-MIBI foi 1,54 (±0.58) contagens radioativas nos MC e 1,04 (±0.10) nos NM (P = 0.007). Houve forte correlação positiva entre a IC-MIBI e a espessura de Breslow (rs = 0.74, P= 0.003). Analisando as lesões em categorias de Breslow, houve diferença estatisticamente significativa (P < 0.001) entre as lesões com Breslow < 1mm (IC-MIBI = 1.23 ± 0.28 contagens radioativas) e Breslow > 1 mm (IC-MIBI = 2.32 ± 0.32 contagens radioativas). Nenhum dos NM apareceu nas imagens de SPECT. Dos MC, 4 lesões, que apresentavam Breslow > 1mm, apareceram nas imagens de SPECT. Conclusão: Neste estudo, embora tenha demonstrado uma diferença significativa entre melanomas finos (< 1mm) e espessos (> 1mm), a IC-MIBI no local da lesão não foi diferente entre NM e melanomas finos ou in situ. Por isso, MIBI parece ser útil principalmente em melanomas espessos, o que também foi confirmado pela positividade do SPECT apenas nestes casos. Entretanto, a possibilidade de correlacionar a IC-MIBI com categorias de Breslow pode facilitar os procedimentos cirúrgicos, permitindo a remoção de melanomas com margens cirúrgicas adequadas e a realização ou não de biópsia de linfonodo sentinela em um mesmo momento cirúrgico, reduzindo morbidade e custos. / Introduction: Given its propensity to metastasize, and lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. The most important prognostic factors are Breslow thickness and nodal metastases. Technetium-99m-sestamibi (MIBI) is a radiopharmaceutical used routinely for cardiologic scintigraphy and has also well-known tumor-seeking properties. It has been used successfully to detect various tumors, including breast cancer, brain tumors, and primary and metastatic melanoma. Objetive: This study has been designed in order to evaluate the correlation between Breslow thickness and MIBI uptake by primary CM lesions. Methods: Patients were recruited by a dermatologist on the grounds of a clinically and dermoscopically suspicious melanocytic lesion. Patients received intravenous injection of 740 – 1110 MBq (20 mCi) of MIBI. After 10 minutes, gamma-probe was used to detect the intensity of MIBI uptake by the cutaneous lesion and at two equidistant points on normal skin. The ratio number of radioactive counts at cutaneous lesion / mean of radioactive counts at normal skin was considered to determinate the MIBI uptake intensity (MIBI-UI). Then, SPECT imaging of the lesion site and respective lymph node region was obtained. After scintigraphy, exeresis of the cutaneous lesion and histological analysis were performed. Lesions with Breslow thickness > 1 mm or < 1 mm with ulceration/spontaneous regression underwent sentinel lymph node biopsy. Results: Sixteen patients with 20 lesions were investigated (8 males, 8 females, age range 34 – 81 years, mean 61 years). Fourteen lesions were CM and 6 were melanocytic nevi (MN). Five lesions were melanoma in situ. Breslow thickness median was 0.45 mm (range 0.30 - 14,9 mm). The mean MIBI-UI was 1.54 (±0.58) radioactive counts in CM and 1.04 (±0.10) radioactive counts in MN (P = 0.007). There was strong positive correlation between MIBI-UI and Breslow thickness (rs = 0.74, P= 0.003). Grouping the lesions on Breslow categories, there was a statistically significant difference (P < 0.001) between lesions with Breslow thickness < 1 mm (MIBI-UI = 1.23 ± 0.28 radioactive counts) and Breslow thickness > 1 mm (MIBI-UI = 2.32 ± 0.32 radioactive counts). None of the MN appeared at SPECT images. Of melanomas, 4 (28,6%) were SPECT positive at cutaneous site. All those were Breslow thickness > 1 mm. Conclusion: On this study, although there is a significant difference between thin (< 1 mm) and thick (> 1 mm) melanomas, MIBI intensity at the lesion site is not different between benign nevus and in situ or thin melanomas. Then, MIBI seems to be useful mainly in thick melanomas, as also confirmed by the positivity of the SPECT image only in these cases. However, the possibility of correlating MIBI uptake intensity with Breslow categories may facilitate surgical procedures, allowing to remove melanomas with appropriated surgical margins and to perform or not sentinel lymph node biopsy in the same surgical time, reducing morbidity and cost.

