{"id":20747,"date":"2025-10-14T06:35:00","date_gmt":"2025-10-14T06:35:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=20747"},"modified":"2025-10-13T14:39:28","modified_gmt":"2025-10-13T14:39:28","slug":"metallic-silver-sign-mais-um-passo-no-auxilio-para-a-deteccao-de-neoplasia-esofagica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/metallic-silver-sign-mais-um-passo-no-auxilio-para-a-deteccao-de-neoplasia-esofagica\/","title":{"rendered":"Metallic Silver Sign: mais um passo no aux\u00edlio para a detec\u00e7\u00e3o de neoplasia esof\u00e1gica"},"content":{"rendered":"\n

A detec\u00e7\u00e3o precoce do carcinoma espinocelular do es\u00f4fago<\/strong> tem evolu\u00eddo significativamente com o uso de t\u00e9cnicas endosc\u00f3picas avan\u00e7adas. Entre os achados visuais mais promissores est\u00e1 o chamado
\u201cSilver Sign\u201d<\/strong> ou \u201cMetallic Silver Sign\u201d (MSS)<\/strong>, que representa um marcador \u00f3ptico sugestivo de neoplasia esof\u00e1gica.
Aqui, vamos tentar compreender melhor a origem, a aplica\u00e7\u00e3o e o valor diagn\u00f3stico desse sinal.<\/p>\n\n\n\n


O que \u00e9 o Silver Sign \/ Metallic Silver Sign?<\/strong><\/h2>\n\n\n\n

O Silver Sign<\/strong> \u00e9 uma reflex\u00e3o prateada ou met\u00e1lica<\/strong> observada em les\u00f5es esof\u00e1gicas sob luz de Narrow Band Imaging<\/em> (NBI), especialmente ap\u00f3s a aplica\u00e7\u00e3o de solu\u00e7\u00e3o de <\/strong>l<\/strong>ugol<\/strong>. Esse fen\u00f4meno foi descrito por Maselli et al. (2013) como uma evolu\u00e7\u00e3o do tradicional Pink Color Sign (PCS)<\/strong> \u2014 uma mudan\u00e7a de cor observada em \u00e1reas iodo-negativas que se tornam rosadas ap\u00f3s alguns minutos da aplica\u00e7\u00e3o de lugol, indicando poss\u00edvel malignidade.<\/p>\n\n\n\n

No entanto, o PCS pode ser sutil e dif\u00edcil de identificar<\/strong>, especialmente em les\u00f5es planas ou em pacientes com m\u00faltiplas \u00e1reas iodo-negativas. O MSS surge como uma alternativa visual mais n\u00edtida: sob NBI, essas \u00e1reas rosadas adquirem uma apar\u00eancia met\u00e1lica e brilhante<\/strong>, facilitando a identifica\u00e7\u00e3o da les\u00e3o.<\/p>\n\n\n\n

No estudo de Maselli et al., foram analisadas 123 les\u00f5es submetidas a ressec\u00e7\u00e3o endosc\u00f3pica (EMR-Cap ou ESD). O MSS foi observado em 98,4% das les\u00f5es cancerosas<\/strong>, com correla\u00e7\u00e3o de 100% com o PCS<\/strong>, com apenas duas les\u00f5es sem apresentar nenhum dos sinais.<\/p>\n\n\n

\n
\"\"<\/a>

Figura 1.<\/strong> A.<\/strong> Les\u00e3o tipo 0-IIa localizada no es\u00f4fago proximal, observada por endoscopia com luz branca. B.<\/strong> Na cromoendoscopia com uso da solu\u00e7\u00e3o de lugol. C.<\/strong> Um minuto ap\u00f3s a exposi\u00e7\u00e3o \u00e0 solu\u00e7\u00e3o de lugol, a les\u00e3o adquire colora\u00e7\u00e3o rosa. D.<\/strong> Apar\u00eancia met\u00e1lica prateada da les\u00e3o sob imagem por NBI (Narrow Band Imaging). Adaptado de Maselli R et al. (2013) [1].<\/figcaption><\/figure>\n<\/div>\n\n\n

Esses achados indicam que a presen\u00e7a do MSS \u00e9 altamente espec\u00edfica para carcinoma espinocelular superficial<\/strong>, independentemente da morfologia macrosc\u00f3pica ou caracter\u00edstica histopatol\u00f3gica. O MSS se mostrou mais evidente que o PCS – que pode ser dif\u00edcil de ser observado devido sua baixa intensidade – tornando-se uma ferramenta valiosa para endoscopistas, especialmente em ambientes cl\u00ednicos com tempo limitado para observa\u00e7\u00e3o prolongada.<\/p>\n\n\n\n

Tsunoda et al. (2019), amplia a discuss\u00e3o ao incorporar tecnologias mais recentes como o Linked Color Imaging (LCI)<\/strong> e o Blue Laser Imaging (BLI)<\/strong>. Embora o foco principal do estudo n\u00e3o seja o MSS, ele refor\u00e7a a ideia de que a diferencia\u00e7\u00e3o visual entre carcinoma e neoplasia intraepitelial<\/strong> pode ser aprimorada com t\u00e9cnicas de imagem que real\u00e7am contraste e textura.<\/p>\n\n\n\n

Ap\u00f3s aplica\u00e7\u00e3o de Lugol, \u00e1reas de carcinoma aparecem como verde no BLI<\/strong> e roxo no LCI<\/strong>, enquanto \u00e1reas de neoplasia intraepitelial podem apresentar colora\u00e7\u00e3o diferente (amarelo p\u00e1lido ou marrom). Essa diferencia\u00e7\u00e3o crom\u00e1tica \u00e9 significativamente maior com LCI e BLI do que com luz branca convencional.<\/p>\n\n\n

