[Differential diagnosis and management of intramuscular myxomas: A review of our experience]. / Diagnóstico diferencial y manejo de mixomas intramusculares: revisión de nuestra experiencia.

BACKGROUND: Intramuscular myxoma is a rare benign soft tissue tumour of mesenchymal origin, which appears as a painless mass of slow growth. Early diagnosis is important in order to differentiate it from other entities, especially soft tissue sarcoma. CLINICAL CASES: Two cases, both women with a mean age of 52.5 years (range 40-65) are presented. The first was seen due to growth of a gluteal mass, and the second by coccydynia. Computed tomography and nuclear magnetic resonance were the diagnostic tests of choice. In one case, where there was a single but large lesion, radical extirpation of the gluteal muscle was chosen. In the other case, in which the lesions were multiple, individualised excision of cysts was performed. Postoperative functional limitation was low in both types of surgery, with good oncological results being obtained. CONCLUSION: Intramuscular myxomas are benign lesions. There are no cases of malignancy or recurrence due to incomplete resection. It has to be determined whether they are single or multiple, since in the latter case, they could be due to syndromes such as Mazabraud syndrome, which is associated with bone fibrous dysplasia, or Albright syndrome that is also associated with pigmented skin spots.

Melanoma esofágico primario: descripción de un caso / Primary esophageal melanoma: report of a case

Introducción: el melanoma esofágico primario es un tumor muy poco frecuente que constituye únicamente el 0,1-0,2% de las enfermedades malignas del esófago. El objetivo del estudio fue presentar el manejo de un nuevo caso clínico diagnosticado y tratado en nuestro centro. Caso clínico: paciente de 67 años que presentaba clínica de disfagia a sólidos sin otros antecedentes ni lesiones cutáneas asociadas. Se le realizó una gastroscopia, apreciándose una formación polipoide en tercio distal esofágico sugestiva de neoplasia. La biopsia fue positiva para melanoma con marcadores inmunohistoquímicos S100 y HMB45 positivos; citoqueratinas y CEA negativos. La tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) no mostraron infiltración local ni metástasis a distancia. Se practicó una esofaguectomía de Ivor-Lewis con linfadenectomía regional. La estancia postoperatoria fue de tres semanas sin producirse complicaciones postoperatorias reseñables. El estudio anatomopatológico de la pieza confirmó el diagnóstico de melanoma esofágico primario. Discusión: el pronóstico del melanoma primario de esófago es infausto, debido a que se trata de un tumor agresivo que suele diagnosticarse en fases avanzadas de la enfermedad, con presencia de invasión local y metástasis. El tratamiento de elección actualmente es la cirugía, obteniéndose resultados limitados con el resto de terapias adyuvantes (AU)

Introduction: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. Case report: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. Discussion: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results (AU)

Rendimiento diagnóstico de la punción aspiración con aguja fina de tejido tiroideo / Diagnostic efficacy of fine needle aspiration of thyroid tissue

Introducción. La punción aspiración con aguja fina (PAAF) de la glándula tiroides constituye un proceso diagnóstico que permite determinar de forma segura y fiable, si un nódulo tiroideo es benigno o maligno. Objetivo. El objetivo del estudio fue evaluar la eficacia diagnóstica de la PAAF en nuestro centro. Material y métodos. Se llevó a cabo de 2009 a 2013 un estudio retrospectivo de pacientes con nódulo tiroideo sospechoso de ser maligno. Las variables del estudio fueron: edad, sexo, tamaño del nódulo tiroideo, realización de PAAF, estudio anatomo-patológico de la biopsia y diagnóstico definitivo. Se comparó el rendimiento diagnóstico de la PAAF frente a los resultados de la biopsia posoperatoria. Resultados. Durante los cinco años del estudio, se practicó PAAF de tejido tiroideo a 112 pacientes (30,2 %, hombres, y 69,8 %, mujeres), con un tamaño medio nodular de 2 cm (rango: 1 a 4). La PAAF fue positiva para neoplasia maligna en 26 casos (23,2 %) y negativa en 86 casos (76,8 %). Los resultados del rendimiento de la prueba fueron: sensibilidad de 45,5 % (intervalo de confianza 95 % [IC95%] 28,1-63,6), especificidad de 86,1 % (IC95% 76,5-92,8), valor predictivo positivo de 57,7 % (IC95% 36,9-76,6) y valor predictivo negativo de 79,1 % (IC95% 69-87,1). Conclusión. Tras este análisis, se obtiene un resultado malo con posibilidad de ser mediocre, por lo que habría que replantearse la utilidad de esta prueba invasiva en nuestro centro y la búsqueda de posibles errores.