Introdução: A incidência do melanoma cutâneo (MC) está crescendo mais rapidamente que a de qualquer outro câncer. Devido ao seu potencial para metástases e à falta de terapias efetivas para a maioria dos pacientes em estágio avançado, o diagnóstico precoce do MC é crucial. Alguns dos fatores prognósticos mais importantes no MC são a espessura de Breslow e a presença de metástase linfonodal. O Tecnécio-99m-sestamibi (MIBI) é um radiofármaco usado rotineiramente em cintilografias miocárdicas e tem conhecidas propriedades para detecção de tumores malignos, incluindo câncer de mama, tumores cerebrais e melanomas primários e metastáticos. Objetivo: Avaliar a correlação entre a espessura de Breslow e a intensidade da captação de MIBI (IC-MIBI) em lesões primárias de MC. Métodos: Foram selecionados pacientes com lesões clinica e dermatoscopicamente suspeitas de MC. Os pacientes receberam uma injeção intravenosa de 740 – 1110 MBq (20 mCi) de MIBI. Após 10 minutos, o equipamento gamma-probe foi usado para detectar a IC-MIBI na lesão cutânea e em 2 pontos equidistantes na pele normal. A razão entre as contagens radioativas na lesão e a média da pele normal foi considerada a IC-MIBI. A seguir, pacientes realizaram SPECT (Single Photon Emission Computed Tomography) do local da lesão e da região linfonodal correspondente. Exérese da lesão cutânea e exame anatomopatológico foram então realizados. Pacientes portadores de lesões com Breslow > 1 mm ou < 1mm com ulceração/regressão espontânea realizaram biópsia do linfonodo sentinela. Resultados: Dezesseis pacientes com 20 lesões foram estudados (8 homens, 8 mulheres, de 34 – 81 anos, média 61 anos). Quatorze lesões eram melanomas e 6 eram nevos melanocíticos (NM). Cinco lesões eram melanomas in situ. A média da espessura de Breslow foi de 0,45 mm (variação: 0,30 – 14,90 mm). A média da IC-MIBI foi 1,54 (±0.58) contagens radioativas nos MC e 1,04 (±0.10) nos NM (P = 0.007). Houve forte correlação positiva entre a IC-MIBI e a espessura de Breslow (rs = 0.74, P= 0.003). Analisando as lesões em categorias de Breslow, houve diferença estatisticamente significativa (P < 0.001) entre as lesões com Breslow < 1mm (IC-MIBI = 1.23 ± 0.28 contagens radioativas) e Breslow > 1 mm (IC-MIBI = 2.32 ± 0.32 contagens radioativas). Nenhum dos NM apareceu nas imagens de SPECT. Dos MC, 4 lesões, que apresentavam Breslow > 1mm, apareceram nas imagens de SPECT. Conclusão: Neste estudo, embora tenha demonstrado uma diferença significativa entre melanomas finos (< 1mm) e espessos (> 1mm), a IC-MIBI no local da lesão não foi diferente entre NM e melanomas finos ou in situ. Por isso, MIBI parece ser útil principalmente em melanomas espessos, o que também foi confirmado pela positividade do SPECT apenas nestes casos. Entretanto, a possibilidade de correlacionar a IC-MIBI com categorias de Breslow pode facilitar os procedimentos cirúrgicos, permitindo a remoção de melanomas com margens cirúrgicas adequadas e a realização ou não de biópsia de linfonodo sentinela em um mesmo momento cirúrgico, reduzindo morbidade e custos. / Introduction: Given its propensity to metastasize, and lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. The most important prognostic factors are Breslow thickness and nodal metastases. Technetium-99m-sestamibi (MIBI) is a radiopharmaceutical used routinely for cardiologic scintigraphy and has also well-known tumor-seeking properties. It has been used successfully to detect various tumors, including breast cancer, brain tumors, and primary and metastatic melanoma. Objetive: This study has been designed in order to evaluate the correlation between Breslow thickness and MIBI uptake by primary CM lesions. Methods: Patients were recruited by a dermatologist on the grounds of a clinically and dermoscopically suspicious melanocytic lesion. Patients received intravenous injection of 740 – 1110 MBq (20 mCi) of MIBI. After 10 minutes, gamma-probe was used to detect the intensity of MIBI uptake by the cutaneous lesion and at two equidistant points on normal skin. The ratio number of radioactive counts at cutaneous lesion / mean of radioactive counts at normal skin was considered to determinate the MIBI uptake intensity (MIBI-UI). Then, SPECT imaging of the lesion site and respective lymph node region was obtained. After scintigraphy, exeresis of the cutaneous lesion and histological analysis were performed. Lesions with Breslow thickness > 1 mm or < 1 mm with ulceration/spontaneous regression underwent sentinel lymph node biopsy. Results: Sixteen patients with 20 lesions were investigated (8 males, 8 females, age range 34 – 81 years, mean 61 years). Fourteen lesions were CM and 6 were melanocytic nevi (MN). Five lesions were melanoma in situ. Breslow thickness median was 0.45 mm (range 0.30 - 14,9 mm). The mean MIBI-UI was 1.54 (±0.58) radioactive counts in CM and 1.04 (±0.10) radioactive counts in MN (P = 0.007). There was strong positive correlation between MIBI-UI and Breslow thickness (rs = 0.74, P= 0.003). Grouping the lesions on Breslow categories, there was a statistically significant difference (P < 0.001) between lesions with Breslow thickness < 1 mm (MIBI-UI = 1.23 ± 0.28 radioactive counts) and Breslow thickness > 1 mm (MIBI-UI = 2.32 ± 0.32 radioactive counts). None of the MN appeared at SPECT images. Of melanomas, 4 (28,6%) were SPECT positive at cutaneous site. All those were Breslow thickness > 1 mm. Conclusion: On this study, although there is a significant difference between thin (< 1 mm) and thick (> 1 mm) melanomas, MIBI intensity at the lesion site is not different between benign nevus and in situ or thin melanomas. Then, MIBI seems to be useful mainly in thick melanomas, as also confirmed by the positivity of the SPECT image only in these cases. However, the possibility of correlating MIBI uptake intensity with Breslow categories may facilitate surgical procedures, allowing to remove melanomas with appropriated surgical margins and to perform or not sentinel lymph node biopsy in the same surgical time, reducing morbidity and cost.

