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1.
Turk J Gastroenterol ; 30(5): 389-397, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31060993

RESUMEN

The diagnosis of celiac disease (CD) no longer rests on a malabsorptive state or severe mucosal lesions. For the present, diagnosis will always require the gold-standard of a biopsy, interpreted through its progressive phases (Marsh classification). Marsh classification articulated the immunopathological spectrum of gluten-induced mucosal changes in association with the recognition of innate (Marsh I infiltration) and T cell-based adaptive (Marsh II, and the surface re-organisation typifying Marsh III lesions) responses. Through the Marsh classification the diagnostic goalposts were considerably widened thus, over its time-course, permitting countless patients to begin a gluten-free diet but who, on previous criteria, would have been denied such vital treatment. The revisions of this classification failed to provide additional insight in the interpretation of mucosal pathology. Morever, the subclassification of Marsh 3 imposed an enormous amount of extra work on pathologists with no aid in diagnosis, treatment, or prognosis. Therefore, it should now be apparent that if gastroenterologists ignore these sub-classifications in clinical decision-making, then on that basis alone, there is no need whatsoever for pathologists to persist in reporting them. Since new treatments are under critical assessment, we might have to consider use of some other higher level histological techniques sensitive enough to detect the changes sought. A promising alternative would be to hear more voices from imaginative histopathologists or morphologists together with some more insightful approaches, involving molecular-based techniques and stem cell research may be to evaluate mucosal pathology in CD.


Asunto(s)
Biopsia/clasificación , Enfermedad Celíaca/clasificación , Enfermedad Celíaca/diagnóstico , Reglas de Decisión Clínica , Duodeno/patología , Humanos , Mucosa Intestinal/patología
4.
Indian J Pathol Microbiol ; 61(3): 339-344, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30004051

RESUMEN

Background: Nerve biopsy has been widely used to investigate patients with peripheral neuropathy and in many centers, it is still a part of the diagnostic armamentarium. In this study, the histopathological spectrum of the nerve biopsies received is being revisited to analyze the various clinical and pathologic features and also to assess their relevance. Materials and Methods: Retrospective analysis of the data retrieved was done for 74 cases of nerve biopsies. Results: On the basis of the data and histopathological features, broad diagnoses were obtained in 52 cases and further categorized into biopsies being supportive for patient management (including acute and chronic axonopathies and demyelinating neuropathies) and biopsies considered essential for patient management (including vasculitic neuropathies, leprous neuropathies, hereditary neuropathies, and chronic inflammatory demyelinating neuropathies). Nine nerve biopsies did not show any abnormal histopathological features, while 13 nerve biopsies were found to be inadequate for diagnosis, both these groups were categorized as noncontributory. Conclusion: With advanced nerve conduction studies available, nerve biopsy is losing its relevance. However, in our experience, nerve biopsy did complement the clinical findings and nerve conduction studies, with which a close correlation is required to make the histopathology of nerve biopsy more relevant in terms of guiding further specific workup and management.


Asunto(s)
Enfermedades del Sistema Nervioso Periférico/diagnóstico , Nervio Sural/patología , Biopsia/clasificación , Enfermedades Desmielinizantes/diagnóstico , Enfermedades Desmielinizantes/patología , Registros de Salud Personal , Humanos , Enfermedades del Sistema Nervioso Periférico/patología , Estudios Retrospectivos
5.
J. bras. pneumol ; 43(6): 424-430, Nov.-Dec. 2017. tab
Artículo en Inglés | LILACS | ID: biblio-893883

RESUMEN

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.


