Utilidad de la elastografía cuantitativa por ultrasonografía endoscópica (USE), para el diagnóstico de las lesiones sólidas del páncreas (LSP).

Palabras clave: Elastografía, ultrasonido endoscópico, lesión pancreática s´lida, elasticidad, páncreas

Resumen

Introducción: la punción con aguja fina guiada por ultrasonografía endoscópica (PAF-USE) permite un diagnóstico de las lesiones sólidas del páncreas (LSP) con una sensibilidad de alrededor del 85 % en la literatura mundial y aún más baja en nuestro medio, por lo cual se requiere explorar nuevos accesorios (agujas) o técnicas tales como la elastografía, que mejoren esta sensibilidad. Esta última permite la cuantificación de la rigidez del tejido con altos grados de precisión y desde 2001 se ha aplicado al diagnóstico de tumores sólidos de diversos órganos como mama y tiroides, músculo, entre otros; y desde 2006 se ha empleado para las LSP y ha demostrado su utilidad como complemento a las herramientas diagnósticas disponibles, ya que mejora la precisión de la biopsia por PAF-USE al seleccionar el área más sospechosa para ser puncionada y también guía el manejo clínico cuando la PAF-USE es negativa o no concluyente.

Objetivo: evaluar el rendimiento diagnóstico de la elastografía cuantitativa de strain ratio (SR) obtenida por ecoendoscopia en las lesiones sólidas pancreáticas teniendo como patrón de oro el diagnóstico citopatológico.

Métodos: 71 pacientes (rango de edad: 35-89, media: 62,2 años); de estos, 35 mujeres fueron sometidas a USE para la evaluación de LSP. El diseño del estudio fue de corte transversal, prospectivo y de un solo centro. La USE se realizó con un ecoendoscopio Pentax lineal y un procesador Hitachi-Noblus. La lesión (área A) y un área de referencia B se seleccionaron para calcular la relación de deformación (B/A, SR expresada en %). Se tomó como punto de corte SR para definir las lesiones malignas (duras) SR > 22 teniendo en cuenta la evidencia actualmente disponible; estos resultados se compararon con la citopatología de las muestras obtenidas por punción guiada por USE. Después de la aplicación de criterios de exclusión, se realiza el análisis estadístico de 56 pacientes y se considera el valor p < 0,05. Se calculó la sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN) y precisión diagnóstica comparando la elastografía SR con los diagnósticos finales por citopatología.

Resultados: la elastografía cuantitativa SR (%) permite detectar las LSP malignas con sensibilidad del 94,6 % (intervalo de confianza [IC] del 95 %: 85,4 %-98,2 %), especificidad del 89,3 % (IC 95 %: 78,5 %-95,0 %), VPP del 89,8 % (IC 95 %: 79,5 %-95,3 %); VPN del 94,3 % (IC 95 %: 84,6 %-98,1 %) y exactitud del 92,0 % (IC 95 %: 85,4 %-95,7 %).

Conclusión: la elastografía cuantitativa SR por USE en LSP es un complemento útil que mejora la precisión de la PAF-USE al seleccionar el área más sospechosa para ser puncionada y guiar el manejo clínico cuando la PAF-USE es negativa o no concluyente, ya que tiene una alta sensibilidad y especificad en el diagnóstico de las LSP malignas.

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Biografía del autor/a

Martín Alonso Gómez-Zuleta, Hospital Universitario Nacional de Colombia

Médico Internista y Gastroenterólogo. Unidad de Gastroenterología y Ecoendoscopia (UGEC). Profesor asociado de Medicina, Universidad Nacional de Colombia. Bogotá, Colombia

Óscar Fernando Ruiz-Morales, Hospital Universitario Nacional de Colombia

Médico especialista en medicina interna y gastroenterología. Bogotá, Colombia

Diego Fernando Cano-Rosales, Clínica Chicamocha

Gastroenterológo e Internista - Gastrocal. Bucaramanga, Santander, Colombia.

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Publicado
2021-10-01
Cómo citar
Gómez Zuleta, M. A., Ruíz Morales, O. F., & Cano Rosales, D. F. (2021). Utilidad de la elastografía cuantitativa por ultrasonografía endoscópica (USE), para el diagnóstico de las lesiones sólidas del páncreas (LSP). Revista Colombiana De Gastroenterología, 36(4), 434-445. https://doi.org/10.22516/25007440.643
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