Impacto da ecoendoscopia com punção aspirativa com agulha fina associada à microhistologia no diagnóstico de cistos pancreáticos em pacientes sintomáticos e assintomáticos
Data
2018-07-12
Autores
Vaiciunas, Spencer 
Orientadores
Ardengh, Jose Celso
Tipo
Tese de doutorado
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Introdução: A ecoendoscopia com punção aspirativa com agulha fina (EE-PAAF) é uma técnica valiosa e segura para investigar cistos pancreáticos (CPs). Porém, na literatura encontramos pouca informação de uma possível contribuição da EE-PAAF associada a microhistologia para o diagnóstico dos CPs. Objetivo: Esse estudo analisa a acurácia e a viabilidade da microhistologia obtida pela EE para o diagnóstico de CPs em pacientes assintomáticos e sintomáticos. Pacientes e métodos: De janeiro de 2010 a janeiro de 2017, incluiu-se todos os pacientes com CPs submetidos a EE-PAAF. O líquido do CP foi coletado para análise microhistológica e quando possível parte do material foi enviado a dosagem bioquímica dos níveis de amilase, CEA e CA 19.9. O principal parâmetro de análise foi a porcentagem de amostras adequadas para o diagnóstico etiológico pela microhistologia associada a análise bioquímica e o cálculo das razões de verossimilhança para o grupo de pacientes com CPs assintomáticos e sintomáticos. O teorema estatístico de Bayes, foi o principal cálculo estatístico. Resultados: A EE-PAAF para o diagnóstico foi realizada em 510/585 (87,1%) pacientes. Ela foi viável e não houve falha técnica. O material obtido pela PAAF foi enviado para a microhistologia e forneceu material adequado em 432 (84,2%). As características clínicas dos CPs assintomáticos (341) e sintomáticos (169), revelou que o primeiro grupo era mais jovem (p=0,004) e com CPs menores [23 mm (2-117)] vs [35 mm (4-144)] com p=<0,001. Nos CPs assintomáticos encontramos mais CPs pré-neoplásicos (38,7% vs 30,2%) com p= 0.016 e menor número de CPs malignos (8,2% vs 24,3%) com p< 0,001. CPs assintomáticos e sintomáticos a microhistologia mostrou sensibilidade, especificidade, VPP, VPN, acurácia e Kappa de: 71,4%, 99,7%, 95,2%, 97,5%, 97,4%, e k=0,80 e 58,5%, 96,9% 85,7%, 87,9%, 87,6% e K=0,62, respectivamente. A prevalência para o diagnóstico de um CP maligno é de 10%. Ao utilizarmos a EE-PAAF em pacientes com CP assintomático e sintomático a probabilidade pós teste foi de 95,7% [IC: 83,9%- 98,9%] versus 64,9% [IC: 47,1-79,4], respectivamente. Conclusões: Em pacientes com CPs assintomáticos ou sintomáticos a EE-PAAF é tecnicamente viável e segura. A análise microhistológica é factível na maioria desse pacientes, cujo benefício é maior para a detecção de CPs nos assintomáticos e nos cistos malignos
Introduction: The EUS-FNA is a valuable and safe technique to investigate PCNs. Although, in literature we find not much information about a association of EUA-FNA with microhistological analysis for a more accurate diagnosis of PCNs. Aim: The aim of this study was to verify the association and accuracy of EUA-FNA with microhistological analysis to investigate PCNs in asymptomatic and symptomatic PCTs. Patients and methods: From January 2010 unitl January 2017, was included all patients with PCNs submitted to EUS-FNA. The PCNs liquid was collected for microhistological analysis and, when possible, part of this material was sent to the biochemical levels analysis of amylase, carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9). The main parameter of analysis was the percentage of samples suitable for the etiological diagnosis by microhistology associated with biochemical analysis and the study of likelihood ratios for the group of patients with asymptomatic and symptomatic PCNs. Likelihood ratios were obtained using the Bayles statistical analysis. Results: The EUS-FNA was performed in 510/585 (87.1%) patients. The FNA was possible in all patients, there was no technical failure. The samples were sent to microhistology and provided adequate material in 432 (84.2%). The clinical characteristics of asymptomatic (341) and symptomatic PCNs (169) revealed that the first group was younger (0.004) and had lower PCNs [23 mm (2-117)] vs [35 mm (4-144)] (<0.001). In the asymptomatic PCNs we found more preneoplastic lesions (38.7% vs 30.2%) (0.016) and a lower number of malignancy (8.2% vs 24.3%) (<0.001). Asymptomatic and symptomatic PCs, microhistology showed sensitivity, specificity, PPV, NPV, accuracy and Kappa index of: 71.4%, 99.7%, 95.2%, 97.5%, 97.4% and K=0.80 and 58.5%, 96.9%, 85.7%, 87.9%, 87.6% and K=0.62 respectively. The pre-test prevalence for the diagnosis of a malignant PCNs was about 10%, The post-test probability in asymptomatic and symptomatic PCN was 95.7% [CI: 83.9%-98.9%] versus 64.9% % [CI: 47.1-79.4], respectively. Conclusions: In asymptomatic or symptomatic PCT, the EUS-FNA is technically feasible and safe. The microhistology obtained a correct etiological diagnosis in most patients with PCTs, but the most benefit for the detection of PCs are the asymptomatic patients and in neoplasia cystics cases
Introduction: The EUS-FNA is a valuable and safe technique to investigate PCNs. Although, in literature we find not much information about a association of EUA-FNA with microhistological analysis for a more accurate diagnosis of PCNs. Aim: The aim of this study was to verify the association and accuracy of EUA-FNA with microhistological analysis to investigate PCNs in asymptomatic and symptomatic PCTs. Patients and methods: From January 2010 unitl January 2017, was included all patients with PCNs submitted to EUS-FNA. The PCNs liquid was collected for microhistological analysis and, when possible, part of this material was sent to the biochemical levels analysis of amylase, carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9). The main parameter of analysis was the percentage of samples suitable for the etiological diagnosis by microhistology associated with biochemical analysis and the study of likelihood ratios for the group of patients with asymptomatic and symptomatic PCNs. Likelihood ratios were obtained using the Bayles statistical analysis. Results: The EUS-FNA was performed in 510/585 (87.1%) patients. The FNA was possible in all patients, there was no technical failure. The samples were sent to microhistology and provided adequate material in 432 (84.2%). The clinical characteristics of asymptomatic (341) and symptomatic PCNs (169) revealed that the first group was younger (0.004) and had lower PCNs [23 mm (2-117)] vs [35 mm (4-144)] (<0.001). In the asymptomatic PCNs we found more preneoplastic lesions (38.7% vs 30.2%) (0.016) and a lower number of malignancy (8.2% vs 24.3%) (<0.001). Asymptomatic and symptomatic PCs, microhistology showed sensitivity, specificity, PPV, NPV, accuracy and Kappa index of: 71.4%, 99.7%, 95.2%, 97.5%, 97.4% and K=0.80 and 58.5%, 96.9%, 85.7%, 87.9%, 87.6% and K=0.62 respectively. The pre-test prevalence for the diagnosis of a malignant PCNs was about 10%, The post-test probability in asymptomatic and symptomatic PCN was 95.7% [CI: 83.9%-98.9%] versus 64.9% % [CI: 47.1-79.4], respectively. Conclusions: In asymptomatic or symptomatic PCT, the EUS-FNA is technically feasible and safe. The microhistology obtained a correct etiological diagnosis in most patients with PCTs, but the most benefit for the detection of PCs are the asymptomatic patients and in neoplasia cystics cases
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Impacto da ecoendoscopia com punção aspirativa com agulha fina associada à microhistologia no diagnóstico de cistos pancreáticos em pacientes sintomáticos e assintomáticos