{"id":3504,"date":"2016-07-18T09:36:49","date_gmt":"2016-07-18T09:36:49","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/clinical-impact-of-atypical-endoscopic-features-in-rectal-neuroendocrine-tumors\/"},"modified":"2022-06-17T15:28:15","modified_gmt":"2022-06-17T15:28:15","slug":"clinical-impact-of-atypical-endoscopic-features-in-rectal-neuroendocrine-tumors","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/clinical-impact-of-atypical-endoscopic-features-in-rectal-neuroendocrine-tumors\/","title":{"rendered":"Caracter\u00edsticas endosc\u00f3picas dos tumores neuroend\u00f3crinos retais podem prever met\u00e1stases linfonodais?"},"content":{"rendered":"
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A  incid\u00eancia de tumores neuroend\u00f3crinos (TNE) retais tem aumentado ao longo dos \u00faltimos 35 anos. A maioria dos TNEs retais s\u00e3o diagnosticados por acaso, provavelmente devido ao aumento do n\u00famero de sigmoidoscopias e colonoscopias de rastreamento.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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O National Comprehensive Cancer Network recomenda que os TNEs retais \u2264 2 cm de di\u00e2metro podem ser ressecados por excis\u00e3o transanal ou por via endosc\u00f3pica e os > 2 cm de di\u00e2metro sejam submetidos a ressec\u00e7\u00e3o radical. No entanto, acometimento linfonodal (LNM) t\u00eam sido relatado em pacientes com TNE retais <6 mm de di\u00e2metro, o que sugere que o tamanho do tumor por si s\u00f3 n\u00e3o \u00e9 preditivo de invas\u00e3o linfonodal.<\/p>\n

Embora o tamanho do TNE retal esteja associado a presen\u00e7a de invas\u00e3o linfonodal, este estudo descobriu que as caracter\u00edsticas at\u00edpicas, especialmente mudan\u00e7as de superf\u00edcie, foram fortemente preditivas de acometimento linfonodal. Vide mais neste artigo.<\/a><\/strong><\/p>\n

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Mas algumas caracter\u00edsticas s\u00e3o incomuns como superf\u00edcie irregular, base pediculada e colora\u00e7\u00e3o enantem\u00e1tica. Estas caracter\u00edsticas incomuns t\u00eam sido associados com acometimento linfonodal, sugerindo uma associa\u00e7\u00e3o entre os achados endosc\u00f3picos e acometimento linfonodal.<\/p>\n

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A capacidade de prever a probabilidade de acometimento linfonodal \u00e9 importante para o tratamento, principalmente se a cirurgia radical for necess\u00e1ria para evitar a progress\u00e3o do tumor. Na colonoscopia, o tamanho do TNE retal foi o \u00fanico preditor de acometimento linfonodal. Este estudo foi desenhado para validar a associa\u00e7\u00e3o entre caracter\u00edsticas endoscopicas at\u00edpicas e acometimento linfonodal.<\/p>\n

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Pacientes<\/strong><\/p>\n

Os dados de 287 pacientes com TNE retais diagnosticados e tratados no Centro Nacional do C\u00e2ncer (Goyang, Cor\u00e9ia do Sul) e Daehang Hospital (Seul, Cor\u00e9ia do Sul) entre janeiro de 2008 e dezembro de 2010 foram revisados. Oito pacientes com c\u00e2ncer colorretal s\u00edncrono, oito que foram submetidos a bi\u00f3psias m\u00faltiplas antes de visitar as institui\u00e7\u00f5es e 24 cujas imagens endosc\u00f3pica n\u00e3o estavam dispon\u00edveis foram exclu\u00eddos deste estudo. Finalmente, 247 pacientes com TNE retais foram analisados. Destas 247 les\u00f5es, 208 foram submetida \u00e0 ressec\u00e7\u00e3o endosc\u00f3pica, 22 foram removidos por via transanal e 16 foram tratados com cirurgia radical. Um paciente recebeu apenas quimioterapia paliativa, porque tinha v\u00e1rias met\u00e1stases hep\u00e1ticas irressec\u00e1veis e peritoneal. Vari\u00e1veis cl\u00ednico-patol\u00f3gicas foram retrospectivamente coletadas dos prontu\u00e1rios dos pacientes. Este estudo foi aprovado pelo Institutional Review Board do Centro Nacional de C\u00e2ncer da Coreia (NCC2014-0104).<\/p>\n

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Avalia\u00e7\u00e3o<\/strong><\/p>\n

Os pacientes foram submetidos a exame endosc\u00f3pico com colonoscopia para diagn\u00f3stico e tratamento. As imagens endosc\u00f3picas foram revisadas independentemente por dois endoscopistas, resultando em coeficiente kappa de 0,76 para concord\u00e2ncia. Quaisquer diverg\u00eancias entre os dois endoscopistas foram resolvidas por discuss\u00f5es abertas com todos os endoscopistas especializados.<\/p>\n

Todos os pacientes foram submetidos a tomografia computadorizada (TC) do abdome e da pelve para a avalia\u00e7\u00e3o de acometimento linfonodal. Os pacientes foram considerados positivos para acometimento linfonodal se a tomografia computadorizada revelasse linfonodos > 3 mm na \u00e1rea periretal ou  linfonodos > 1 cm na pelve.<\/p>\n

