Impacto do exame transoperatório de congelação nas tireoidectomias

Abstract

Introdução: a indicação da congelação intra-operatória (CIP) em tireoidectomias é questão de debate no meio academico-médico. A utilização da CIP, sob justificativa de que poderia auxiliar no diagnóstico nos casos lesões malignas, e assim evitar reintervenções cirúrgicas, se mostra duvidoso. Objetivo: analisar a precisão e concordância entre a PAAF e a CIP e a influência da CIP na cirurgia de tireoide. Métodos: Foram avaliados retrospectivamente os dados de pacientes submetidos a tireoidectomias pelo serviço de Cirurgia Geral e Oncológica do Hospital de Clínicas de Porto Alegre no período de de janeiro de 2015 a dezembro de 2018. Foram analisados os dados da consulta pré-operatória, descrição cirúrgica, evoluções durante a internação, exames complementares e consultas pós operatórias. Foi utilizado o programa SPSS para a análise estatística sendo estabelecido o intervalo de confiança de 95% para a observação das diferenças entre as variáveis em estudo. Nas variáveis qualitativas foi calculado o percentual, e nas variáveis quantitativas médias e desvios-padrão respectivos. Resultados: a acurácia da CIP no diagnóstico das lesões tireoidianas mostrou sensibilidade de 74%, especificidade de 98,75, valor preditivo positivo de 96,1 e valor preditivo negativo de 89,6%. Os resultados com melhor acurácia foram encontrados nas categorias II, III e IV de Bethesda, quando estes são considerados com lesões benignas, na concordância com a CIP (acurácia= 95,5%) e AP (acurácia= 88,1%). Conclusão: a CIP tem baixa sensibilidade no diagnóstico de lesões malignas e sua indicação como ferramenta auxiliar no planejamento cirúrgico deve ser reconsiderada.

Background: the indication of intraoperative freezing (CIP) in thyroidectomies is a matter of debate in the medical field. Used in many services, under the justification that the technique could assist in the diagnosis of malignant lesions and, thus, avoid surgical reinterventions, especially in cases where the diagnosis regarding the malignancy of the lesion is doubtful. In addition, it is known that a CIP presents good results in terms of specificity for malignancy, reaching 100% in most articles. It is also known that it has a high cost, increases the surgical time and denotes low diagnostic sensitivity. Aim: to determine accuracy and intertest agreement of PAAF and CIP findings in thyroid surgery, and to assess the influence of CIP findings on decision making and the utiity of CIP in thyroid surgery. Methods: all patients submitted to thyroidectomies were retrospectively evaluated by the General and Oncological Surgery service of Hospital de Clínicas de Porto Alegre (HCPA). The following was checked: the preoperative consultation, the surgical description, the evolution during the hospitalization, the complementary exams (including the definitive anatomopathological exam) and the postoperative consultations. The database was stored in the Excel program and the statistical analysis was converted for analysis by the SPSS program. A statistical analysis was performed using the same program, with 95% confidence intervals for observing the differences between the variables under study. Frequency tables were made available for all variables under study. In qualitative variables, it is possible to define the percentage, and in quantitative variables, means and standard deviations. Results: the assessment of the accuracy of the CIP in the diagnosis of thyroid lesions revealed a sensitivity of 74%, specificity of 98.75, a positive predictive value of 96.1 and a negative predictive value of 89.6%. The results with the best accuracy were found in Bethesda categories II, III and IV, when they are considered to have benign lesions, in agreement with the CIP (accuracy = 95.5%) and AP (accuracy = 88.1%). Conclusion: The results of the study demonstrate that IPC has low sensitivity in the diagnosis of malignant lesions and its indication as an auxiliary tool in surgical planning should be reconsidered.