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Carta al Director
Biopsia con aguja gruesa en el diagnóstico de cáncer de pulmón
Core-needle biopsy in the diagnosis of lung cancer
Jorge Lima Álvarez
Corresponding author
jorgelial@hotmail.com

Autor para correspondencia.
, Alberto Beiztegui Sillero
Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Sevilla, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos le&#237;do con gran inter&#233;s las recomendaciones SEPAR de diagn&#243;stico y tratamiento del c&#225;ncer de pulm&#243;n de c&#233;lulas no peque&#241;as&#44; publicado como n&#250;mero extraordinario en mayo de 2016<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nos resulta un trabajo muy adecuado a las necesidades del neum&#243;logo hoy d&#237;a&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sin embargo&#44; en el apartado que versa sobre estudios de confirmaci&#243;n citohistol&#243;gica y estadificaci&#243;n&#44; subapartado &#171;T&#233;cnicas m&#237;nimamente invasivas&#187;&#44; hemos advertido con sorpresa la ausencia de la biopsia con aguja gruesa &#40;BAG&#41; entre todas las t&#233;cnicas descritas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Es un procedimiento muy similar a la punci&#243;n aspirativa con aguja fina transtor&#225;cica &#40;PAAFT&#41;&#46; Se emplean las mismas t&#233;cnicas de control en una y otra&#44; habitualmente tomograf&#237;a computarizada &#40;TC&#41; y en ocasiones la ecograf&#237;a&#46; La diferencia fundamental entre ambas est&#225; en el calibre de la aguja&#44; habitualmente 18<span class="elsevierStyleHsp" style=""></span>G&#44; con posibilidades de tomar uno o 2<span class="elsevierStyleHsp" style=""></span>cm de espesor de muestra seg&#250;n las caracter&#237;sticas particulares de cada aguja y de la lesi&#243;n&#46; Por razones de calibre se debe anestesiar siempre el trayecto de la punci&#243;n&#46; En nuestro centro estas 2 t&#233;cnicas las practicamos los neum&#243;logos&#46; En el trabajo de Capalbo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> comparan estos 2 procedimientos entre s&#237; en el diagn&#243;stico de lesiones pulmonares&#44; obteniendo una mayor sensibilidad en la PAAFT &#40;94&#44;83&#37;&#41; frente a la BAG &#40;81&#44;82&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Como se recoge en la literatura&#44; esta t&#233;cnica se emplea en el proceso diagn&#243;stico del c&#225;ncer de pulm&#243;n desde hace a&#241;os con un porcentaje de complicaciones aceptable<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a>&#46; El tama&#241;o de la muestra es mayor que el obtenido mediante la PAAFT&#46; Esta diferencia la hace especialmente relevante a la hora de estudiar mutaciones gen&#233;ticas en los tumores pulmonares&#44; como <span class="elsevierStyleItalic">epidermal growth factor</span> &#40;EGFR&#41; y <span class="elsevierStyleItalic">anaplastic lymphoma kinasa</span> &#40;ALK&#41;&#44; entre otros&#46; Aunque en algunos centros estas determinaciones tambi&#233;n se pueden realizar en las muestras citol&#243;gicas&#44; tales t&#233;cnicas de laboratorio no est&#225;n tan extendidas como las que se realizan sobre la muestra histol&#243;gica&#44; y como describe el trabajo de Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a>&#44; la BAG puede resultar m&#225;s rentable que la PAAFT para el estudio de mutaciones como demuestra en su art&#237;culo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En definitiva&#44; creemos que en el apartado 3&#46;d de las recomendaciones SEPAR de diagn&#243;stico y tratamiento del c&#225;ncer de pulm&#243;n de c&#233;lulas no peque&#241;as&#44; sobre t&#233;cnicas m&#237;nimamente invasivas&#44; junto a la broncoscopia&#44; punci&#243;n transbronquial ciega&#44; ultrasonograf&#237;a endobronquial&#44; ultrasonograf&#237;a endosc&#243;pica digestiva&#44; broncoscopia de navegaci&#243;n electromagn&#233;tica&#44; punci&#243;n aspirativa con aguja fina&#44; toracocentesis&#44; biopsia pleural y PAAFT&#44; deber&#237;a aparecer la BAG como un procedimiento diagn&#243;stico m&#225;s del carcinoma de pulm&#243;n de c&#233;lulas no peque&#241;as&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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