Utilidad de la broncoscopía flexibe como diagnóstico precoz en pacientes oncológicos con infiltrados pulmonares 2014- 2016
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Las enfermedades infecciosas y masas pulmonares son una causa importante de mortalidad
en los pacientes onco-hematológicos. El diagnóstico oportuno mediante métodos mínimos
invasivos, permite realizar y administrar un tratamiento adecuado evitando complicaciones y
mejorar la calidad de vida.El objetivo de nuestro estudio es determinar la utilidad de
lavideobroncoscopía en el diagnóstico temprano de pacientes hemato- oncológicos, en el
Hospital Solca periodo 2014- 2016 para así dar prioridad en la efectividad del tratamiento o
determinar la progresión de la enfermedad, en relación a su estadío.Se realizó un estudio
cuantitativo, descriptivo, observacional, prospectivo, de corte transversal con enfoque a
paradigma positivista, en pacientes con hallazgos anormales en imágenes de tórax
candidatos a realizarsevideobroncoscopía en Solca- Guayaquil periodo 2014- 2016 para el
diagnóstico de su enfermedad.Se recolectaron 98 pacientes. La edad promedio fue de 61.08 ±
17.7 años. La relación entre género femenino vs masculino fue de 1.2:1. Se halló
principalmente casos con antecedentes de tumores sólidos (92/98, 93.9%). Existió un mayor
número de patrones imagenológicos sugestivos de lesión maligna, de entre los que destacó la
presencia de masas (54/98; 55.1%), mientras que el infiltrado fue sugestivo de proceso
infeccioso, (20/98; 20.4%). En general, la fibrobroncoscopía permitió aislar gérmenes en
18/98 pacientes. El lavado bronquioloalveolar aisló gérmenes en un mayor número de
pacientes (11/18), seguido del líquido bronquial (10/18), y el esputo post-FBC (3/18). En
36/74 casos la histopatología determinó malignidad. De estos, 18/36 correspondieron a
adenocarcinoma, seguido de 12/36 a carcinoma, 5/36 metástasis de origen desconocido, y
1/36 carcinoma de células pequeñas. La Broncoscopía tiene utilidad en la definición del
diagnóstico. Existía un bajo impacto clínico en cuanto al número de lesiones malignas o
infecciosas que descubría la Broncoscopía o el número de lesiones diferentes a las malignas o
infecciosas que se descubrían después del procedimiento. La imagenología presentaba una
suficiencia diagnostica baja. El lavado bronquioloalveolar presenta baja sensibilidad y
especificidad, y por ende, presenta bajo impacto clínico en la evolución de los pacientes.
Existe una relación estadísticamente significativa entre determinados hallazgos
imagenológicos (cavernas y ganglios) para con la presencia de manifestaciones clínicas
(síntomas respiratorios).
Infectious diseases and lung masses are an important cause of mortality in onco-hematologic patients. The Early diagnosis through minimal invasive methods, allows to perform and to administer an appropriate treatment avoiding complications and to improve the quality of life. The purpose of our study was to determine the usefulness of video-bronchoscopy in the early diagnosis of hematopoietic patients at the Solca Hospital during 2014-2016, in order to prioritize the effectiveness of the treatment or to determine the progression of the disease, in relation to Its stage.A quantitative, descriptive, observational, prospective, cross-sectional study with a focus on a positivist paradigm was carried out in patients with abnormal findings in chest images who were candidates for videobronchoscopy in Solca-Guayaquil from 2014 to 2016 for the diagnosis of their disease.98 patients were collected. The mean age was 61.08 ± 17.7 years. The ratio between female vs. male gender was 1.2: 1. Cases with a history of solid tumors were found (92/98, 93.9%). There was a greater number of imaging patterns suggestive of malignant lesions, among them the presence of masses (54/98, 55.1%), while the infiltrate was suggestive of an infectious process, (20/98, 20.4%). In general, fiberoptic bronchoscopy allowed the isolation of germs in 18/98 patients. Bronchoalveolar lavage isolated germs in a greater number of patients (11/18), followed by bronchial fluid (10/18), and post-FBC sputum (3/18). In 36/74 cases, histopathology determined malignancy. Of these, 18/36 corresponded to adenocarcinoma, followed by 12/36 to carcinoma, 5/36 metastases of unknown origin, and 1/36 small cell carcinoma.Bronchoscopy is useful in defining the diagnosis. There was a low clinical impact in terms of the number of malignant or infectious lesions discovered by the Bronchoscopy or the number of lesions other than malignant or infectious that were discovered after the procedure. Imaging had a low diagnostic adequacy. Bronchoalveolar lavage has low sensitivity and specificity, and therefore has a low clinical impact on the evolution of patients. There is a statistically significant relationship between certain imaging findings (caverns and ganglia) for the presence of clinical manifestations (respiratory symptoms).
Infectious diseases and lung masses are an important cause of mortality in onco-hematologic patients. The Early diagnosis through minimal invasive methods, allows to perform and to administer an appropriate treatment avoiding complications and to improve the quality of life. The purpose of our study was to determine the usefulness of video-bronchoscopy in the early diagnosis of hematopoietic patients at the Solca Hospital during 2014-2016, in order to prioritize the effectiveness of the treatment or to determine the progression of the disease, in relation to Its stage.A quantitative, descriptive, observational, prospective, cross-sectional study with a focus on a positivist paradigm was carried out in patients with abnormal findings in chest images who were candidates for videobronchoscopy in Solca-Guayaquil from 2014 to 2016 for the diagnosis of their disease.98 patients were collected. The mean age was 61.08 ± 17.7 years. The ratio between female vs. male gender was 1.2: 1. Cases with a history of solid tumors were found (92/98, 93.9%). There was a greater number of imaging patterns suggestive of malignant lesions, among them the presence of masses (54/98, 55.1%), while the infiltrate was suggestive of an infectious process, (20/98, 20.4%). In general, fiberoptic bronchoscopy allowed the isolation of germs in 18/98 patients. Bronchoalveolar lavage isolated germs in a greater number of patients (11/18), followed by bronchial fluid (10/18), and post-FBC sputum (3/18). In 36/74 cases, histopathology determined malignancy. Of these, 18/36 corresponded to adenocarcinoma, followed by 12/36 to carcinoma, 5/36 metastases of unknown origin, and 1/36 small cell carcinoma.Bronchoscopy is useful in defining the diagnosis. There was a low clinical impact in terms of the number of malignant or infectious lesions discovered by the Bronchoscopy or the number of lesions other than malignant or infectious that were discovered after the procedure. Imaging had a low diagnostic adequacy. Bronchoalveolar lavage has low sensitivity and specificity, and therefore has a low clinical impact on the evolution of patients. There is a statistically significant relationship between certain imaging findings (caverns and ganglia) for the presence of clinical manifestations (respiratory symptoms).
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Broncoscopía, Diagnóstico precoz, Oncología médica, Enfermedades pulmonares, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador