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ABSTRACT Purpose: This study aimed to analyze the association between magnetic resonance imaging apparent diffusion coefficient map value and histopathological differentiation in patients who underwent eye enucleation due to retinoblastomas. Methods: An observational chart review study of patients with retinoblastoma that had histopathology of the lesion and orbit magnetic resonance imaging with apparent diffusion coefficient analysis at Hospital de Clínicas de Porto Alegre between November 2013 and November 2016 was performed. The histopathology was reviewed after enucleation. To analyze the difference in apparent diffusion coefficient values between the two major histopathological prognostic groups, Student's t-test was used for the two groups. All statistical analyses were performed using SPSS version 19.0 for Microsoft Windows (SPSS, Inc., Chicago, IL, USA). Our institutional review board approved this retrospective study without obtaining informed consent. Results: Thirteen children were evaluated, and only eight underwent eye enucleation and were included in the analysis. The others were treated with photocoagulation, embolization, radiotherapy, and chemotherapy and were excluded due to the lack of histopathological results. When compared with histopathology, magnetic resonance imaging demonstrated 100% accuracy in retinoblastoma diagnosis. Optic nerve invasion detection on magnetic resonance imaging showed a 66.6% sensitivity and 80.0% specificity. Positive and negative predictive values were 66.6% and 80.0%, respectively, with an accuracy of 75%. In addition, the mean apparent diffusion coefficient of the eight eyes was 0.615 × 103 mm2/s. The mean apparent diffusion coefficient value of poorly or undifferentiated retinoblastoma and differentiated tumors were 0.520 × 103 mm2/s and 0.774 × 103 mm2/s, respectively. Conclusion: This study revealed that magnetic resonance imaging is useful in the diagnosis of retinoblastoma and detection of optic nerve infiltration, with a sensitivity of 66.6% and specificity of 80%. Our results also showed lower apparent diffusion coefficient values in poorly differentiated retinoblastomas with a mean of 0.520 × 103 mm2/s, whereas in well and moderately differentiated, the mean was 0.774 × 103 mm2/s.
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Introdução: A dor é um dos sintomas mais prevalentes e incapacitantes em pacientes oncológicos. A dor causada pelo câncer comumente é atribuída aos efeitos direto do tumor, ao tratamento da neoplasia maligna ou a outros distúrbios não relacionados a doença ou a seu tratamento. Apesar de ser altamente prevalente, a dor oncológica frequentemente é mal manejada, seja por parte do médico, do paciente, ou por questões sociais. O objetivo deste estudo foi realizar uma breve revisão da literatura sobre dor crônica oncológica, buscando informações relevantes para a prática clínica. Métodos: Artigos recentes foram avaliados na plataforma PubMed, além de diretrizes e consensos nacionais e internacionais sobre o tema. Resultados: O tratamento da dor crônica oncológica baseia-se na escada analgésica da Organização Mundial da Saúde, modificada em 2010, a qual tem em seu centro o uso de opioides, além de anti-inflamatórios não esteroidais, medicações adjuvantes, terapias complementares e técnicas invasivas. Essa abordagem leva não apenas à melhora da qualidade de vida, como também ao aumento da sobrevida dos pacientes. A presença de dor deve ser sempre questionada nas consultas e as medicações modificadas quando o tratamento atual não estiver sendo efetivo. O uso de antidepressivos tricíclicos e anticonvulsivantes também devem ser considerados, dependendo do tipo de dor apresentada. Conclusão: Sendo a dor crônica oncológica tanto importante quanto complexa, uma abordagem integral é necessária para que o paciente obtenha melhores resultados de seu tratamento.
Introduction: Pain is one of the most prevalent and incapacitating symptoms in oncologic patients. The pain caused by cancer is usually attributed to direct effects of the tumor, treatment of the malignant neoplasm or to other disorders not related the disease or its treatment. In spite of being highly prevalent, cancer pain is often handled inappropriately, either by the physician, the patient, or for social issues. The objective of this study was to perform a short literature review regarding chronic cancer pain, searching for information that is relevant for clinical practice. Methods: Literature review was performed in PubMed database, and national and international guidelines and consensus about the topic were also included. Results: The treatment of chronic cancer pain is based on the World Health Organization analgesic ladder, modified in 2010, which has in its core the use of opioids, in addition to non-steroidal anti-inflammatories, adjuvant drugs, complementary therapies and invasive techniques. This approach leads not only to a better quality of life, but also to an increase in patient survival. The presence of pain should always be questioned in consultations and medications modified when the current treatment is not effective. The employment of tricyclic antidepressants and anticonvulsants should also be considered, depending on the presented kind of pain. Conclusion: Being chronic cancer pain both important and complex, an integrative approach is necessary so that the patient can reach better treatment results.