Background: Thyroid fine needle aspiration (FNA) is a safe and reliable diagnostic procedure for determining if a thyroid nodule is benign or malignant. Objective: The objective of this study was to evaluate the efficacy of FNA diagnosed in our center. Material and methods: Retrospective study of patients with thyroid nodule suspicious for malignancy, in the period 2009 to 2013. The variables used in this study were: age, sex, size of thyroid nodule, FNA performance, pathology and definitive diagnosis. The diagnostic accuracy of FNA was compared with the results of postoperative biopsy. Results: During the 5-year study, FNA of thyroid tissue was performed at 112 patients (30.2% men and 69.8% women), with nodules of average size of 2 cm (range 1-4). FNA was positive for malignancy in 26 cases (23.2%) and negative in 86 cases (76.8%). The performance results of the test were: sensitivity 45.5% (confidence interval [CI] 95%: 28.1% -63.6%), specificity of 86.1% (95% CI: 76.5 % - 92.8%), positive predictive value of 57.7% (95% CI: 36.9% - 76.6%) and negative predictive value of 79.1% (95% CI: 69% - 87 1%) Conclusion: A bad result with the possibility of being mediocre is obtained with this analysis, which should rethink the usefulness of this invasive test in our center and search for possible errors.

Alteraciones nutricionales tras dieta muy baja en calorías previa a cirugía bariátrica / Nutritional alterations after very low-calorie diet before bariatric surgery

INTRODUCCIÓN: El número de personas obesas ha aumentado de forma alarmante en todo el mundo. Actualmente no existe un consenso acerca de si los pacientes que van a ser sometidos a una cirugía bariátrica deben o no perder peso antes de la misma. El objeto de la presente investigación es analizar la influencia de la pérdida de peso preoperatoria en los parámetros nutricionales de los pacientes. MÉTODOS: Se sometió a 50 pacientes que iban a ser intervenidos de una cirugía bariátrica a una dieta de muy bajo contenido calórico durante las 4 semanas previas a la intervención. Se analizaron los parámetros nutricionales en 3 momentos específicos: antes de empezar la dieta, en el momento de la intervención (al finalizar la dieta) y un mes después. RESULTADOS: La media de hemoglobina, albúmina y linfocitos se mantuvo dentro del rango de la normalidad en todo momento a pesar de que los descensos de dichos parámetros fueron estadísticamente significativos a lo largo del estudio (p < 0,05). Con la dieta de muy bajo contenido calórico se anemizó menos del 9,5% de la muestra. CONCLUSIONES: La pérdida de peso preoperatoria no influye de manera significativa en los parámetros nutricionales analizados. Estos resultados apoyarían la indicación de una pérdida de peso preoperatoria en los pacientes candidatos a cirugía bariátrica

INTRODUCTION: There has been an alarming worldwide increase of obese people in recent years. Currently, there is no consensus on whether patients that are scheduled to undergo bariatric surgery should lose weight before the intervention. The objective of this research is to analyse the influence of pre-surgery loss of weight in the nutritional parameters of patients. METHODS: Fifty patients that were scheduled to undergo bariatric surgery followed a very low caloric diet during 4 weeks prior to the surgery. The nutritional parameters were analysed at 3 specific moments: before starting the diet, at the moment of surgery (when the diet was concluded) and one month after the surgery. RESULTS: Average values for hemoglobin, albumina and lymphocytes were kept within the range of normal values at all moments, even though the decrease of those parameters was statistically significant throughout the study (P < .05). By following the very low caloric diet, less than 9.5% of the sample suffered anaemia. CONCLUSIONS: Loss of weight prior to surgery does not have a significant influence in the nutritional paramters of the patient. These results would support the indication of losing weight for patients that are considered candidates for bariatric surgery

Primary esophageal melanoma: report of a case.

