Utilidade clínica da aquisição tecidual de lesões císticas pancreáicas por agulha guiada por ultrassom endoscópico para análise histológica
Data
2024-04-18
Autores
Castro, Juliana Silveira Lima de 
Tipo
Dissertação de mestrado
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Objetivos: determinar acurácia diagnóstica da biópsia guiada por ultrassom endoscópico com a agulha dedicada a aquisição tecidual para diferenciar entre neoplasia mucinosa e não-mucinosa e identificar as lesões císticas pancreáticas malignas bem como seus eventos adversos (sangramento, pancreatite aguda, infecção e perfuração) em pacientes com lesões císticas pancreáticas sem diagnóstico classificatório por exames de imagem. Métodos: Neste estudo observacional, retrospectivo, em centro único, todos os pacientes com lesões císticas pancreáticas que foram submetidos a biópsia por agulha guiada por ultrassom endoscópico devido a dúvidas diagnóstica em exames de imagem ou que durante o seguimento apresentaram pancreatite aguda, elevação do CA 19.9, tiveram aparecimento de diabetes ou apresentaram parentes com câncer de pâncreas, foram recrutados consecutivamente no período de junho de 2017 a dezembro de 2021. Resultados: Cento e quarenta e cinco pacientes foram submetidos a biópsia por agulha fina guiado por ultrassom endoscópico, sendo 83 mulheres (57.2%), média de idade de 62.2 anos (21-91 anos). O tamanho médio foi de 2.3 cm (0.6 a 10 cm) e 81 (77.9%) eram menores que 3,0 cm. O diagnóstico final foi obtido pela biópsia por agulha fina guiada por ultrassom endoscópico (81), cirurgia (58) e seguimento (6). A prevalência das lesões neoplásicas na amostra foi 25 (17%). A sensibilidade, especificidade, valor preditivo positivo, negativo e acurácia para o diferencial entre neoplasia mucinosa e não mucinosa e uma lesão cística pancreática maligna foram de 92.6%, 98.4%, 98.7%, 91.3% e 95.2% (kappa=0.9) e 92%, 99.2%, 95.8%, 98.3% e 97.9% (Kappa=0.93), respectivamente. A taxa de eventos adversos foi 2,7% sem mortes nessa coorte. Conclusão: A biópsia por agulha fina guiada por ultrassom endoscópico tem elevada acurácia e sucesso técnico com baixa taxa de eventos adversos. Esses resultados mostram que este método é preciso além de ser seguro, para o diagnóstico de uma lesão cística pancreática duvidosa. Mais estudos multicêntricos, randomizados, controlados e prospectivos serão necessários para confirmar esses resultados iniciais.
Objectives: This study aimed to determine the accuracy of endosonography-guided tissue acquisition with ProCore 20G for differentiating between mucinous neoplasia and non-mutinous neoplasia and identifying malignant pancreatic cystic lesions, as well as its adverse events (bleeding, acute pancreatitis, infection and perforation) in patients with pancreatic cystic lesions without a classificatory diagnosis by imaging exams. Methods: In this observational, retrospective, single-center study, all patients with pancreatic cystic lesions who underwent endosonography-guided tissue acquisition due to diagnostic doubts in imaging studies were consecutively recruited from June 2017 to December 2021. Results: In this study, 145 patients underwent fine needle biopsy guided by endoscopic ultrasound, 83 women (57.2%), mean age 62.2 years (21-91 years). The mean size was 2.3 cm (0.6 to 10 cm) and 81 (77.9%) were smaller than 3.0 cm. The final diagnosis was obtained by fine needle biopsy guided by endoscopic ultrasound (81), surgery (58) and follow-up (6). The prevalence of neoplastic lesions in the sample was 25 (17%). The sensitivity, specificity, positive and negative predictive value and accuracy for the differential between mucinous and non-mucinous cystic neoplasms and a malignant pancreatic cystic lesions were 92.6%, 98.4%, 98.7%, 91.3% and 95.2% (kappa=0.9) and 92%, 99.2%, 95.8%, 98.3% and 97.9% (Kappa=0.93), respectively. The adverse events rate was 2.7% with no deaths in this cohort. Conclusion: Fine needle biopsy guided by endoscopic ultrasound with the 20 Gauge ProCore has high accuracy and technical success with a low rate of adverse events. These results show that fine needle biopsy guided by endoscopic ultrasound is accurate as well as safe for the diagnosis of dubious pancreatic cystic lesions. More multicenter, randomized, controlled and prospective studies will be needed to confirm these initial results.
Objectives: This study aimed to determine the accuracy of endosonography-guided tissue acquisition with ProCore 20G for differentiating between mucinous neoplasia and non-mutinous neoplasia and identifying malignant pancreatic cystic lesions, as well as its adverse events (bleeding, acute pancreatitis, infection and perforation) in patients with pancreatic cystic lesions without a classificatory diagnosis by imaging exams. Methods: In this observational, retrospective, single-center study, all patients with pancreatic cystic lesions who underwent endosonography-guided tissue acquisition due to diagnostic doubts in imaging studies were consecutively recruited from June 2017 to December 2021. Results: In this study, 145 patients underwent fine needle biopsy guided by endoscopic ultrasound, 83 women (57.2%), mean age 62.2 years (21-91 years). The mean size was 2.3 cm (0.6 to 10 cm) and 81 (77.9%) were smaller than 3.0 cm. The final diagnosis was obtained by fine needle biopsy guided by endoscopic ultrasound (81), surgery (58) and follow-up (6). The prevalence of neoplastic lesions in the sample was 25 (17%). The sensitivity, specificity, positive and negative predictive value and accuracy for the differential between mucinous and non-mucinous cystic neoplasms and a malignant pancreatic cystic lesions were 92.6%, 98.4%, 98.7%, 91.3% and 95.2% (kappa=0.9) and 92%, 99.2%, 95.8%, 98.3% and 97.9% (Kappa=0.93), respectively. The adverse events rate was 2.7% with no deaths in this cohort. Conclusion: Fine needle biopsy guided by endoscopic ultrasound with the 20 Gauge ProCore has high accuracy and technical success with a low rate of adverse events. These results show that fine needle biopsy guided by endoscopic ultrasound is accurate as well as safe for the diagnosis of dubious pancreatic cystic lesions. More multicenter, randomized, controlled and prospective studies will be needed to confirm these initial results.
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CASTRO, Juliana Silveira Lima de. Utilidade clínica da aquisição tecidual de lesões císticas pancreáicas por agulha guiada por ultrassom endoscópico para análise histológica. 2024. 49 f. Dissertação (Mestrado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.