RESUMEN Objetivo: Estudios previos demuestran que la biopsia pleural cerrada (BPC) para diagnóstico de malignidad tiene una sensibilidad menor al 60%, por lo que recientemente ha despertado controversia su valor como prueba diagnóstica. Nuestro objetivo fue evaluar la exactitud de la BPC para diagnóstico de malignidad en pacientes con derrame pleural. Métodos: Estudio prospectivo de 8 años en individuos que se sometieron a la realización de BPC para establecer la etiología del derrame. La información de cada paciente se tomó de los registros de anatomopatología y del expediente clínico. Cuando el resultado de la BPC demostró malignidad o tuberculosis, esto se tomó como biopsia diagnóstica y quedó éste como diagnóstico definitivo. En los casos en que el resultado del estudio histopatológico de la biopsia resultó inespecífico, el diagnóstico definitivo se estableció en base a otros procedimientos diagnósticos, como toracoscopia, toracotomía, fibrobroncoscopia, estudio bioquímico y celular del líquido pleural y/o pruebas microbiológicas. Mediante una tabla de contingencia de 2 × 2 se midieron los indicadores para una prueba diagnóstica. Resultados: Se estudiaron 1034 biopsias de pacientes con derrame pleural, de las cuales se excluyeron 171 (16.54%) por muestra inadecuada o información insuficiente. El desempeño para malignidad fue: sensibilidad, 77%; especificidad, 98%; valores predictivos positivo y negativo, 99% y 66%, respectivamente; índices de probabilidad positivo y negativo, 38.5 y 0.23, respectivamente; probabilidad antes y después de la prueba, 2.13 y 82, respectivamente. Conclusión: La BPC es útil como prueba diagnóstica en la práctica clínica, debido a que produce un cambio importante de la probabilidad antes de la prueba a la probabilidad después de la prueba.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Biopsia/clasificación , Biopsia/métodos , Derrame Pleural Maligno/patología , Pleura/patología , Toracoscopía , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad
6.
Radiología (Madr., Ed. impr.) ; 59(1): 40-46, ene.-feb. 2017. tab
Artículo en Español | IBECS | ID: ibc-159695

RESUMEN

Objetivo. Realizar estudio de costo-efectividad de la biopsia por aspiración al vacío (BAV) (9 G) guiada por estereotaxia vertical o ecografía comparada con biopsia con aguja gruesa (BAG) (14 G) y biopsia con arpón. Material y métodos. Analizamos 997 biopsias mamarias (181 BAV, 626 BAG y 190 arpones). Calculamos costes totales (directos e indirectos) de los tres tipos de biopsia. No calculamos costes intangibles. El efecto a medir fue el "porcentaje de diagnósticos correctos" obtenidos con cada una de las técnicas. Calculamos los ratios medios de los tres tipos de biopsias e identificamos la opción dominante más costo-efectiva. Resultados. Costes totales de BAG 225,09 Euros, de BAV 638,90 Euros y de biopsia con arpón 1780,01 Euros. Porcentaje de diagnósticos correctos globales con BAG 91,81%, BAV 94,03% y biopsia con arpón 100%, sin diferencias significativas (p=0,3485). En microcalcificaciones, los porcentajes de diagnósticos correctos fueron con BAG 50% y con BAV 96,77%, p<0,0001. En nódulos tampoco hubo diferencias significativas. El ratio medio costo-efectividad considerando todas las lesiones en conjunto, fue para BAG 2,45, BAV 6,79 y arpón 17,80. Conclusión. La BAG fue la opción dominante para el diagnóstico de lesiones mamarias sospechosas de malignidad en general. En el caso de las microcalcificaciones, el bajo porcentaje de diagnósticos de la BAG (50%) desaconsejan su uso y colocan a la BAV como técnica de elección; la BAV es, además, más costo-efectiva que el arpón, que es la otra técnica indicada para biopsiar microcalcificaciones (AU)


Objectives. To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. Material and methods. We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. Results. Total costs were Euros 225.09 for core biopsy, Euros 638.90 for vacuum-assisted biopsy, and Euros 1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. Conclusion. Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications (AU)


Asunto(s)
Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Biopsia/clasificación , Biopsia/economía , Biopsia , Biopsia con Aguja Gruesa/economía , Biopsia con Aguja Gruesa , Biopsia Guiada por Imagen/economía , Mama , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/organización & administración , Análisis Costo-Beneficio/normas , Evaluación de Costo-Efectividad , Estudios Retrospectivos , Análisis Estadístico
7.
J Bras Pneumol ; 43(6): 424-430, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29340490

RESUMEN

OBJECTIVE: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. METHODS: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. RESULTS: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. CONCLUSIONS: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.


