Nuestros investigadores

Natalia Rodríguez-Spiteri Sagredo

Publicaciones científicas más recientes (desde 2010)

Autores: Elizalde, Arlette María; Rodríguez-Spiteri, Natalia;
Revista: REVISTA DE SENOLOGIA Y PATOLOGIA MAMARIA
ISSN 0214-1582  Vol. 30  Nº 1  2017  págs. 21 - 27
Debido a las limitaciones de la mamografía de cribado, especialmente en mamas densas, ha surgido una nueva técnica complementaria: la tomosíntesis. Esta técnica, al ser tomográfica, permite aumentar la detección de cánceres ocultos en la mamografía a la vez que puede disminuir los resultados falsos positivos provocados por superposición de imágenes. En este artículo revisamos el papel de la tomosíntesis en el cribado, analizando los 3 principales ensayos clínicos prospectivos que han tenido lugar en Europa: el ensayo OSLO, el ensayo STORM y el ensayo MALMÖ. Aunque la técnica mamográfica empleada es diferente en el estudio MALMÖ, los 3 han demostrado un significativo aumento de la sensibilidad (32, 34 y 43%, respectivamente), existiendo más diferencias en cuanto a las rellamadas (+32%, ¿27%, +43%). A pesar de que el tiempo de lectura se incrementa, parece que la técnica es coste-efectiva y contribuye poco al sobrediagnóstico, por lo que la tomosíntesis está llamada a jugar un papel importante en el cribado del cáncer de mama.
Autores: Garcia-Velloso, Maria Jose; Rodríguez-Fraile, M; et al.
Revista: EUROPEAN RADIOLOGY
ISSN 0938-7994  Vol. 27  Nº 8  2017  págs. 3190-3198
Our aim was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in primary tumour staging of patients with breast cancer. METHODS: This retrospective study evaluated 45 women with 49 pathologically proven breast carcinomas. MRI and prone PET-CT scans with time-of-flight and point-spread-function reconstruction were performed with the same dedicated breast coil. The studies were assessed by a radiologist and a nuclear medicine physician, and evaluation of fused images was made by consensus. The final diagnosis was based on pathology (90 lesions) or follow-up¿¿¿24 months (17 lesions). RESULTS: The study assessed 72 malignant and 35 benign lesions with a median size of 1.8 cm (range 0.3-8.4 cm): 31 focal, nine multifocal and nine multicentric cases. In lesion-by-lesion analysis, sensitivity, specificity, positive and negative predictive values were 97%, 80%, 91% and 93% for MRI, 96%, 71%, 87%, and 89% for prone PET, and 97%. 94%, 97% and 94% for MRI fused with PET. Areas under the curve (AUC) were 0.953, 0.850, and 0.983, respectively (p¿<¿0.01). CONCLUSIONS: MRI fused with FDG-PET is more accurate than FDG-PET in primary tumour staging of breast cancer patients and increases the specificity of MRI.
Autores: Cambeiro, Felix Mauricio; Martínez, Fernando; Rodríguez-Spiteri, Natalia; et al.
Revista: BRACHYTHERAPY
ISSN 1538-4721  Vol. 15  Nº 4  2016  págs. 485 - 494
Purpose: To assess the safety, feasibility, and efficacy of free-hand intraoperative multicatheter breast implant (FHIOMBI) and perioperative high-dose-rate brachytherapy (PHDRBT) in early breast cancer. Methods and Materials: Patients with early breast cancer candidates for breast conservative surgery (BCS) were prospectively enrolled. Patients suitable for accelerated partial breast irradiation (APBI) (low or intermediate risk according GEC-ESTRO criteria) received PHDRBT (3.4 Gy BID × 10 in 5 days). Patients not suitable for APBI (high risk patients according GEC-ESTRO criteria) received PHDRBT boost (3.4 Gy BID × 4 in 2 days) followed by whole breast irradiation. Results: From June 2007 to November 2014, 119 patients were treated and 122 FHIOMBI procedures were performed. Median duration of FHIOMBI was 25 minutes. A median of eight catheters (range, 4-14) were used. No severe intraoperative complications were observed. Severe early postoperative complications (bleeding) were documented in 2 patients (1.6%), wound healing complications in 3 (2.4%), and infection (mastitis or abscess) in 2 (1.6%). PHDRBT was delivered as APBI in 88 cases (72.1%) and as a boost in 34 (27.8%). The median clinical target volume T was 40.8 cc (range, 12.3-160.5); median D90 was 3.32 Gy (range, 3.11-3.85); median dose homogeneity index was 0.72 (range, 0.48-0.82). With a median followup of 38.4 months (range, 8.7-98.7) no local, elsewhere, or regional relapses were observed; there was only one distant failure in PHDRBT boost. No major (acute or late) RTOG grade 3 or higher were documented in any of the 119 patients treated with PHDRBT. Cosmetic outcome in APBI patients was excellent or good in (87.0%) and fair or poor in (11.9%) while in boost patients was excellent or good in (76.4%) and fair in (23.5%). Conclusion: The FHIOMBI-PHDRBT program does not add complications to conservative surgery. It allows precise selection of APBI patients and offers excellent results in disease control and cosmetics. It also offers logistic advantages because it dramatically shortens the time of local treatment and avoids further invasive procedures.
