Background: This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. Methods: A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. Results: The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions’ intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.

Resumo A Medicina Nuclear desempenha um importante papel no manejo de pacientes com doenças crônicas, especialmente oncológicas e cardiovasculares. Neste estudo, foi realizada uma análise da evolução da área no Brasil, no âmbito do Sistema Único de Saúde. Para tanto, foram realizadas análises restrospectivas entre 2015 e 2021 de dados públicos. Embora o Brasil possua uma quantidade considerável de instalações, sua distribuição geográfica é desigual. A mesma disparidade é observada em relação às unidades produtoras e distribuidoras de radiofármacos, limitando o acesso da população brasileira, particularmente àqueles com meia-vida inferior a duas horas. Percebe-se a alta dependência tecnológica de empresas estrangeiras, com pouca ou nenhuma produção nacional, o que contribui para o déficit na balança comercial. Apesar das possíveis demandas crescentes sobre a área devido a fatores como o envelhecimento da população e mudanças epidemiológicas a área não se expandiu. É crucial implementar políticas sociais e econômicas voltadas à área para reduzir as vulnerabilidades do sistema de saúde, assegurar sua sustentabilidade e promover um acesso igualitário e universal aos serviços de Medicina Nuclear.

Nuclear Medicine plays an important role in the management of patients with chronic diseases, especially oncological and cardiovascular conditions. In this study, an analysis of the evolution of this field in Brazil was conducted within the framework of the Unified Health System. Retrospective analyses from 2015 to 2021 of public data were performed. Although Brazil has a considerable number of facilities, their geographical distribution is uneven. The same disparity is observed in relation to units that produce and distribute radiopharmaceuticals, limiting access for the Brazilian population, particularly to those with a half-life of less than two hours. There is a noticeable high technological dependence on foreign companies, with little or no domestic production, contributing to a deficit in the trade balance. Despite the increasing demands due to factors such as population aging and epidemiological changes, the area did not expand. It is crucial to implement social and economic policies to reduce vulnerabilities in the public healthcare system, ensure its sustainability, and promote equal and universal access to Nuclear Medicine.

A Medicina Nuclear é crucial para o cuidado de pacientes com doenças, especialmente oncológicas e cardiovasculares. No entanto, o acesso a ela é desigual, devido à falta de equipamentos e unidades produtoras e fornecedoras de insumos. As legislações atuais não abordam adequadamente esses aspectos, e o domínio do capital externo é uma preocupação, pois pode levar ao sucateamento do parque atual. A produção nacional de radiofármacos tem sofrido inúmeros reveses, como cortes orçamentários, a abertura indiscriminada de mercado e o atraso na conclusão do projeto do Reator Multipropósito Brasileiro. Foram analisados dados públicos de 2015 a 2021 para avaliar o acesso à Medicina Nuclear pelo SUS, incluindo o número de instalações, procedimentos, tarifas e balança comercial. Embora o Brasil tenha muitas instalações de Medicina Nuclear, sua distribuição geográfica é extremamente desigual. Fatores como custos de aquisição e manutenção de equipamentos e falta de pessoal qualificado são obstáculos reais à expansão da MN no Brasil. O país é financeiramente dependente de capital estrangeiro para essa área, o que limita a expansão da área de acordo com as diretrizes do SUS. Políticas sociais e econômicas são necessárias para minimizar as vulnerabilidades tecnológicas do SUS, promover a sustentabilidade do sistema e garantir o acesso universal e equânime aos serviços especializados de saúde.

Introduction: It is estimated that prostate cancer will reach 66 thousand by the triennium 2020-2022 according to the National Cancer Institute (INCA). After initial diagnosis and staging the patient may undergo radical prostatectomy and/or curative radiotherapy. In patients with biochemical relapse (PSA >0.2 ng/ml) initially treated with radical prostatectomy, salvage external radiotherapy is indicated. The [⁶⁸Ga] Prostate Specific Membrane Antigen Positron Emission Tomography-Computed Tomography (PSMA PET-CT) scan is mainly used for localization of prostate cancer in the setting of first biochemical recurrence and can significantly influence the clinical management of the patient.Methods: The overall objective of this work is to perform a treatment cost analysis for patients in first biochemical recurrence of prostate cancer after curative radical prostatectomy and after performing [⁶⁸Ga] PSMA PET-CT from the perspective of the Brazilian Health System (SUS). A decision tree was constructed through consultation with experts to outline the patient’s entire treatment. Values per modelled therapeutic procedure were surveyed in two different scenarios, with and without [⁶⁸Ga] PSMA PET-CT. The average treatment in scenario 1 was stereotaxic radiation therapy (SBRT), and rescue radiotherapy and androgen deprivation therapy (ADT). In scenario 2, it was salvage radiotherapy and ADT. The reimbursement table was prepared from data collected by SUS system. Variations were analyzed using a sensitivity study. Total average values included: individual procedure, according to medical management (up to 3 years) and population percentage with and without [⁶⁸Ga] PSMA PET-CT.Results: Values were calculated in Brazilian currency (BRL) for each procedure. The total amount calculated for scenario 1 was BRL 264,965,465.00 (USD 55,642,747.65) and for scenario 2 was BRL 123,585,612.72 (USD 26,162,978.67).Conclusions: The reimbursement of line of care adopted after [⁶⁸Ga] PSMA PET-CT is an important information to expand access to the Brazilian population. It shows an increased cost with [⁶⁸Ga] PSMA PET-CT adoption. A prospective study should be considered with high follow up.