Asunto(s)
Biopsia , Derrame Pleural Maligno/patología , Biopsia/clasificación , Biopsia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pleura/patología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Toracoscopía
8.
Arch. esp. urol. (Ed. impr.) ; 69(6): 302-310, jul.-ago. 2016. tab
Artículo en Inglés | IBECS | ID: ibc-154262

RESUMEN

Despite advances in the diagnosis of prostate cancer over the past century, it remains a leading cause of cancer related death. A recent recommendation against screening has further complicated the diagnosis and management of this condition. It remains to be demonstrated if newer diagnostic modalities will have an impact on mortality rates. Most certainly, not all prostate cancers need to be diagnosed, and methods of accurately diagnosing those cancers that lead to death needs more work. In this review article, we describe the different techniques, approaches and diagnostic accuracies of the currently used biopsy methods (AU)


A pesar de los avances en el diagnóstico del cáncer de próstata durante el siglo pasado, éste sigue siendo una causa principal de muerte relacionada con cáncer. Una recomendación reciente contra el screening ha complicado más aún el diagnóstico y tratamiento de esta enfermedad. Sigue por demostrarse si las modalidades diagnósticas más nuevas tendrán un impacto sobre las tasas de mortalidad. Con toda certeza, no es necesario diagnosticar todos los cánceres de próstata, y es necesario seguir trabajando con los métodos que permiten diagnosticar con precisión los cánceres mortales. En este artículo de revisión describimos las diferentes técnicas, abordajes y precisión diagnóstica de los métodos de biopsia utilizados actualmente (AU)


Asunto(s)
Humanos , Masculino , Neoplasias de la Próstata/diagnóstico , Antígeno Prostático Específico/análisis , Biopsia/clasificación , Biopsia , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Tamizaje Masivo/métodos , Técnicas de Diagnóstico Urológico/instrumentación , Técnicas de Diagnóstico Urológico/tendencias , Técnicas de Diagnóstico Urológico
9.
Vet J ; 214: 50-60, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27387727

RESUMEN

Flexible endoscopy has become a valuable tool for the diagnosis of many small animal gastrointestinal (GI) diseases, but the techniques must be performed carefully so that the results are meaningful. This article reviews the current diagnostic utility of flexible endoscopy, including practical/technical considerations for endoscopic biopsy, optimal instrumentation for mucosal specimen collection, the correlation of endoscopic indices to clinical activity and to histopathologic findings, and new developments in the endoscopic diagnosis of GI disease. Recent studies have defined endoscopic biopsy guidelines for the optimal number and quality of diagnostic specimens from different regions of the gut. They also have shown the value of ileal biopsy in the diagnosis of canine and feline chronic enteropathies, and have demonstrated the utility of endoscopic biopsy specimens beyond routine hematoxylin and eosin histopathological analysis, including their use in immunohistochemical, microbiological, and molecular studies.


Asunto(s)
Biopsia/veterinaria , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Perros/diagnóstico , Endoscopía/veterinaria , Enfermedades Gastrointestinales/veterinaria , Animales , Biopsia/clasificación , Biopsia/métodos , Gatos , Perros , Endoscopía/clasificación , Endoscopía/métodos , Enfermedades Gastrointestinales/diagnóstico
11.
Mem Inst Oswaldo Cruz ; 109(7): 944-7, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25411000

RESUMEN

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.


Asunto(s)
ADN Bacteriano/análisis , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/genética , Piel/patología , Biopsia/clasificación , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Lepra Paucibacilar/clasificación , Masculino , Reacción en Cadena de la Polimerasa/métodos , Piel/lesiones , Centros de Atención Terciaria
12.
Mem. Inst. Oswaldo Cruz ; 109(7): 944-947, 11/2014. tab, graf
Artículo en Inglés | LILACS | ID: lil-728804

RESUMEN

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.