Autores: Elizalde, Arlette María; Rodríguez-Spiteri, Natalia;
Revista: REVISTA DE SENOLOGIA Y PATOLOGIA MAMARIA
ISSN 0214-1582  Vol. 29  Nº 2  2016  págs. 69-74
La mamografía es la técnica habitual para el cribado poblacional del cáncer de mama. Sin embargo, la sensibilidad mamográfica disminuye mucho en las mamas densas, pudiendo ser de tan solo el 50%. En estos casos la ecografía complementaria puede jugar un papel importante al mejorar la sensibilidad, llegando a tasas de detección de cáncer de hasta el 0,3%. Sin embargo, la ecografía disminuye la especificidad y aumenta la tasa de rellamadas y de biopsias. La ecografía manual es operador dependiente, obliga a emplear mucho tiempo de radiólogo y no permite una revisión retrospectiva. La ecografía automatizada permite solventar varias de estas limitaciones, por lo que puede llegar a emplearse en el cribado como técnica adicional a la mamografía, especialmente en el caso de las mamas densas.
Autores: Murillo Jaso, L.; Rodríguez-Spiteri, Natalia; et al.
Revista: JOURNAL OF CLINICAL ONCOLOGY
ISSN 0732-183X  Vol. 33  Nº 15 Supl.  2015  págs. e11617
Background: Amplification of the HER-2 gene occurs in 20% of breast cancer (BC) patients (pts). Trastuzumab administered concurrently with chemotherapy (CT) is the standard of care in the neoadjuvant setting. Moreover, the use of a combination of antiHER2 therapies with CT are related to an increased pCR, which could be a surrogate marker for survival. Methods: We retrospectively analyzed three historic cohorts with overexpressing HER2 BC. They received neoadjuvant CT based on dose dense anthracyclines followed by three schedules of antiHER2 therapy: 1) docetaxel plus trastuzumab (DT; n = 33 pts); 2) DT plus CBDCA (DTP; n = 17 pts); and 3) DT plus double blockade with triweekly pertuzumab or daily L (750mg/day; n = 12) (DTD; n = 14) before surgery. Study endpoints were safety, pCR (breast + axilla) based on Miller&Payne criteria and DFS. Results: Sixty-four pts with HER2 overexpressing BC were studied since 2005. Baseline characteristics were well balanced. The median age was 48 (range 23-80). Coexpression of ER and HER2 in each cohort was 48% in DT, 53%% in DTP and 57% DTD (p = 0.855) as well as initial BC stages (p = 0.64). Grade 3-4 toxicity in DT, DTP and DTD were respectively: asthenia 0%, 5.8% and 0% (p = 0.71), hand-foot syndrome 3%, 5.8% and 0% in DT, DTP and DTD (p = 0.719), anemia 0%, 5.8% and 0% (p = 0.71) leukopenia 6%, 11.7% and 0% in DTD (p = 0.60) and diarrhea in 35.7% in DTD (p = 0.002). We did not find differences in pCR (42.4% in the DT, 29.4%% in the DTP and 42.8% in DTD cohorts; p = 0.67), axillar response (type D) was significantly superior in the DTD cohort with the followed distribution of 51.1%, 52.9% and 85.7% respectively (p = 0.04). However breast responses were similar in the three cohorts (p = 0.9). With a median follow-up of 72, 90 and 21 months respectively, the number of pts who progressed were 12.1%, 11.7% and 0% in DT, DTP and DTD. Conclusions: We did not find differences in pCR in any cohort. The best significant axillary responses were in the DTD cohort, however this fact did not impact in total pCR. DTD cohort has more gastrointestinal toxicity. To date, median survival has not been reached.
Autores: Rodríguez-Spiteri, Natalia; Torre, Wenceslao; et al.
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 36  Nº 1  2013  págs. 141 - 144
Background. Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. Methods. We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. Results. It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. Conclusion. The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment.
Autores: Rodríguez-Spiteri, Natalia; Martínez, Fernando; Olartecoechea, Begoña; et al.
