Objective: Multiple studies have evaluated the usefulness of F-18-FDG-PET/CT in the initial staging of breast cancer, demonstrating an important clinical impact with a change in therapeutic management. However, its ro...
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Objective: Multiple studies have evaluated the usefulness of F-18-FDG-PET/CT in the initial staging of breast cancer, demonstrating an important clinical impact with a change in therapeutic management. However, its role in current clinical practice is controversial and its use remains optional for major guidelines. Our objective is to assess the usefulness of PET/CT in this context. Material and method: The results of PET/CT in patients recently diagnosed with breast cancer (2021-2022) have been analyzed visually and semiquantitatively using SUVmax. Positive findings were confirmed by specific imaging procedures. Results: We prospectively evaluated 166 patients (59.8 +/- 12.08 years). The primary tumor was detected by PET/CT in all cases. At diagnosis, 58 patients had axillary lymph node involvement by PET/CT. Axillary ultrasound detected lymph node involvement in 79% (46/58). Furthermore, in the 46 patients with lymph node involvement detected by both tests, PET/CT increased the number of lymph node lesions, thus modifying the stage. Unsuspected distant metastases were diagnosed by PET/CT in 12 patients, 10 had axillary lymph node involvement. The variables significantly associated with a higher probability of axillary or distant metastases in PET/CT were: histological grade 2-3 (p = 0.03), elevated Ki67 (p = 0.002) and higher SUVmax of the primary lesion (p = 0.02). Conclusions: Our results suggest a potential usefulness of PET/CT in the initial staging of patients with breast cancer, particularly in those with axillary involvement, for the detection of unsuspected distant metastases.
A review of the diagnostic and therapeutic management algorithm of the pathogen Clostridioides difficile for daily practice is presented. Its diagnosis, in any unformed stool sample sent to the laboratory, is based on...
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A review of the diagnostic and therapeutic management algorithm of the pathogen Clostridioides difficile for daily practice is presented. Its diagnosis, in any unformed stool sample sent to the laboratory, is based on a two-step algorithm, with demonstration of the pathogen by means of its enzyme glutamate dehydrogenase by immunoassay and subsequent PCR (polymerase chain reaction) of its toxin. The mainstay of step therapy, reserved for symptomatic patients, is fidaxomicin, over vancomycin. Metronidazole is not an adequate treatment. Emerging therapies, such as faecal microbiota transplantation or the antibody bezlotoxumab, are gaining importance in patients with risk factors or relapses. Surgery is indicated in patients with worse prognosis and complications. Prevention is essential, based on vigilance and contact precautions, in addition to the elimination of spores from the environment.
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