Hallazgos tomográficos y patológicos en el manejo quirúrgico de los nódulos pulmonares en el Servicio de Cirugía de Tórax del Hospital Rafael Ángel Calderón Guardia del 2005 al 2017
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2019
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Objetivo: Analizar los nódulos pulmonares resecados en el servicio de cirugía de tórax del Hospital Dr. Rafael Ángel Calderón Guardia (HCG) del 2005 al 2017, identificando etiología, abordaje quirúrgico, factores de riesgo, y predecir malignidad basado en los reportes radiológicos de tomografía computarizada de tórax (TC) preoperatoria. Metodología: Estudio observacional, retrospectivo y descriptivo de 208 pacientes, mayores de 15 años, con nódulo pulmonar resecado en HCG del 2005 al 2017. Se realizó análisis de las variables número de nódulos, antecedente de neoplasia extrapulmonar, grupo de edad y localización del nódulo relacionándolos con malignidad con Chi-cuadrado. Se valoraron las causas etiológicas más frecuentes de nódulos benignos, malignos y metastásicos, y según nódulo pulmonar solitario (NPS), dominante (NPD) o nódulos múltiples (NPM), la técnica y el procedimiento realizado. Identificando los pacientes que tenían reporte preoperatorio formal de TC tórax por radiólogo, se obtuvo una subpoblación de 127 casos, donde los factores de riesgo y los hallazgos tomográficos fueron evaluados mediante un análisis de regresión logístico para determinar la probabilidad de neoplasia maligna. Resultados: Población total (n=208), la edad (p<0.0013), antecedente de neoplasia extrapulmonar maligna (p<0.0001) y el número de nódulos (p<0.0248) presentaron asociación estadística con el resultado de benigno o maligno. 52% de los reportes patológicos fueron benigno (histoplasmomas 21%, granulomas por tuberculosis y hamartomas). El 48% restante eran malignas, con 14% neoplasia maligna primaria de pulmón (adenocarcinoma invasor 42%, tumor carcinoide típico 25% y carcinoma epidermoide 14%) y 34% metástasis (adenocarcinomas colorrectales 21%, carcinoma de células renales y carcinoma adenoide quístico de cabeza y cuello). Al evaluar según número de lesiones, 41...
Inglés: Purpose: To analyze the resected lung nodules in the thoracic surgery service of Dr. Rafael Ángel Calderón Guardia Hospital (HCG) from 2005 to 2017, identifying etiology, surgical approach, risk factors; and to predict malignancy using radiological preoperative reports of chest computed tomography (CT). Materials and methods: Observational, retrospective and descriptive study of 208 patients, older than 15 years, with pulmonary nodules resected in HCG from 2005 to 2017. Analysis of the number of nodule variables, history of extrapulmonar tumor, age group and location of the nodule was performed, using Chi-square for relating them with malignancy. The most frequent etiological causes of benign, malignant and metastatic nodules were assessed, and also for solitary pulmonary nodule (NPS), dominant (NPD) or multiple nodules (NPM), the technique and the procedure performed. By identifying patients who had a formal preoperative chest CT scan by radiologist, a subpopulation of 127 cases was obtained, where risk factors and tomographic findings were evaluated by means of a logistic regression analysis to determine the probability of malignancy. Results: Total population (n = 208), age (p <0.0013), history of malignant extrapulmonar neoplasm (p <0.0001) and number of nodules (p <0.0248) presented a statistical association with benign or malignant nodule. 52% lung nodules were benign (histoplasmomas 21%, tuberculosis nodules and hamartomas). 48% were malignant, with 14% primary malignant neoplasm of the lung (invasive adenocarcinoma 42%, typical carcinoid tumor 25% and squamous cell carcinoma 14%) and 34% metastases (21% colorectal adenocarcinoma, renal cell carcinoma and cystic adenoid carcinoma of head and neck). According to number of lesions, 41% were NPS (histoplasmoma, invasive adenocarcinoma and tuberculosis nodules), 36% NPD (metastasis of colorectal adenocarcinoma, hamartomas, granulomas) and 23...
Inglés: Purpose: To analyze the resected lung nodules in the thoracic surgery service of Dr. Rafael Ángel Calderón Guardia Hospital (HCG) from 2005 to 2017, identifying etiology, surgical approach, risk factors; and to predict malignancy using radiological preoperative reports of chest computed tomography (CT). Materials and methods: Observational, retrospective and descriptive study of 208 patients, older than 15 years, with pulmonary nodules resected in HCG from 2005 to 2017. Analysis of the number of nodule variables, history of extrapulmonar tumor, age group and location of the nodule was performed, using Chi-square for relating them with malignancy. The most frequent etiological causes of benign, malignant and metastatic nodules were assessed, and also for solitary pulmonary nodule (NPS), dominant (NPD) or multiple nodules (NPM), the technique and the procedure performed. By identifying patients who had a formal preoperative chest CT scan by radiologist, a subpopulation of 127 cases was obtained, where risk factors and tomographic findings were evaluated by means of a logistic regression analysis to determine the probability of malignancy. Results: Total population (n = 208), age (p <0.0013), history of malignant extrapulmonar neoplasm (p <0.0001) and number of nodules (p <0.0248) presented a statistical association with benign or malignant nodule. 52% lung nodules were benign (histoplasmomas 21%, tuberculosis nodules and hamartomas). 48% were malignant, with 14% primary malignant neoplasm of the lung (invasive adenocarcinoma 42%, typical carcinoid tumor 25% and squamous cell carcinoma 14%) and 34% metastases (21% colorectal adenocarcinoma, renal cell carcinoma and cystic adenoid carcinoma of head and neck). According to number of lesions, 41% were NPS (histoplasmoma, invasive adenocarcinoma and tuberculosis nodules), 36% NPD (metastasis of colorectal adenocarcinoma, hamartomas, granulomas) and 23...
Descripción
Tesis (especialista en cirugía torácica general)--Universidad de Costa Rica. Sistema de Estudios de Posgrado, 2019
Palabras clave
Hospital Dr. Rafael Ángel Calderón Guardia (Costa Rica), PULMONES - ENFERMEDADES, PULMONES - ENFERMEDADES - CIRUGIA, PULMONES - ENFERMEDADES - DIAGNOSTICO, PULMONES - ENFERMEDADES - PATOLOGIA, TORAX - TOMOGRAFIA