ABSTRACT
Several markers have been studied for their ability to make the CNS infiltration diagnosis earlier and more precise; previous studies showed that CSF ferritin concentrations were higher in patients with malignant invasion of CNS. The objective was to determine the importance of CSF ferritin as a biomarker for the diagnosis of CNS neoplasic infiltration. This study is based on 93 CSF samples, divided into five groups: malignant cells present (n13); malignant cells not present (n26); inflammatory neurological diseases (n16); neurocysticercosis (n20); acute bacterial meningitis (n18). CSF ferritin values were determined by micro particle enzyme immunoassay. CSF ferritin level (mean±SD) in the group with neoplasic cells in the CSF was 42.8±49.7 ng /mL, higher than in the other groups (p<0.0001). We conclude that CSF ferritin with the cut off 20 ng/mL could be an adjuvant biomarker to the diagnosis of CNS malignant infiltration.
Diversos marcadores foram estudados com a finalidade de avaliar sua capacidade de diagnosticar a infiltração neoplásica no SNC precocemente e de forma mais precisa. Estudos anteriores mostraram que as concentrações de ferritina no LCR eram mais elevadas nos pacientes com infiltração neoplásica no SNC. O objetivo foi determinar a importância da ferritina no LCR como biomarcador para o diagnóstico de infiltração neoplásica no SNC. Este estudo é baseado em 93 amostras do LCR, divididas em cinco grupos: células malignas presentes (n13); células malignas ausentes (n26); doenças neurologicas inflamatórias (n16); neurocisticercose (n20); meningites bacterianas agudas (n18). Os valores de ferritina no LCR foram determinados por ELISA de microparticulas. O nível de ferritina no LCR (média±desvio padrão) no grupo com células neoplásicas no LCR foi 42,8±49,7 ng/mL, mais elevado do que nos outros grupos (p<0.0001). Concluímos que a ferritina no LCR com cut off de 20 ng/mL pode ser um biomarcador para o diagnóstico de infiltração maligna no SNC.
Subject(s)
Humans , Central Nervous System Neoplasms/cerebrospinal fluid , Ferritins/cerebrospinal fluid , Biomarkers, Tumor/cerebrospinal fluid , Central Nervous System Neoplasms/diagnosis , Enzyme-Linked Immunosorbent Assay , Sensitivity and SpecificityABSTRACT
El diagnóstico citológico e histopatológico en casos de tumores pulmonares se realiza con alta confiabilidad a través de muestras obtenidas por fibrobroncoscopía (FBC). Puede haber diferencias que dependen de la localización del tumor. Objetivo: Determinar la sensibilidad del lavado, cepillado bronquial y biopsia por (FBC) en una muestra de tumores pulmonares centrales, donde hay alteraciones endoscópicas evidentes y en otra de tumores pulmonares periféricos con sospecha de malignidad donde las alteraciones son menos frecuentes. Casos: Se estudiaron 86 enfermos con tumores pulmonares, 44 centrales (Grupo A) y 42 periféricos (Grupo B). Todos fueron objeto de estudio por FBC con lavado y cepillado; en 15 casos se practicó biopsia. Resultados: Hubo una diferencia significativa (p < 0.005) con respecto a la apariencia normal y anormal entre tumores centrales (A) y periféricos (B). El diagnóstico de malignidad basado en la presencia de células malignas por cepillado y lavado bronquiales fue positivo en 21 del Grupo A y en 14 del Grupo B con sensibilidad de 60 y 40%, respectivamente. En 15 casos de tumor endobronquial se practicó biopsia. En los casos negativos, 23 del A y 28 del B, se emplearon otros métodos diagnósticos (p < 0.05). Se detectaron 76 casos de neoplasias, predominando el carcinoma bronquiogénico (43%). Diez casos fueron procesos infecciosos. Conclusión: El estudio por FBC permanece como un importante método diagnóstico en casos de tumores pulmonares. El lavado y el cepillado tuvieron resultados positivos en 35/86, cifra relativamente baja que sugiere la necesidad de mejorar la calidad de las muestras obtenidas. La negatividad por FBC obliga el empleo de otros métodos diagnósticos. El costo estimado de los procedimientos, erogado por el paciente en dólares americanos, es notablemente menor que en países como Holanda, que se tomó como comparativo.
Cytologic and histologic diagnosis of lung tumors can usually be done by means of fiberoptic bronchoscopy (FOB), but there are some differences in cases of central or peripheral tumors. Objective: To determine the sensititivity of bronchial brushing, lavage and biopsy performed by FBO in a sample of central tumors, with evident bronchial alterations, and another sample of peripheral lesions in which these alterations are less frequent. A preliminary comparison of the costs of FOB in Mexico and Holland was also done. Cases: There were 86 patients with tumoral lesions suspicious of malignancy, 44 central (Group A) and 42 peripheral (Group B); all were subjected to FOB, lavage and bronchial brush ings; biopsy was done in 15 cases of endobronchial lesions. Results: There was a significat difference (p < 0.005) as to the normal or abnormal appearance of the bronchial mucosa between central tumors (A) and peripheral (B) lesions. Diagnosis of malignancy by lavage and brushing based in the finding of malignant cells was positive in 21 of the Group A and in 14 of Group B, sensitivity of 60% and 40% respectively. Biopsy was performed in 15 cases with endobronchial tumor. In the negative cases, 23 in Group A and 28 in Group B, other diagnostic methods were employed (p < 0.05). A total of 76 cases of malignancy were detected; bronchogenic carcinoma was predominant (43%). Ten cases of infectious diseases were identified. Conclusion: FOB remains as an important diagnostic tool in cases of lung tumors. Bronchial lavage and brushing had positive results for malignant cells in 35/86; this relative low figure suggests the need to improve the quality of the samples obtained by FOB. Other diagnostic methods must be used in cases with negative FOB results. Estimated costs, in US dollars, of diagnostic methods are much lower in Mexico than in an European country, The Netherlands.