ABSTRACT
Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "AsociaciónEspañola de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Humans , Lung Neoplasms , Neoplasm StagingABSTRACT
El cáncer de pulmón es una de las neoplasias más frecuentes en nuestro medio y la principal causa de muerte por cáncer en países occidentales. El manejo diagnóstico y terapéutico de estos pacientes es complejo, desempeñando en el mismo un papel muy relevante la punción guiada por ultrasonografía endoscópica (USE-PAAF), que clásicamente realizan los gastroenterólogos. Al tratarse de una enfermedad no relacionada con el aparato digestivo, los gastroenterólogos han tenido que actualizar sus conocimientos en este campo, para diagnosticar de forma adecuada a este nutrido grupo de pacientes. La incorporación en estos últimos años de nuevas y prometedoras técnicas, como la punción aspirativa transbronquial guiada por ecobroncoscopia (USEB-PAAF), han modificado el acercamiento al diagnóstico y estadificación de estos pacientes. En la presente guía clínica, la Sociedad Española de Endoscopia Digestiva (SEED), la Sociedad Española de Patología Digestiva (SEPD) y la Asociación Española de Gastroenterología (AEG), han aunado esfuerzos para actualizar el grado de conocimiento existente sobre este tema y dar recomendaciones basadas en la evidencia a sus miembros (AU)
Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the digestive tract, gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the Sociedad Española de Endoscopia Digestiva (SEED), Sociedad Española de Patología Digestiva (SEPD) and the Asociación Española de Gastroenterología, have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations (AU)
Subject(s)
Humans , Male , Female , Adult , Biopsy, Needle/instrumentation , Biopsy, Needle/methods , Carcinoma/complications , Carcinoma/diagnosis , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/trends , Endoscopy, Digestive System , Societies, Medical/ethics , Societies, Medical/legislation & jurisprudence , Societies, Medical/standards , Biopsy, Needle , Endoscopy, Digestive System/instrumentation , Societies, Medical/organization & administration , Societies, Medical/trends , Societies, MedicalABSTRACT
OBJECTIVES: The early prognostic evaluation of acute pancreatitis (AP) is a key step in the appropriate management of the disease. Plasma levels of polymorphonuclear elastase have proved to be an accurate early prognostic marker of AP in research conditions. Whether the test remains sufficiently accurate in routine clinical conditions has been questioned. The aim of our study was to evaluate the accuracy of plasma polymorphonuclear-elastase levels for the early prognostic evaluation of AP in the clinical setting. METHODS: A total of 224 consecutive patients with AP admitted to our Gastroenterology Department were included. A blood sample for polymorphonuclear-elastase quantification was obtained from all of them in the first morning of hospital stay, together with samples for routine haematological and biochemical analysis. Blood samples for polymorphonuclear-elastase evaluation were sent to the laboratory and managed there according to routine protocols. AP was classified as mild or severe according to the Atlanta classification, whereas polymorphonuclear-elastase results were kept blind. Results were shown as mean+/-SD and compared using Student's t-test for unrelated samples. The accuracy of the test for the prognostic evaluation of AP was calculated after drawing the corresponding receiver operator curve. RESULTS: Fifty patients (23%) suffered from severe AP. The plasma levels of polymorphonuclear elastase were 217.8+/-93.5 microg/l in patients with severe AP and 68.1+/-32.7 microg/l in those with mild disease (P<0.001). The sensitivity and specificity of the test for the detection of severe AP were 92 and 91%, respectively, for an optimal cut-off value of 110 microg/l. The positive and negative predictive values for a prevalence of severe disease of 20% were 78 and 96%, respectively. The area under the receiver operator curve was 0.956. CONCLUSION: Quantification of plasma polymorphonuclear-elastase levels is a very accurate method for the early prognostic evaluation of AP, and is easily applicable in the clinical setting.