O tamanho dos tumores foram confirmados por relat\u00f3rios de patologia, com exce\u00e7\u00e3o de um paciente que n\u00e3o foi submetidos a ressec\u00e7\u00e3o curativa, por causa de extensas met\u00e1stases hep\u00e1ticas. Todos os tumores foram classificados por tamanho (di\u00e2metro mais longo), e, em seguida, por caracter\u00edsticas endosc\u00f3picas, tais como forma, cor, e as altera\u00e7\u00f5es de superf\u00edcie como: depress\u00e3o, eros\u00e3o e ulcera\u00e7\u00e3o. Dos 247 les\u00f5es, 217 tamb\u00e9m foram avaliados imunohistoquimicamente.<\/p>\n

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O valor de corte para o tamanho do tumor neuroend\u00f3crino que pode determinar o plano de tratamento e avaliar o progn\u00f3stico do paciente n\u00e3o foi definitivamente estabelecido. Os tumores \u2264 10 mm de di\u00e2metro podem ser localmente ressecados por m\u00e9todos tais como a ressec\u00e7\u00e3o endosc\u00f3pica, a excis\u00e3o transanal ou microcirurgia endosc\u00f3pica transanal.<\/p>\n

O American Joint Committee  recomenda que pacientes com tumores \u2265 20 mm, seja realizada a ressec\u00e7\u00e3o cirur\u00fargica radical com dissec\u00e7\u00e3o de linfonodos. No entanto, o m\u00e9todo adequado de remo\u00e7\u00e3o TNE retais 11-19 mm em tamanho permanece indeterminado, e nenhum estudo prospectivo controlado foi realizado para o planejar o tratamento para estes pacientes. Al\u00e9m disto dados da literatura demonstram em alguns estudos que met\u00e1stases para linfonodos e \u00f3rg\u00e3os distantes podem ocorrer em pacientes com TNE retais \u2264 10 mm de tamanho.<\/p>\n

No levantamento feito neste artigo, 3 pacientes com tumores <10 mm de di\u00e2metro tinham comprometimento linfonodal ao diagn\u00f3stico. Assim, o tamanho dos TNE de retais por si s\u00f3 \u00e9 insuficiente para predizer o comprometimento linfonodal e assim determinar planos de tratamento.<\/p>\n

Dos 3 pacientes com TNE retais \u2264 10 mm e comprometimento linfonodal, um apresentava caracter\u00edstica at\u00edpica, sendo uma les\u00e3o semipediculada com eros\u00e3o de superf\u00edcie. Enquanto todos os 9 pacientes com tumores >10mm e <20mm e comprometimento linfonodal apresentavam les\u00f5es com uma ou mais caracter\u00edsticas at\u00edpicas.<\/p>\n

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Limita\u00e7\u00f5es do estudo<\/strong><\/p>\n

A an\u00e1lise retrospectiva dos dados. Para avaliar o comprometimento dos linfonodos, foram usados como crit\u00e9rios na tomografia, n\u00f3dulos > 3 mm de di\u00e2metro na \u00e1rea periretal ou > 1 cm de di\u00e2metro na pelve. Estes crit\u00e9rios demonstraram uma sensibilidade de cerca de 73% e uma especificidade de 58%. Assim, deve-se considerar a diferen\u00e7a entre a constata\u00e7\u00e3o na tomografia e na patologia. Tempo m\u00e9dio de follow-up dos pacientes do estudo foi de 44 meses (intervalo de 0-78 m), que, embora maior do que em outros estudos, ainda \u00e9 curto para avaliar met\u00e1stases distantes ou recorr\u00eancia do tumor. Estudos de acompanhamento prospectivo de longo prazo s\u00e3o necess\u00e1rios para as an\u00e1lises de sobreviv\u00eancia.<\/p>\n

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Conclus\u00e3o<\/strong><\/p>\n

Em conclus\u00e3o, o presente estudo sugere que os TNE retais \u2264 10 mm de di\u00e2metro podem ser tratados por excis\u00e3o local, enquanto que os tumores \u2265 20 mm de di\u00e2metro devem ser tratados por ressec\u00e7\u00e3o radical com dissec\u00e7\u00e3o de linfonodos. Caracter\u00edsticas endosc\u00f3picas at\u00edpicas podem ajudar a selecionar os planos de tratamento ideal para pacientes com redes retais 11-19 mm de di\u00e2metro.<\/p>\n

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Clique aqui e leia o artigo na \u00edntegra:  Clinical impact of atypical endoscopic features in rectal neuroendocrine tumors<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

  A  incid\u00eancia de tumores neuroend\u00f3crinos (TNE) retais tem aumentado ao longo dos \u00faltimos 35…<\/p>\n","protected":false},"author":1772,"featured_media":3505,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[142],"tags":[],"ano":[281],"tipo":[156],"volume":[147],"class_list":["post-3504","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigoscomentados","ano-281","tipo-colonoscopia","volume-volume-ii"],"yoast_head":"\nCaracter\u00edsticas endosc\u00f3picas dos tumores neuroend\u00f3crinos retais podem prever met\u00e1stases linfonodais? • Endoscopia Terapeutica<\/title>\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\/artigoscomentados\/clinical-impact-of-atypical-endoscopic-features-in-rectal-neuroendocrine-tumors\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Caracter\u00edsticas endosc\u00f3picas dos tumores neuroend\u00f3crinos retais podem prever met\u00e1stases linfonodais?\" \/>\n<meta property=\"og:description\" content=\"  A  incid\u00eancia de tumores neuroend\u00f3crinos (TNE) retais tem aumentado ao longo dos \u00faltimos 35 anos. 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