Introdução: A incidência do melanoma cutâneo (MC) está crescendo mais rapidamente que a de qualquer outro câncer. Devido ao seu potencial para metástases e à falta de terapias efetivas para a maioria dos pacientes em estágio avançado, o diagnóstico precoce do MC é crucial. Alguns dos fatores prognósticos mais importantes no MC são a espessura de Breslow e a presença de metástase linfonodal. O Tecnécio-99m-sestamibi (MIBI) é um radiofármaco usado rotineiramente em cintilografias miocárdicas e tem conhecidas propriedades para detecção de tumores malignos, incluindo câncer de mama, tumores cerebrais e melanomas primários e metastáticos. Objetivo: Avaliar a correlação entre a espessura de Breslow e a intensidade da captação de MIBI (IC-MIBI) em lesões primárias de MC. Métodos: Foram selecionados pacientes com lesões clinica e dermatoscopicamente suspeitas de MC. Os pacientes receberam uma injeção intravenosa de 740 – 1110 MBq (20 mCi) de MIBI. Após 10 minutos, o equipamento gamma-probe foi usado para detectar a IC-MIBI na lesão cutânea e em 2 pontos equidistantes na pele normal. A razão entre as contagens radioativas na lesão e a média da pele normal foi considerada a IC-MIBI. A seguir, pacientes realizaram SPECT (Single Photon Emission Computed Tomography) do local da lesão e da região linfonodal correspondente. Exérese da lesão cutânea e exame anatomopatológico foram então realizados. Pacientes portadores de lesões com Breslow > 1 mm ou < 1mm com ulceração/regressão espontânea realizaram biópsia do linfonodo sentinela. Resultados: Dezesseis pacientes com 20 lesões foram estudados (8 homens, 8 mulheres, de 34 – 81 anos, média 61 anos). Quatorze lesões eram melanomas e 6 eram nevos melanocíticos (NM). Cinco lesões eram melanomas in situ. A média da espessura de Breslow foi de 0,45 mm (variação: 0,30 – 14,90 mm). A média da IC-MIBI foi 1,54 (±0.58) contagens radioativas nos MC e 1,04 (±0.10) nos NM (P = 0.007). Houve forte correlação positiva entre a IC-MIBI e a espessura de Breslow (rs = 0.74, P= 0.003). Analisando as lesões em categorias de Breslow, houve diferença estatisticamente significativa (P < 0.001) entre as lesões com Breslow < 1mm (IC-MIBI = 1.23 ± 0.28 contagens radioativas) e Breslow > 1 mm (IC-MIBI = 2.32 ± 0.32 contagens radioativas). Nenhum dos NM apareceu nas imagens de SPECT. Dos MC, 4 lesões, que apresentavam Breslow > 1mm, apareceram nas imagens de SPECT. Conclusão: Neste estudo, embora tenha demonstrado uma diferença significativa entre melanomas finos (< 1mm) e espessos (> 1mm), a IC-MIBI no local da lesão não foi diferente entre NM e melanomas finos ou in situ. Por isso, MIBI parece ser útil principalmente em melanomas espessos, o que também foi confirmado pela positividade do SPECT apenas nestes casos. Entretanto, a possibilidade de correlacionar a IC-MIBI com categorias de Breslow pode facilitar os procedimentos cirúrgicos, permitindo a remoção de melanomas com margens cirúrgicas adequadas e a realização ou não de biópsia de linfonodo sentinela em um mesmo momento cirúrgico, reduzindo morbidade e custos. / Introduction: Given its propensity to metastasize, and lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. The most important prognostic factors are Breslow thickness and nodal metastases. Technetium-99m-sestamibi (MIBI) is a radiopharmaceutical used routinely for cardiologic scintigraphy and has also well-known tumor-seeking properties. It has been used successfully to detect various tumors, including breast cancer, brain tumors, and primary and metastatic melanoma. Objetive: This study has been designed in order to evaluate the correlation between Breslow thickness and MIBI uptake by primary CM lesions. Methods: Patients were recruited by a dermatologist on the grounds of a clinically and dermoscopically suspicious melanocytic lesion. Patients received intravenous injection of 740 – 1110 MBq (20 mCi) of MIBI. After 10 minutes, gamma-probe was used