INTRODUCTION: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site. CASE REPORT: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma. DISCUSSION: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.

Nutritional alterations after very low-calorie diet before bariatric surgery.

INTRODUCTION: There has been an alarming worldwide increase of obese people in recent years. Currently, there is no consensus on whether patients that are scheduled to undergo bariatric surgery should lose weight before the intervention. The objective of this research is to analyse the influence of pre-surgery loss of weight in the nutritional parameters of patients. METHODS: Fifty patients that were scheduled to undergo bariatric surgery followed a very low caloric diet during 4 weeks prior to the surgery. The nutritional parameters were analysed at 3 specific moments: before starting the diet, at the moment of surgery (when the diet was concluded) and one month after the surgery. RESULTS: Average values for hemoglobin, albumina and lymphocytes were kept within the range of normal values at all moments, even though the decrease of those parameters was statistically significant throughout the study (P<.05). By following the very low caloric diet, less than 9.5% of the sample suffered anaemia. CONCLUSIONS: Loss of weight prior to surgery does not have a significant influence in the nutritional parameters of the patient. These results would support the indication of losing weight for patients that are considered candidates for bariatric surgery.

Carcinoma medular quístico de mama / Cystic medullary breast carcinoma

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Abordaje laparoscópico de la oclusión intestinal / Laparoscopic approach to intestinal obstruction

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Current status of ovarian cancer in the Spanish Province of Castellon. Prognostic factors in observed and relative survival. A population cancer-registry-based study between 2004 and 2008 / Estado actual del cáncer de ovario en la provincia de Castellón. Factores pronósticos en la supervivencia observada y relativa. Un estudio basado en registros poblacionales de cáncer de entre 2004 y 2008

Background. The aim of this population-based study was to assess independent prognostic factors in ovarian cancer by analyzing observed and relative survival in a representative Spanish population. Methods. We carried out a retrospective, observational, population-registry-based study. Data on 207 patients with ovarian cancer were provided by the Castellon Cancer Registry. Observed and relative survival were described at 1, 3 and 5 years. The effect of prognostic factors on survival was assessed with univariate and multivariate analyses. Results. The median follow-up was 40.8 months (range: 12-108 months). Observed and relative survival rates at 1, 3 and 5 years were 79%, 51%, 33%, and 84%, 58%, 40%, respectively. Age older than 70 years showed worse observed survival in the univariate and multivariate analyses. Only FIGO stage was an independent prognostic factor for observed and relative survival. Conclusions. Survival is poor in patients with ovarian cancer. In our population-registry-based study, only age at diagnosis and FIGO stage were independent prognostic factors for observed survival, whereas only FIGO stage could be considered a prognostic factor for relative survival (AU)

Antecedentes. El objetivo de este estudio poblacional fue evaluar los factores pronósticos independientes de cáncer de ovario mediante el análisis de la supervivencia observada y relativa en una población española representativa. Métodos. Se realizó un estudio retrospectivo, observacional, y basado en un registro de población. Los datos de 207 pacientes con cáncer de ovario proceden del Registro de Cáncer de Castellón. Se describió la supervivencia observada y relativa a 1, 3 y 5 años. El efecto de los factores pronósticos en la supervivencia se evaluó mediante análisis univariantes y multivariantes. Resultados. La mediana de seguimiento fue de 40,8 meses (intervalo: 12-108 meses). Las tasas de supervivencia observada y relativa a 1, 3 y 5 años fueron de 79%, 51% y 33% y de 84%, 58% y 40%, respectivamente. La edad superior a los 70 años mostró la peor supervivencia observada en los análisis univariantes y multivariantes. Sólo el estadio en la clasificación FIGO fue un factor pronóstico independiente de la supervivencia observada y relativa. Conclusiones. La supervivencia en los pacientes con cáncer de ovario es limitada. En nuestro estudio basado en un registro de población, sólo la edad en el momento del diagnóstico y el estadio de FIGO fueron factores pronósticos independientes para la supervivencia observada, mientras que sólo el estadio de la FIGO se podría considerar un factor pronóstico en la supervivencia relativa (AU)

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study]. / Relación del tamaño tumoral con la recidiva tras cirugía conservadora en el cáncer de mama en estadio tumoral T1-T2. Estudio poblacional.