Revista: CIRUGIA ESPAÑOLA
ISSN 0009-739X  Vol. 91  Nº 8  2013  págs. 490 - 495
Introduction: Accelerated partial breast irradiation (APBI) with multicatheters after lumpectomy for breast cancer (BC) may be an alternative to whole breast irradiation in selected patients. The aim is to show our 5 year experience. Method: Between June 2007 and June 2012, 87 BC patients have been evaluated for APBI. Inclusion criteria were: age over 40 years, unifocal tumour, infiltrating ductal or intraductal carcinoma, tumour size smaller than 3 cm and no lymph node involvement. Complications, cosmetic results and local and distant recurrences were evaluated. Results: Treatment was completed in 48 patients and contraindicated in 39. The average age of treated patients was 59 years. Operating time was 123. min with 9 implanted catheters in each patient. No complications were observed during surgery or radiotherapy. Patients were discharged from hospital after 4 days. Tumour size was 11. mm. Of these, 35 were infiltrating ductal and 13 intraductal carcinomas. A total of 44 patients received adjuvant treatment. Mean follow-up was 22 months with no evidence of local or distant recurrence. The cosmetic outcome was good or excellent in 66% of cases. Conclusions: APBI with multicatheter placed after lumpectomy for BC is feasible and safe but requires a strict selection of patients.
Autores:  et al.
Revista: RADIOLOGIA
ISSN 0033-8338  Vol. 54  Nº 4  2012  págs. 350 - 356
Objective: To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. Material and methods: We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. Results: The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). Conclusion: When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance
Autores: Inoges S; et al.
Revista: CANCER RESEARCH
ISSN 0008-5472  Vol. 72  Nº Sup.24  2012 
Autores: Garcia-Velloso, Maria Jose; et al.
Revista: JOURNAL OF NUCLEAR MEDICINE
ISSN 0161-5505  Vol. 51  Nº Supl. 2  2010  págs. 1197
Objectives Sentinel node biopsy (SNB) has become a standard treatment in staging axillary lymph nodes in early breast cancer. However, SNB is an invasive procedure. Breast cancer is frequently characterised by increased 18FDG uptake and many studies have shown encouraging results in detecting axillary lymph node metastases. The aim of this study was to compare SNB and positron emission tomography/computed tomography (PET/CT) imaging, to assess their values in detecting occult axillary metastases. Methods Forty-nine women (mean age 55-year old) with 50 breast cancer (mean primary tumor size 1.97 cm) and clinically negative axilla were enrolled in the study. 18FDG PET was carried out before surgery, using a PET/CT scanner. In all patients, SNB was carried out after identification through lymphoscintigraphy. Patients underwent axillary lymph nodes dissection (ALND) in cases of positive SNB. The results of PET scan were compared with histopathology of SNB and ALND. Results In all, 23 out of the 49 patients (47%) had metastases in axillary nodes. The standardized uptake value (SUV) was related to the histological grading (2.6±1.1 in well differentiated vs 3.7±3.1 in poorly differentiated). Sensitivity of FDG-PET scan for detection of axillary lymph node metastases in this series was very low (13%) due to 7 false negative in micrometastases and 6 false negative in immunohistochemistry metastases. Positive predictive value was 75% due to a false positive diagnosis. However, specificity was acceptable (96%). Conclusions The high specificity of PET/CT imaging indicates that patients who have a PET-positive axilla should have an ALND rather than an SNB for axillary staging. In contrast, FDG-PET showed poor sensitivity in the detection of axillary metastases, confirming the need for SNB in cases where PET is negative in the axilla
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 577-591
Autores: Rodríguez-Spiteri, Natalia; Martínez, Fernando;
Libro:  Senología. La mama normal y su patología
2010  págs. 21-25
Autores: Sola, Jesús Javier; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 176-188
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 395-406
Autores: Sola, Jesús Javier; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 351-374
Autores: Rodríguez-Spiteri, Natalia; Martínez, Fernando;
Libro:  Senología: la mama normal y su patología
2010  págs. 597-601
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 504-524
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 377-393
Autores: Rodríguez-Spiteri, Natalia;
Título: Dolor mamario
Libro:  Senología: la mama normal y su patología
2010  págs. 106-110
Autores: Rodríguez-Spiteri, Natalia;
Título: Mamografía
Libro:  Senología : la mama normal y su patologia
2010  págs. 42-50
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 147-154
Autores: Rodríguez-Spiteri, Natalia;
Título: Tumor mamario
Libro:  Senología: la mama normal y su patología
2010  págs. 111-117
Autores: Martínez, Fernando; Rodríguez-Spiteri, Natalia;
Libro:  Senología: la mama normal y su patología
2010  págs. 119-125