Carta al Director
Respuesta de los autores
Authors' Reply
Albert Sánchez-Font
, V.. Víctor Curull, Joaquim Gea
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Servei de Pneumologia, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), Barcelona, España
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"nombre" => "José Luis" "apellidos" => "Aguayo-Albasini" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289609002877?idApp=UINPBA00003Z" "url" => "/03002896/0000004500000012/v1_201305150211/S0300289609002877/v1_201305150211/es/main.assets" ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Respuesta de los autores" "tieneTextoCompleto" => true "saludo" => "Sr. Director:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "621" "paginaFinal" => "622" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Albert Sánchez-Font, Víctor Curull, Joaquim Gea" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Albert" "apellidos" => "Sánchez-Font" "email" => array:1 [ 0 => "ASanchezF@imas.imim.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "V." "nombre" => "Víctor" "apellidos" => "Curull" ] 2 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Gea" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servei de Pneumologia, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), Barcelona, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Authors' Reply" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">Agradecemos la carta de Campillo-Soto et al referente a nuestro trabajo recientemente publicado en <span class="elsevierStyleSmallCaps">Archivos</span><span class="elsevierStyleSmallCaps">de</span><span class="elsevierStyleSmallCaps">Bronconeumología</span><a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>. Estamos de acuerdo en sus apreciaciones acerca de las limitaciones metodológicas de algunos estudios que reflejan diseños epidemiológicos concretos, y para los cuales hay guías específicas sobre la redacción del manuscrito (véase <a href="http://www.equator-network.org/">http://www.equator-network.org/</a>). Sin embargo, discrepamos de la interpretación que realizan sobre nuestro estudio. En él no se analiza la “precisión” diagnóstica (<span class="elsevierStyleItalic">diagnostic accuracy</span>) de una técnica, sino su utilidad en la práctica clínica. Por ello, la lista de comprobación STARD y las consideraciones que de ella se derivan no serían aplicables en nuestro caso.</p><p class="elsevierStylePara elsevierViewall">Una vez clarificado este punto, no podemos dejar de mostrar nuestra sorpresa cuando afirman que “la sensibilidad y la especificidad carecen de utilidad práctica clínica”. Artículos publicados en revistas tan prestigiosas como <span class="elsevierStyleItalic">Chest</span> o <span class="elsevierStyleItalic">JAMA</span><a class="elsevierStyleCrossRefs" href="#bib2"><span class="elsevierStyleSup">2,3</span></a> muestran la sensibilidad, la especificidad y los valores predictivos de la ultrasonografía endobronquial sin que, hasta la fecha, se haya cuestionado la validez de los resultados obtenidos mediante esta técnica diagnóstica. Por otro lado, queda demostrado en un interesante metaanálisis publicado en <span class="elsevierStyleItalic">Thorax</span> por Holty et al<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> que la sensibilidad de la punción aspirativa transbronquial depende de la prevalencia de infiltración tumoral en las adenopatías mediastínicas. Como señalan Burgueño et al<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a>, “cuando se afirma que la sensibilidad y la especificidad son independientes de la prevalencia se hace referencia a la prevalencia de enfermos en la muestra global a la que se aplica la prueba. La sensibilidad sí depende de la prevalencia de los distintos grados de la enfermedad en un grupo de pacientes”. En nuestro caso, esto hace referencia a la existencia o no de cáncer de pulmón. Podemos recomendarles, en este sentido, la lectura de un interesante trabajo metodológico de Brenner y Grefeller<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>.</p><p class="elsevierStylePara elsevierViewall">Finalmente, el solapamiento de los intervalos de confianza no invalida, como mencionan Campillo-Soto et al, que una diferencia pueda ser estadísticamente significativa<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>. En nuestro estudio, con un intervalo de confianza del 95% el rendimiento de la punción aspirativa transbronquial en las estaciones paratraqueales e hiliares fue del 19,6 al 48,7% para la punción convencional, y del 45,4 al 72,9% para la punción guiada con ultrasonografía endobronquial radial, siendo la diferencia de estos resultados estadísticamente significativa. Esto implica, corroborando estudios anteriores realizados en otros países, que la segunda técnica tiene probablemente una utilidad clínica superior a la primera.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidad de la punción aspirativa transbronquial guiada con ultrasonografía endobronquial (USEB) radial para el diagnóstico de adenopatías mediastínicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Sánchez-Font" 1 => "V. Curull" 2 => "I. Vollmer" 3 => "L. Pijuan" 4 => "A. Gayete" 5 => "J. 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| 2015 February | 52 | 0 | 52 |
| 2015 January | 54 | 0 | 54 |
| 2014 December | 54 | 0 | 54 |
| 2014 November | 77 | 0 | 77 |
| 2014 October | 114 | 0 | 114 |
| 2014 September | 60 | 0 | 60 |
| 2014 August | 67 | 0 | 67 |
| 2014 July | 63 | 0 | 63 |
| 2014 June | 82 | 0 | 82 |
| 2014 May | 101 | 0 | 101 |
| 2014 April | 104 | 0 | 104 |
| 2014 March | 101 | 0 | 101 |
| 2014 February | 89 | 0 | 89 |
| 2014 January | 77 | 0 | 77 |
| 2013 December | 77 | 0 | 77 |
| 2013 November | 52 | 0 | 52 |
| 2013 October | 62 | 0 | 62 |
| 2013 September | 78 | 0 | 78 |
| 2013 August | 111 | 0 | 111 |
| 2013 July | 105 | 0 | 105 |
| 2013 June | 65 | 0 | 65 |
| 2013 May | 44 | 0 | 44 |
| 2013 April | 32 | 0 | 32 |
| 2013 March | 17 | 0 | 17 |
| 2000 January | 1153 | 0 | 1153 |
Show all