BACKGROUND: Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. METHODS: A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. RESULTS: The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). CONCLUSIONS: Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

Antecedentes: la cirugía conservadora es un patrón de referencia del tratamiento de la mayor parte de los tumores mamarios en estadios iniciales. Sin embargo, una minoría de pacientes intervenidas con esta opción tendrá recurrencia local o locorregional. Por ello resulta de interés evaluar los posibles factores relacionados con esta recurrencia. Material y métodos: estudio retrospectivo, con base poblacional, efectuado con base en los datos del Registro de Tumores de Castellón (Comunidad Valenciana, España) de pacientes intervenidas de cáncer primario de mama no metastático de enero de 2000 a diciembre de 2008. Se utilizaron las curvas de Kaplan-Meier y la prueba de log-rank para estimar la recurrencia local a cinco años. Se definieron dos grupos de pacientes, uno con cirugía conservadora y otro con cirugía no conservadora de la mama. Se realizó un estudio multivariado de Cox. Resultados: se encontraron 410 pacientes con promedio de 6.8% de recurrencias locales. En el análisis univariado sólo el tamaño tumoral y la afectación ganglionar demostraron diferencias significativas. En el análisis multivariado los factores pronóstico independientes fueron: la cirugía conservadora (Hazard ratio [HR] 4.62; IC [intervalo de confianza] 95% 1.12-16.82), el número de ganglios linfáticos positivos (HR 1.07; IC 95% 1.01-1.17) y el tamaño del tumor en milímetros (HR 1.02; IC 95% 1.01-1.06). Conclusiones: la recurrencia local postcirugía conservadora de mama es mayor en tumores de más de 2 cm. Aunque el tamaño del tumor no debería ser una contraindicación para esta cirugía sí deben tomarse en cuenta como un factor de riesgo.

Short-term results for laparoscopic repair of large paraesophageal hiatal hernias with Gore Bio A® mesh.

BACKGROUND: The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. One of the most debated issues is the risk of complications related to the use of the prosthesis, such as esophageal erosion and postoperative dysphagia. The aim of this study is to present our short-terms results in the treatment of laparoscopic paraesophageal hiatal hernia (LPHH) with a synthetic polyglycolic acid:trimethylene carbonate mesh (Gore Bio A(®)). METHODS: From January 2011 to December 2012, 10 patients with large paraesophageal hiatal hernias and hiatal defect over 5 cm were included. Primary simple suture of the crura and additional reinforcement with a Gore Bio A(®) mesh was performed. Hiatal hernia or gastroesophageal reflux disease (GERD) symptoms recurrence, dysphagia and mesh-related complications were investigated. RESULTS: Of the 10 patients undergoing mesh repair, there were 7 women and 3 men with a mean age of 65.5 years. All operations were completed laparoscopically. Median postoperative stay was 3 days. After a median follow-up of 20.3 months, one patient developed a recurrent hiatal hernia (10%). There were no mesh-related complications. CONCLUSIONS: The use of Gore Bio A(®) mesh for the laparoscopic repair of large paraesophageal hiatal hernias is safe and with a reasonably low recurrence rate in this short-term study. Additional long-term studies with ample numbers carried out for years will be necessary to see if this synthetic mesh is not only safe but also successful in the prevention of recurrences.

