La toracocentesis en la evaluación del cáncer de pulmón con derrame pleural*
Thoracentesis for the assessment of lung cancer with pleural effusion
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López-Campos Bodineau, J. Fernández Guerra, L. Moreno, J.J. Cebrián Gallardo, J.M. García Jiménez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Campos Bodineau" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Fernández Guerra" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Moreno" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Cebrián Gallardo" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "García Jiménez" ] ] ] 1 => array:2 [ "autoresLista" => "A. Lara Blanquer, E. Perea-Milla López" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lara Blanquer" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Perea-Milla López" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028960275268X?idApp=UINPBA00003Z" "url" => "/03002896/0000003800000010/v1_201307081551/S030028960275268X/v1_201307081551/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "La toracocentesis en la evaluación del cáncer de pulmón con derrame pleural<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">*</span></a>" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "479" "paginaFinal" => "484" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Martín Díaz, A. Arnau Obrer, M. Martorell Cebollada, A. Cantó Armengod" "autores" => array:4 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Martín Díaz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Arnau Obrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Martorell Cebollada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Cantó Armengod" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicios de Cirugía Torácica.Hospital General Universitario de Valencia" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicios de Anatomía Patológica. Hospital General Universitario de Valencia" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Servicio de Cirugía Torácica.Hospital Universitario Nuestra Señora de Candelaria.Ctra. del Rosario, s/n. 38010 Santa Cruz de Tenerife" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Thoracentesis for the assessment of lung cancer with pleural effusion" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-02-11" "fechaAceptado" => "2002-06-18" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190669" "palabras" => array:4 [ 0 => "Cáncer de pulmón" 1 => "Derrame pleural" 2 => "Citología tumoral" 3 => "Metástasis pleural" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190670" "palabras" => array:4 [ 0 => "Lung cancer" 1 => "Pleural effusion" 2 => "Tumor cytology" 3 => "Pleural metastasis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la repercusión pleural y ganglionar mediastínica de la citología tumoral obtenida por toracocentesis del derrame pleural (DP) diagnosticado mediante radiografía de tórax en pacientes con cáncer de pulmón (CP)</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio realizado en pacientes con CP primario y DP evidente en la radiografía de tórax a los que se les realizó toracocentesis seguida de videotoracoscopia (VT) para valorar la infiltración pleural directa por el tumor, la afección ganglionar mediastínica y la existencia de diseminación metastásica pleural. Fueron intervenidos quirúrgicamente aquellos sin contraindicación, pese a tener citología tumoral. Al encontrar metástasis pleural se practicó pleurodesis con talco y tratamiento quimioterápico. El estudio estadístico contempló los siguientes aspectos: descripción de las variables epidemiológicas; validez de la VT para el diagnóstico de metástasis pleural y de la citología por toracocentesis para evaluar la infiltración pleural por contigüidad, enfermedad N2 y la existencia de metástasis pleural; supervivencia</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 971 pacientes consecutivos con CP hubo 188 con DP, 72 visibles en la radiografía de tórax. El volumen fue superior a 425 ml. La citología fue tumoral en 29 casos (40%). Hubo metástasis pleural en 54 pacientes (75%), 23 con citología tumoral. En los otros 6 pacientes con citología tumoral, la neoplasia primaria infiltraba la pleura visceral, en 5 de forma completa, 4 de los cuales presentaban infiltración de la pleura mediastínica. Se realizó la exéresis del tumor primario y adenopatías en 11 pacientes, 3 con citología tumoral. La evaluación pleural de visu por VT para el diagnóstico