\n
\"\"<\/a>

Figura 2. 1. Imagens endosc\u00f3picas de neoplasia de c\u00e9lulas escamosas do es\u00f4fago.<\/strong> (A\u2013C) Antes da colora\u00e7\u00e3o com iodo.<\/strong> (A)<\/strong> A imagem com luz branca mostra uma les\u00e3o levemente avermelhada entre as posi\u00e7\u00f5es de 3 e 5 horas. (B)<\/strong> A imagem com Linked Color Imaging revela uma les\u00e3o roxa. (C)<\/strong> A imagem com Blue Laser Imaging mostra uma les\u00e3o marrom. (D\u2013F) Tr\u00eas minutos e 35 segundos ap\u00f3s a colora\u00e7\u00e3o com iodo.<\/strong> (D)<\/strong> Toda a les\u00e3o apresenta sinal positivo de colora\u00e7\u00e3o rosa na imagem com luz branca. (E)<\/strong> A Linked Color Imaging mostra uma \u00e1rea roxa na maior parte da les\u00e3o principal, mas com mucosa amarelo-p\u00e1lida na posi\u00e7\u00e3o de 4 horas (seta azul clara). (F) <\/strong>A Blue Laser Imaging revela uma les\u00e3o verde na maior parte da les\u00e3o principal, mas h\u00e1 mucosa marrom na posi\u00e7\u00e3o de 4 horas (seta azul clara). Adaptado de Tsunoda M et al. (2019) [2].<\/figcaption><\/figure>\n<\/div>\n\n\n

Embora o MSS n\u00e3o seja diretamente abordado nesse estudo, os achados corroboram a ideia de que a intera\u00e7\u00e3o entre corantes vitais e tecnologias \u00f3pticas avan\u00e7adas pode revelar padr\u00f5es visuais altamente espec\u00edficos<\/strong>, como o brilho met\u00e1lico observado no MSS.<\/p>\n\n\n\n

A identifica\u00e7\u00e3o do MSS tem v\u00e1rias implica\u00e7\u00f5es pr\u00e1ticas: melhora a acur\u00e1cia diagn\u00f3stica<\/strong> em pacientes com m\u00faltiplas les\u00f5es ou mucosa alterada; facilita o direcionamento de bi\u00f3psias<\/strong>, reduzindo o risco de falsos negativos; complementa o PCS<\/strong>, especialmente quando este \u00e9 pouco evidente; pode ser integrado a sistemas de intelig\u00eancia artificial<\/strong> para reconhecimento autom\u00e1tico de padr\u00f5es visuais; pode ser \u00fatil em protocolos de rastreamento em popula\u00e7\u00f5es de alto risco<\/strong>, como pacientes com hist\u00f3rico de neoplasias de cabe\u00e7a e pesco\u00e7o, tabagismo cr\u00f4nico ou consumo excessivo de \u00e1lcool.<\/p>\n\n\n\n

Cada vez mais a tecnologia tem auxiliado no diagn\u00f3stico precoce de les\u00f5es por\u00e9m, seu uso e interpreta\u00e7\u00e3o \u00e9 profissional dependente. E voc\u00ea, iniciar\u00e1 a busca por les\u00f5es esof\u00e1gicas utilizando estes sinais?<\/p>\n\n\n\n

Veja mais: Padr\u00e3o IPCL de CEC de Es\u00f4fago – classifica\u00e7\u00e3o da sociedade Japonesa \u2022 Endoscopia Terapeutica<\/a><\/p>\n\n\n\n


Refer\u00eancias<\/strong><\/h2>\n\n\n\n
    \n
  1. Maselli R et al. (2013)<\/strong>. The metallic silver sign with narrow-band imaging: a new endoscopic predictor for pharyngeal and esophageal neoplasia<\/em>. Gastrointest Endosc. 78(3):551\u2013553.<\/li>\n\n\n\n
  2. Tsunoda M et al. (2019)<\/strong>. New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining<\/em>. Clin Endosc. 52(5):497\u2013501.<\/li>\n<\/ol>\n\n\n\n

    Como citar este artigo<\/strong><\/h2>\n\n\n\n

    Brito HP. Metallic Silver Sign: mais um passo no aux\u00edlio para a detec\u00e7\u00e3o de neoplasia esof\u00e1gica. Endoscopia Terapeutica 2025 Vol II. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/metallic-silver-sign-mais-um-passo-no-auxilio-para-a-deteccao-de-neoplasia-esofagica\/<\/a><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    A detec\u00e7\u00e3o precoce do carcinoma espinocelular do es\u00f4fago tem evolu\u00eddo significativamente com o uso…<\/p>\n","protected":false},"author":5778,"featured_media":20750,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[836,837],"ano":[783],"tipo":[153],"volume":[147],"class_list":["post-20747","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-metallic-silver-sign","tag-neoplasia-esofagica","ano-783","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"\nMetallic Silver Sign: mais um passo no aux\u00edlio para a detec\u00e7\u00e3o de neoplasia esof\u00e1gica • Endoscopia Terapeutica<\/title>\n<meta name=\"description\" content=\"Metallic Silver Sign: mais um passo no aux\u00edlio para a detec\u00e7\u00e3o de neoplasia esof\u00e1gica\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/metallic-silver-sign-mais-um-passo-no-auxilio-para-a-deteccao-de-neoplasia-esofagica\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Metallic Silver Sign: mais um passo no aux\u00edlio para a detec\u00e7\u00e3o de neoplasia esof\u00e1gica\" \/>\n<meta property=\"og:description\" content=\"A detec\u00e7\u00e3o precoce do carcinoma espinocelular do es\u00f4fago tem evolu\u00eddo significativamente com o uso de t\u00e9cnicas endosc\u00f3picas avan\u00e7adas. 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