RESUMO
The accuracy of an alternative method of preparing cytologic smears from material collected under laparoscopic examination was studied. "Washed-biopsy" cytology was performed by saline solution lavage of the fragments using a cytocentrifuge. Rich and well-preserved cellularity was obtained. Among 51 cases, cytology revealed 12 benign, 3 suspicious and 36 malignant cases, including 9 true negatives, 3 false negatives and 36 true positives. Suspicious cases were excluded from the analysis. The sensitivity, specificity, positive and negative predictive values, and efficiency, when comparing the cytologic to the definitive diagnoses, were, respectively, 92.3%, 100.0%, 100.0%, 75.0% and 93.7%. We recommend the routine use of the washed-biopsy method in laparoscopic examinations to improve the accuracy of cytologic investigations.
Assuntos
Neoplasias Abdominais/patologia , Técnicas de Preparação Histocitológica , Neoplasias Abdominais/ultraestrutura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
Three hundred and sixty patients with gastric carcinoma were evaluated by laparoscopy. The following tumor attributes were used in the staging workup: serosal infiltration, tumor fixation, metastasis to lymph nodes, peritoneal dissemination, and liver metastasis. For the detection of liver metastases, subgroups of these patients were also tested by liver scintigraphy, ultrasonography, and serum alkaline phosphatase determination. Use of diagnostic indexes with their confidence intervals provided an objective means of assessing performance for the various combinations of tests and attributes. The attributes which were most accurately detected by laparoscopy were peritoneal dissemination and liver metastases with 89.4% and 96.5% efficiency, respectively. Laparoscopy was a superior diagnostic method when compared to the other tests for detection of liver involvement. Scintigraphy and ultrasonography presented comparable sensitivities, 78.7% and 78.6%, respectively (as opposed to 87.2% of laparoscopy), but the former yielded a high rate of false-positive results, 62.6%. Detection of liver metastases by assaying alkaline phosphatase levels was the least sensitive diagnostic alternative examined.
Assuntos
Laparoscopia , Neoplasias Hepáticas/secundário , Estadiamento de Neoplasias/métodos , Neoplasias Gástricas/patologia , Adulto , Idoso , Fosfatase Alcalina/sangue , Erros de Diagnóstico , Estudos de Avaliação como Assunto , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cintilografia , Neoplasias Gástricas/sangue , UltrassonografiaRESUMO
Os linfomas gastricos primitivos sao lesoes incomuns (0,81% da serie de neoplasias gastricas), de diagnostico extremamente dificil com os exames clinicos, radiologicos ou endoscopicos, falhando em estabelecer o diagnostico pre-operatorio em 95% dos nossos casos. Contudo, em vista do melhor prognostico que o carcinoma gastrico, todo o esforco deve estar voltado para o estabelecimento do diagnostico. A terapeutica e cirurgica nos casos que obedecem aos criterios que definem um linfoma como primitivo do estomago. A radioterapia tem indicacoes precisas e a poliquimioterapia deve ser associada em todos os casos