to detect the intensity of MIBI uptake by the cutaneous lesion and at two equidistant points on normal skin. The ratio number of radioactive counts at cutaneous lesion / mean of radioactive counts at normal skin was considered to determinate the MIBI uptake intensity (MIBI-UI). Then, SPECT imaging of the lesion site and respective lymph node region was obtained. After scintigraphy, exeresis of the cutaneous lesion and histological analysis were performed. Lesions with Breslow thickness > 1 mm or < 1 mm with ulceration/spontaneous regression underwent sentinel lymph node biopsy. Results: Sixteen patients with 20 lesions were investigated (8 males, 8 females, age range 34 – 81 years, mean 61 years). Fourteen lesions were CM and 6 were melanocytic nevi (MN). Five lesions were melanoma in situ. Breslow thickness median was 0.45 mm (range 0.30 - 14,9 mm). The mean MIBI-UI was 1.54 (±0.58) radioactive counts in CM and 1.04 (±0.10) radioactive counts in MN (P = 0.007). There was strong positive correlation between MIBI-UI and Breslow thickness (rs = 0.74, P= 0.003). Grouping the lesions on Breslow categories, there was a statistically significant difference (P < 0.001) between lesions with Breslow thickness < 1 mm (MIBI-UI = 1.23 ± 0.28 radioactive counts) and Breslow thickness > 1 mm (MIBI-UI = 2.32 ± 0.32 radioactive counts). None of the MN appeared at SPECT images. Of melanomas, 4 (28,6%) were SPECT positive at cutaneous site. All those were Breslow thickness > 1 mm. Conclusion: On this study, although there is a significant difference between thin (< 1 mm) and thick (> 1 mm) melanomas, MIBI intensity at the lesion site is not different between benign nevus and in situ or thin melanomas. Then, MIBI seems to be useful mainly in thick melanomas, as also confirmed by the positivity of the SPECT image only in these cases. However, the possibility of correlating MIBI uptake intensity with Breslow categories may facilitate surgical procedures, allowing to remove melanomas with appropriated surgical margins and to perform or not sentinel lymph node biopsy in the same surgical time, reducing morbidity and cost.

Made available in DSpace on 2016-03-22T17:26:57Z (GMT). No. of bitstreams: 1 Neivo.pdf: 343535 bytes, checksum: e65c41380c8ceabe9bc780ffcc1c99f1 (MD5) Previous issue date: 2005-02-14 / Objective: The objective of this study is to describe the reproducibility of the sentinel lymph node technique in patients with prostate cancer and verify if there is improved accuracy over modified lymphadenectomy. Material and methods: Twenty-three patients with biopsy proven prostate cancer were enrolled in this study. Lymphoscintigraphy was performed after the transrectal administration of 99mTc-Sulphur Colloid guided by ultrasound, with one injection in each prostate lobe. Images were obtained 15 and 180 minutes after injection. Sentinel lymph node was harvested during surgery using a gamma probe, followed by extended lymphadenectomy. Results: The mean age of the patients in this study was 66 years old. An average of 3.36 sentinel lymph nodes was found for each patient. Radioactive lymph nodes were identified by the gamma probe in 21 out of 23 patients. In one of the patients there was no radiopharmaceutical migration from the injection site and in another the sentinel lymph node was visualized by lymphoscintigraphy but was not found during surgery. Three patients had lymph node metastasis; in one of these patients the sentinel lymph node was the only positive node and was found outside the modified lymphadenectomy region (dissection of the lymph nodes from the obturator fossa and the external iliac). Conclusion: Sentinel lymph node biopsy in prostate cancer adds important information to the staging of patients, not always attained through the lymphadenectomy restricted to the obturator fossa and external iliac. Such information is essencial for the choice of the best treatment to be applied. / n