de mestástasis pleural dio una sensibilidad (S) del 93%, especificidad (E) del 82%, un valor predic-tivo positivo (VPP) del 94% y un valor predictivo negativo (VPN) del 78%. La citología por toracocentesis para el diagnóstico de metástasis pleural presentó: S 43%, E 67%, VPP 79% y VPN 28%; para infiltración pleural por contigüidad, sin metástasis pleural: S 40%, E 100%, VPP 100% y VPN 25%; y en la invasión ganglionar mediastínica evaluada clínicamente: S 55%, E 62%, VPP 18% y VPN 90%. La supervivencia tras toracotomía alcanzó el 39% a los 2 años, con una mediana de 14,5 meses y en los 11 pacientes resecados fue del 53% a los 2 años. La comparación de las supervivencias de los pacientes intervenidos por toracotomía y los tratados mediante pleurodesis tras VT fue significativa (p < 0,01). La supervivencia de los 3 pacientes con citología tu-moral resecados alcanzó 84, 39 y 25 meses</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El 19% de los pacientes con CP tiene un DP y el 7% puede ser diagnosticado en la radiografía de tórax, en cuyo caso la probabilidad de que coexista con metástasis pleural es del 75%. El hallazgo de citología tumoral en el DP no es equivalente de metástasis pleural. La toracoscopia se puede considerar la técnica idónea en el análisis de la invasión pleural directa por el tumor o la diseminación metastásica</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the pleural and mediastinal effect of thoracentesis tumorpositive cytology in pleural effusions (PE) detected by chest X ray of lung cancer patients</p> <span class="elsevierStyleSectionTitle">Patients And Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study was performed in patients with lung cancer for whom PE was evident in chest X ray films, who then underwent thoracentesis followed by video-assisted thoracoscopy (VAT) to evaluate direct pleural tumor infiltration, mediastinal node involvement and the existence of pleural metastasis. Patients without contraindication underwent the procedure, even if tumor positive cytology was present. When pleural metastasis was found the treatment employed was talc pleurodesis and chemotherapy. Descriptive statistics were compiled and the validity of VAT for pleural metastasis diagnosis, of thoracentesis pleural cytology to detect infiltration of the tumoradyacent pleura, N2 disease and pleural metastasis were calculated. Survival was also analyzed</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">PE was present in 188 of 971 consecutive lung cancer patients. Seventy two PEs were visible in the chest X ray films. Volume exceeded 425 mL. Tumor positive pleural cytology was detected in 29 cases (40%). Pleural metastasis were found in 54 patients, 23 of whom had tumor positivepleural cytology. In the other 6 patients with positive cytology the primary neoplasm infiltrated the visceral pleura, completely in 5. In 4 of those 5, the mediastinal pleura was also involved. The primary tumor and diseased lymph nodes were removed from 11 patients, 3 of them with tumoral pleural cytology. Visual pleural inspection by VAT had a sensitivity of 93%, specificity of 82%, positive predicted value (PPV) of 94% and negative predicted value (NPV) of 78% for the diagnosis of pleural metastasis. Thoracentesis cytology showed a sensitivity of 43%, specificity of 67%, PPV of 79% and NPV of 28% for pleural metastasis. For the evaluation of adjacent pleura infiltration, without pleural metastasis, the sensitivity of cytology was 40%, specificity 100%, PPV 100% and NPV 25%. For mediastinal node invasion clinically evaluated, the sensitivity of cytology was 55%, specificity of 62%, PPV 18% and NPV 90%. Survival after thoracotomy was 39% after 2 years, and the median survival time was 14.5 months. In the 11 resected patients, survival was 53% at two years. The difference in survival between patients treated by thoracotomy and those treated by talc pleurodesis after VAT was significant (p < 0.01). The 3 resected patients with pleural tumor-positive cytology sur-vived 84, 39 and 25 months</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nineteen percent of patients with lung cancer have PE, of which 7% can be seen in chest X ray films. In such patients the likelihood of pleural metastasis is 75%. Pleural metastasis is not necessarily present when PE cytology indicates that tumor is present. VAT can be considered the ideal technique for the assessment of direct pleural invasion by the tumor or of pleural metastasis</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Premio López Trigo de la Diputación Provincial de Valencia. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 3 | 5 |