Asunto(s)
Femenino , Humanos , Masculino , ADN Bacteriano/análisis , Lepra Paucibacilar/diagnóstico , Mycobacterium leprae/genética , Piel/patología , Biopsia/clasificación , Técnicas de Apoyo para la Decisión , Lepra Paucibacilar/clasificación , Reacción en Cadena de la Polimerasa/métodos , Piel/lesiones , Centros de Atención Terciaria
14.
Actas urol. esp ; 38(8): 499-505, oct. 2014. tab
Artículo en Español | IBECS | ID: ibc-128829

RESUMEN

Objetivos: Examinar los resultados del tratamiento en pacientes con cáncer de próstata (CP) tratados con prostatectomía radical (PR) que podrían ser buenos candidatos para vigilancia activa (VA) y evaluar la confianza y fiabilidad de los criterios de VA para predecir la enfermedad en estadios avanzados (puntuación de Gleason en PR ≥ 7 o estadio patológico T3). Métodos: Entre 2005 y 2012 se examinaron los registros de 401 pacientes sometidos a PR con un diagnóstico de CP. De estos pacientes 173 resultaron ser candidatos para VA. Los criterios de inclusión fueron los siguientes: estadio clínico T2a o inferior, PSA < 10 ng/ml, 2 o menos núcleos afectados por cáncer, ningún núcleo con una afectación máxima por cáncer del 50% o más y ninguna puntuación de Gleason mayor de 3 en la muestra. Resultados: Los análisis univariantes revelaron que los pacientes con un estadio más avanzado de la enfermedad tenían una densidad del antígeno prostático específico (PSAD) más elevada, un mayor porcentaje máximo (% máx) de núcleos positivos y un mayor volumen tumoral en PR. En los análisis multivariantes la PSAD, el % máx de núcleos positivos y el volumen tumoral en PR eran factores estadísticamente significativos de enfermedad en estadios avanzados. Los análisis ROC revelaron que el volumen tumoral en PR es un buen test de la enfermedad en estadio avanzado. Conclusiones: Se debería considerar reducir los valores umbral de PSAD y % máx en núcleos positivos como criterios de inclusión para VA. Si se pudiera calcular el volumen tumoral antes de la PR podríamos minimizar los fracasos del tratamiento (exceso o falta de tratamiento) de CP. Quizás los nuevos protocolos de biopsias, los biomarcadores de tejidos y la tecnología de imágenes moleculares puedan perfeccionar los criterios para VA


Objectives: To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criteria for predicting advanced stage disease (RP Gleason score ≥7 or pathological stage T3). Methods: Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA < 10 ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen. Results: Univariate analyses revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max %) in positive cores and higher RP tumor volumes. In multivariate analyses PSAD, max % in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyses revealed that the RP tumor volume is a good test on advanced stage disease. Conclusions: Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or under treatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria


Objectives: To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criteria for predicting advanced stage disease (RP Gleason score ≥7 or pathological stage T3). Methods: Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA < 10 ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen. Results: Univariate analyses revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max %) in positive cores and higher RP tumor volumes. In multivariate analyses PSAD, max % in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyses revealed that the RP tumor volume is a good test on advanced stage disease. Conclusions: Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or under treatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Vigilancia en Salud Pública/métodos , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/prevención & control , Neoplasias de la Próstata/terapia , Prostatectomía/mortalidad , Prostatectomía/métodos , Prostatectomía/tendencias , Carga Tumoral/fisiología , Biopsia/clasificación , Biopsia/métodos , Biopsia , Neoplasias/patología , Neoplasias/terapia
15.
In. Guimarães, Marcos Duarte; Chojniak, Rubens. Oncologia. Rio de Janeiro, Elservier, 2014. p.901-933, ilus, 82, ilusuras.
Monografía en Portugués | LILACS | ID: lil-751111
16.
In. Paniagua Estévez, Manuel Eusebio; Piñol Jiménez, Felipe Neri. Gastroenterología y hepatología clínica. Tomo 1. La Habana, ECIMED, 2014. .
Monografía en Español | CUMED | ID: cum-60694
19.
Urol Oncol ; 31(7): 1166-70, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22300757