25 años de cirugía laparoscópica en España / 25 years of laparoscopic surgery in Spain

INTRODUCCIÓN: La introducción de la cirugía laparoscópica (CL) puede considerarse el avance más importante que ha experimentado nuestra especialidad en los últimos 25 años. A pesar de sus ventajas, la implantación y consolidación de la CL no ha sido homogénea, especialmente si tenemos en cuenta las técnicas laparoscópicas avanzadas. El objetivo de este trabajo es analizar el nivel de desarrollo e implantación de la CL en España en el momento actual y analizar su evolución en los últimos años. MATERIAL Y MÉTODOS: Durante el segundo semestre de 2012 se desarrolló una encuesta que evaluaba distintos aspectos relacionados con la implantación y el desarrollo de la CL en nuestro país. La encuesta se realizó mediante un cuestionario electrónico. RESULTADOS: La tasa global de respuesta a la encuesta fue del 16% y 103 jefes de Servicio contestaron el cuestionario. El 92% correspondió a cirujanos de centros sanitarios públicos. El 99% de los encuestados realizaba CL básica y el 85,2%, avanzada. La mayor parte de los encuestados (79%) considera que el instrumental y los equipos para CL de los que dispone son correctos y el 71% considera que, en su medio, la CL está en el lugar adecuado. CONCLUSIONES: La CL básica ha logrado desarrollarse en nuestro país hasta considerarse un estándar practicado por la mayoría de los cirujanos y ser parte de la formación básica del residente de cirugía. Con respecto a la CL avanzada, aunque los porcentajes de utilización son altos, todavía existen déficits y, en consecuencia, oportunidades de mejora

INTRODUCTION: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. MATERIAL AND METHODS: During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. RESULTS: The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. CONCLUSIONS: Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement

Empiema necessitatis tras traumatismo torácico / Empiema Necessitatis Following Chest Trauma

No disponible

[25 years of laparoscopic surgery in Spain]. / 25 años de cirugía laparoscópica en España.

INTRODUCTION: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. MATERIAL AND METHODS: During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. RESULTS: The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. CONCLUSIONS: Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement.

Dermatomiositis asociada a cáncer de mama. Síndrome paraneoplásico infrecuente / Dermatomyositis associated with breast cancer. An infrequent paraneoplastic syndrome

La dermatomiositis es un síndrome paraneoplásico raro que se asocia al diagnóstico de diferentes tumores. El cáncer de mama es un tumor asociado de manera muy infrecuente con la dermatomiositis. Se presenta el caso de una mujer de 50 años que comenzó como una dermatomiositis y que fue diagnosticada de un cáncer de mama. El tratamiento quirúrgico del cáncer de mama supuso la desaparición de los síntomas de debilidad muscular y de las alteraciones cutáneas(AU)

Dermatomyositis is a rare paraneoplastic syndrome associated with several malignant tumors. The association with breast cancer is much less frequent. We report a 50-year-old woman who presented with dermatomyositis and was diagnosed with breast cancer. Surgical treatment of breast cancer improved the symptoms of muscular weakness and the cutaneous manifestations of dermatomyositis(AU)

Rentabilidad diagnóstica de la punción percutánea pancreática en función del tamaño de la lesión / Diagnostic yield of pancreatic percutaneous puncture depending on the size of the lesion

Introducción El objetivo del presente estudio fue analizar la eficacia diagnóstica de la punción percutánea de tejido pancreático. Material y métodos Estudio retrospectivo de pacientes con sospecha de neoplasia de origen pancreático, con biopsia percutánea de tejido pancreático, desde el 2000 hasta el 2011. Para el análisis estadístico comparativo se estratificó la muestra por tamaño, en menores o iguales a 3 cm frente a mayores. Resultados Se realizaron un total de 90 biopsias. Se llegó al diagnóstico de neoplasia pancreática en 47 casos (52%), 16 falsos negativos (18%), 0 falsos positivos y al de pancreatitis crónica en 24 casos (27%). Los resultados de rendimiento de la prueba fueron: sensibilidad (S) global del 75% (intervalo de confianza [IC] 95%: 62-85%), especificidad (E) del 100% (IC 95%: 87-100%), valor predictivo positivo (VPP) del 100% (IC 95%: 92-100%) y valor predictivo negativo (VPN) del 63% (IC 95%: 46-77%). En masas ≤ 3 cm la S fue del 70% (IC 95%: 45-88%), la E del 100% (IC 95%: 66-100%), el VPP del 100% (IC 95%: 76-100%) y el VPN 60% (IC 95%: 32-83%). Frente a masas mayores de 3 cm que presentaron una S del 88% (IC 95%: 70-98%), una E del 100% (IC 95%: 75-100%), un VPP del 100% (IC 95%: 85-100%) y un VPN del 81% (IC 95%: 54-96%).Conclusiones La rentabilidad de la biopsia percutánea pancreática está fuertemente condicionada por el tamaño de la lesión. Para tamaños tumorales menores de 3 cm la sensibilidad y el valor predictivo negativo son inaceptablemente bajos, porque lo que resultados negativos no serían fiables (AU)

Introduction The aim of the present study was to study the diagnostic efficacy of the percutaneous puncture of pancreatic tissue. Material and methods A retrospective study was conducted on patients with suspicion of pancreatic neoplasm, and with a percutaneous biopsy of pancreatic tissue, from 2000 to 2011. For the statistical comparative analysis, the sample was stratified by tumour size: ≤ 3 cm and > 3 cm. Results A total of 90 biopsies were performed. Pancreatic neoplasm diagnosis was made in 47 cases (52%), with 16 false negatives (18%), no false positives, and chronic pancreatitis in 24 cases (27%). The efficacy of the test results were: an overall sensitivity of 75% (95% CI: 62%-85%), a specificity of 100% (95% CI: 87%-100%), a positive predictive value of 100% (95% CI: 92%-100%), and a negative predictive value of 63% (95% CI: 46%-77%). For tumour sizes ≤ 3 cm the sensitivity was 70% (95% CI: 45%-88%), with a specificity of 100% (95% CI 66%-100%), a positive predictive value of 100% (95% CI: 76%-100%, and a negative predictive value 60% (95% CI: 32%-83%). For tumours greater than 3 cm, the sensitivity was 88% (95% CI: 70%-98%), the specificity was 100% (95% CI: 75%-100%), with a positive predictive value of 100% (95% CI: 85%-100%) and a negative predictive value of 81% (95% CI: 54%-96%).Conclusions Pancreatic percutaneous biopsy efficacy was strongly determined by lesion size. For tumour sizes less than 3 cm, the sensitivity and negative predictive value are unacceptably low, as negative results would not reliable (AU)

[Diagnostic yield of pancreatic percutaneous puncture depending on the size of the lesion]. / Rentabilidad diagnóstica de la punción percutánea pancreática en función del tamaño de la lesión.

INTRODUCTION: The aim of the present study was to study the diagnostic efficacy of the percutaneous puncture of pancreatic tissue. MATERIAL AND METHODS: A retrospective study was conducted on patients with suspicion of pancreatic neoplasm, and with a percutaneous biopsy of pancreatic tissue, from 2000 to 2011. For the statistical comparative analysis, the sample was stratified by tumour size: ≤ 3cm and > 3cm. RESULTS: A total of 90 biopsies were performed. Pancreatic neoplasm diagnosis was made in 47 cases (52%), with 16 false negatives (18%), no false positives, and chronic pancreatitis in 24 cases (27%). The efficacy of the test results were: an overall sensitivity of 75% (95% CI: 62%-85%), a specificity of 100% (95% CI: 87%-100%), a positive predictive value of 100% (95% CI: 92%-100%), and a negative predictive value of 63% (95% CI: 46%-77%). For tumour sizes ≤ 3cm the sensitivity was 70% (95% CI: 45%-88%), with a specificity of 100% (95% CI 66%-100%), a positive predictive value of 100% (95% CI: 76%-100%, and a negative predictive value 60% (95% CI: 32%-83%). For tumours greater than 3cm, the sensitivity was 88% (95% CI: 70%-98%), the specificity was 100% (95% CI: 75%-100%), with a positive predictive value of 100% (95% CI: 85%-100%) and a negative predictive value of 81% (95% CI: 54%-96%). CONCLUSIONS: Pancreatic percutaneous biopsy efficacy was strongly determined by lesion size. For tumour sizes less than 3cm, the sensitivity and negative predictive value are unacceptably low, as negative results would not reliable.