Novas Técnicas Endoscópicas de Diagnóstico do Carcinoma Urotelial do Trato Urinário Superior
DOI:
https://doi.org/10.24915/aup.35.3-4.91Palavras-chave:
Aumento da Imagem, Neoplasias Urológicas/ diagnóstico por imagem, Sistema Urinário/diagnóstico por imagemResumo
O carcinoma urotelial do trato superior (CUTS) é raro, mas a maioria dos casos apresenta-se invasiva ao diagnóstico. O tratamento padrão do CUTS consiste na nefroureterectomia radical. No entanto, os CUTS de baixo risco podem ser abordados com cirurgia poupadora de nefrónios (CPN), sem compromisso do prognóstico oncológico. As técnicas de diagnóstico atuais apresentam várias falhas no diagnóstico de CUTS, principalmente na deteção de carcinoma in situ (CIS), uma lesão plana, de alto grau e com elevado risco de progressão. Assim, torna-se pertinente a investigação de novas técnicas de diagnóstico capazes de detetar as lesões de CUTS numa fase mais precoce.
Esta revisão procura analisar o desempenho das novas técnicas de imagem disponíveis para o diagnóstico do CUTS. Foi conduzida uma pesquisa da literatura atual na base de dados PubMed e foram revistos artigos sobre a narrow band imaging (NBI), Image1 S, diagnóstico fotodinâmico (DFD), confocal laser endomicroscopy (CLE) e optical coherence tomography (OCT).
Foram selecionados seis artigos para revisão, todos referentes a estudos in vivo em humanos. Não foi encontrado nenhum artigo sobre o Image1 S. Todas as técnicas descritas são compatíveis com os ureterorrenoscópios flexíveis atuais. A NBI, o Image1 S e o DFD visam uma melhor deteção do CUTS. A CLE e a OCT visam a caracterização histopatológica e minimamente invasiva das lesões, em tempo real. Quer a NBI, quer o DFD apresentam melhor taxa de deteção das lesões em comparação com a ureterorrenoscopia flexível (URSF) convencional, mas apenas o DFD mostrou melhor deteção de CIS. A CLE permite distinguir o urotélio saudável do maligno e as lesões de baixo grau das de alto grau. No entanto, não avalia o estadiamento. A OCT apresenta maior sensibilidade do que a biópsia para o estadiamento e gradação do CUTS, mas as lesões com mais de 2 mm de espessura podem gerar diagnósticos falsos-positivos.
A combinação da URSF com uma ou várias das novas técnicas de diagnóstico poderia aumentar a sua precisão diagnóstica e capacidade de selecionar adequadamente os candidatos para CPN. São necessários mais estudos que validem a utilização das novas técnicas no diagnóstico de CUTS.
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21. Cauberg EC, de Bruin DM, Faber DJ, van Leeuwen TG, de la Rosette JJ, de Reijke TM. A new generation of optical diagnostics for bladder cancer: technology, diagnostic accuracy, and future applications. Eur Urol. 2009;
56: 287-97. doi: 10.1016/j.eururo.2009.02.033.
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2019-01-19
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