| 2024 October | 36 | 26 | 62 |
| 2024 September | 42 | 15 | 57 |
| 2024 August | 52 | 43 | 95 |
| 2024 July | 41 | 24 | 65 |
| 2024 June | 42 | 37 | 79 |
| 2024 May | 46 | 25 | 71 |
| 2024 April | 31 | 32 | 63 |
| 2024 March | 50 | 36 | 86 |
| 2024 February | 40 | 35 | 75 |
| 2024 January | 0 | 3 | 3 |
| 2023 December | 0 | 3 | 3 |
| 2023 November | 0 | 3 | 3 |
| 2023 October | 0 | 9 | 9 |
| 2023 September | 0 | 4 | 4 |
| 2023 August | 0 | 1 | 1 |
| 2023 July | 0 | 7 | 7 |
| 2023 June | 1 | 8 | 9 |
| 2023 May | 0 | 2 | 2 |
| 2023 April | 0 | 2 | 2 |
| 2023 March | 15 | 7 | 22 |
| 2023 February | 62 | 27 | 89 |
| 2023 January | 27 | 22 | 49 |
| 2022 December | 36 | 28 | 64 |
| 2022 November | 40 | 26 | 66 |
| 2022 October | 23 | 38 | 61 |
| 2022 September | 28 | 30 | 58 |
| 2022 August | 32 | 50 | 82 |
| 2022 July | 19 | 26 | 45 |
| 2022 June | 18 | 38 | 56 |
| 2022 May | 24 | 38 | 62 |
| 2022 April | 22 | 21 | 43 |
| 2022 March | 30 | 30 | 60 |
| 2022 February | 24 | 21 | 45 |
| 2022 January | 24 | 32 | 56 |
| 2021 December | 18 | 29 | 47 |
| 2021 November | 19 | 40 | 59 |
| 2021 October | 17 | 36 | 53 |
| 2021 September | 19 | 46 | 65 |
| 2021 August | 20 | 38 | 58 |
| 2021 July | 22 | 30 | 52 |
| 2021 June | 33 | 37 | 70 |
| 2021 May | 24 | 32 | 56 |
| 2021 April | 31 | 43 | 74 |
| 2021 March | 43 | 43 | 86 |
| 2021 February | 46 | 20 | 66 |
| 2021 January | 32 | 22 | 54 |
| 2020 December | 21 | 17 | 38 |
| 2020 November | 20 | 20 | 40 |
| 2020 October | 16 | 14 | 30 |
| 2020 September | 20 | 15 | 35 |
| 2020 August | 21 | 16 | 37 |
| 2020 July | 37 | 27 | 64 |
| 2020 June | 18 | 14 | 32 |
| 2020 May | 21 | 25 | 46 |
| 2020 April | 22 | 16 | 38 |
| 2020 March | 19 | 26 | 45 |
| 2020 February | 28 | 22 | 50 |
| 2020 January | 25 | 24 | 49 |
| 2019 December | 29 | 21 | 50 |
| 2019 November | 11 | 14 | 25 |
| 2019 October | 625 | 24 | 649 |
| 2019 September | 8 | 41 | 49 |
| 2019 August | 18 | 18 | 36 |
| 2019 July | 37 | 33 | 70 |
| 2019 June | 14 | 17 | 31 |
| 2019 May | 43 | 41 | 84 |
| 2019 April | 30 | 32 | 62 |
| 2019 March | 6 | 34 | 40 |
| 2019 February | 14 | 20 | 34 |
| 2019 January | 9 | 21 | 30 |
| 2018 December | 9 | 24 | 33 |
| 2018 November | 22 | 39 | 61 |
| 2018 October | 54 | 38 | 92 |
| 2018 September | 16 | 27 | 43 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 13 | 1 | 14 |
| 2018 April | 5 | 5 | 10 |
| 2018 March | 12 | 9 | 21 |
| 2018 February | 7 | 12 | 19 |
| 2018 January | 8 | 29 | 37 |
| 2017 December | 15 | 30 | 45 |
| 2017 November | 7 | 32 | 39 |
| 2017 October | 6 | 45 | 51 |
| 2017 September | 11 | 25 | 36 |
| 2017 August | 16 | 31 | 47 |
| 2017 July | 8 | 27 | 35 |
| 2017 June | 54 | 32 | 86 |
| 2017 May | 11 | 26 | 37 |
| 2017 April | 6 | 15 | 21 |
| 2017 March | 13 | 26 | 39 |
| 2017 February | 4 | 22 | 26 |
| 2017 January | 7 | 18 | 25 |
| 2016 December | 10 | 22 | 32 |
| 2016 November | 19 | 23 | 42 |
| 2016 October | 19 | 27 | 46 |
| 2016 September | 25 | 21 | 46 |
| 2016 August | 23 | 9 | 32 |
| 2016 July | 27 | 11 | 38 |
| 2016 June | 33 | 19 | 52 |
| 2016 May | 17 | 10 | 27 |
| 2016 April | 12 | 2 | 14 |
| 2016 March | 14 | 4 | 18 |
| 2016 February | 12 | 4 | 16 |
| 2016 January | 29 | 25 | 54 |
| 2015 December | 38 | 15 | 53 |
| 2015 November | 40 | 11 | 51 |
| 2015 October | 208 | 1 | 209 |
| 2015 September | 222 | 0 | 222 |
| 2015 August | 197 | 0 | 197 |
| 2015 July | 215 | 0 | 215 |
| 2015 June | 167 | 0 | 167 |
| 2015 May | 233 | 0 | 233 |
| 2015 April | 195 | 0 | 195 |
| 2015 March | 207 | 0 | 207 |
| 2015 February | 207 | 0 | 207 |
| 2015 January | 159 | 0 | 159 |
| 2014 December | 216 | 0 | 216 |
| 2014 November | 230 | 0 | 230 |
| 2014 October | 305 | 0 | 305 |
| 2014 September | 244 | 0 | 244 |
| 2014 August | 250 | 0 | 250 |
| 2014 July | 218 | 0 | 218 |
| 2014 June | 231 | 0 | 231 |
| 2014 May | 219 | 0 | 219 |
| 2014 April | 183 | 0 | 183 |
| 2014 March | 187 | 0 | 187 |
| 2014 February | 150 | 0 | 150 |
| 2014 January | 111 | 0 | 111 |
| 2013 December | 96 | 0 | 96 |
| 2013 November | 98 | 0 | 98 |
| 2013 October | 119 | 0 | 119 |
| 2013 September | 111 | 0 | 111 |
| 2013 August | 109 | 0 | 109 |
| 2013 July | 130 | 0 | 130 |
| 2013 June | 93 | 0 | 93 |
| 2013 May | 106 | 0 | 106 |
| 2013 April | 53 | 0 | 53 |
| 2013 March | 14 | 0 | 14 |
| 2000 January | 4359 | 0 | 4359 |
Show all