RESUMEN

OBJECTIVES: To determine accuracy of upper tract cytology and ureteroscopic biopsy according to the 2004 World Health Organization (WHO) classification in predicting the correct tumor grade in patients with urothelial cancer of the upper urinary tract (UUT-UC). METHODS: Pathology reports of 77 nephroureterectomy specimens were retrospectively analyzed for tumor grade and compared with preoperatively gained cytology and ureteroscopic biopsy results. For analysis, the 2004 WHO classification was used. RESULTS: Overall sensitivity of cytology and biopsy in diagnosis of UUT-UC was 64% and 74%, respectively. Accuracy of cytology and biopsy in predicting high grade cancer was 53% and 58%, respectively. Combination of cytology and biopsy could improve sensitivity (84%) and accuracy (68%), but even for this combination, 15% of high grade tumors were misinterpreted as low grade cancer. CONCLUSION: Our results show only limited accuracy for preoperative cytology and ureterorenoscopically performed biopsies in the prediction of the correct tumor grading of an UUT-UC. Therefore, we suggest the use of additional diagnostic procedures before the decision for definitive surgical treatment in patients with UUT-UC is made.


Asunto(s)
Biopsia/métodos , Carcinoma de Células Transicionales/diagnóstico , Citodiagnóstico/métodos , Neoplasias Urológicas/diagnóstico , Anciano , Anciano de 80 o más Años , Biopsia/clasificación , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Citodiagnóstico/clasificación , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Nefrectomía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Uréter/patología , Uréter/cirugía , Orina/citología , Neoplasias Urológicas/patología , Neoplasias Urológicas/cirugía , Urotelio/patología , Urotelio/cirugía , Organización Mundial de la Salud
20.
J. bras. patol. med. lab ; 48(3): 211-215, jun. 2012. ilus, tab
Artículo en Inglés | LILACS | ID: lil-640745

RESUMEN

INTRODUCTION: Focal segmental glomerulosclerosis (FSGS) is the most frequent primary glomerulopathy in Brazil and its incidence is increasing worldwide. Pathogenesis is related to podocyte injury, which may be due to several factors including viruses, drugs, genetics and immunological factors. In 2004, the Columbia classification of FSGS identified five histological variants of the disease: collapsing (COL), usual (NOS), tip lesion (TIP), perihilar (PHI) and cellular variant (CEL). The objective of this study was to classify the FSGS biopsies in these morphological variants. METHODS: One hundred thirty-one cases of renal biopsies with primary FSGS diagnosis, which had been performed at a Brazilian reference center from 1996 to 2006, were classified according to the Columbia criteria. RESULTS: FSGS cases were distributed as follows: 38.2% NOS variant, 36.6% COL, 14.5% TIP, 6.9% PHI and 3.8% CEL. CONCLUSION: COL variant of FSGS seems to be more prevalent in Brazil in comparison with other centers worldwide, which may be related to environmental and socioeconomic factors.


INTRODUÇÃO: A glomerulosclerose segmentar e focal (GESF) é a glomerulopatia primária mais frequente no Brasil e sua incidência está aumentando em todo o mundo. Sua patogênese está relacionada com a lesão de podócitos, que pode ser devida a vários fatores, incluindo vírus, drogas, fatores genéticos e imunológicos. Em 2004, a classificação de Columbia GESF definiu cinco variantes histológicas da doença: colapsante (COL), usual (NOS), lesão apical (TIP), Peri-hilar (PHI) e variante celular (CEL). O objetivo deste estudo foi classificar as biópsias com diagnóstico de GESF nessas variantes morfológicas. MÉTODOS: Cento e trinta e um casos de biópsias renais com diagnóstico de GESF primária em um centro brasileiro de referência em nefrologia, no período de 1996 a 2006, foram classificados de acordo com os critérios de Columbia. RESULTADOS: Os casos se distribuíram da seguinte forma: 38,2% da variante de NOS; 36,6% de COL; 14,5% de TIP; 6,9% de PHI; 3,8% de CEL. CONCLUSÃO: A variante COL de GESF parece ser mais prevalente no Brasil do que em outros centros internacionais e isso pode ser reflexo de fatores socioeconômicos e ambientais.


Asunto(s)
Biopsia/clasificación , Glomeruloesclerosis Focal y Segmentaria/clasificación , Glomeruloesclerosis Focal y Segmentaria/genética , Glomeruloesclerosis Focal y Segmentaria/patología , Factores de Riesgo
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