Avaliação do estadiamento de pacientes portadores de câncer de pulmão de células não pequenas através do exame de ressonância magnética do corpo inteiro

A evolucao da ressonância Magnetica (RM) obtida nas ultimas duas decadas permitiu a elaboracao de protocolos otimizados e de qualidade, que possibilitaram a realizacao do exames de ressonância magnetica de corpo inteiro (RMCI). Na abordagem do paciente portador de câncer de pulmao de celulas nao pequenas (CPCNP), essa tecnica pode fornecer uma avaliacao oncologica adequada, podendo ser empregada como uma ferramenta alternativa no estadiamento destes pacientes. Objetivo Principal: O objetivo do presente estudo foi o de avaliar o papel da RMCI no estadiamento de pacientes portadores de CPCNP. Materiais e metodos: Foram estudados 48 pacientes do AC Camargo Cancer Center com diagnostico histologico confirmado de CPCNP no periodo entre Abril de 2011 a setembro de 2012. No momento da realizacao do PET-CT + RM do crânio para o estadiamento incial, os pacientes elegiveis foram recrutados para a realizacao da RMCI incluindo as sequencias T1, STIR e difusao. Todos os exames foram realizados no Departamento de Imagem do A Camargo Cancer Center. Resultados: As de taxas de sensibilidade, especificidade, VPP, VPN e acuracia para o estadiamento N atraves do PET-CT + RM de crânio foram: 82,0%, 100,0%, 100,0%, 79,2% e 89,6 %, respectivamente e para o estadiamento M foram: 75,0%, 91,7%, 90,0%, 78,6% e 83,3 %, respectivamente. As de taxas de sensibilidade, especificidade, VPP, VPN e acuracia para o estadiamento N atraves da RMCI foram: 96,42%, 85,0%, 90,0%, 94,44% e 91,66 %, respectivamente e para o estadiamento M foram: 87,5%, 88,0%, 87,5%, 91,7% e 89,6 %, respectivamente. O PET-CT + RM de crânio foi mais especifico (p=0,04) e a RMCI foi mais sensivel (0,04) na avaliacao N. Na avaliacao M nao houve diferencas estatisticamente significativas entre as taxas de ambos os exames (p>0,05). Os exames de PET-CT + RM de crânio e a RMCI apresentaram uma correlacao considerada boa (Kappa=0,63; 0,48-0,79) na avaliacao dos grupos de estadiamento clinico IA, IB, IIA, IIB, IIIA... The magnetic resonance imaging (MRI) development achieved in the last two decades provided better protocols enabling the whole-body scan with MR (WBMRI). In the assessment of patients with nonsmall cell lung cancer (NSCLC), this method can provide an adequate oncological evaluation and can be used as an alternative tool for patient staging. Main Objective: The objective of this study was to evaluate the role of WBMRI in staging patients NSCLC. Materials and Methods: 48 patients from the AC Camargo Cancer Center (ACCC) were enrolled between April 2011 and September 2012 with histological confirmation of NSCLC diagnosis. These patients were staged by PET-CT plus brain MRI and by WBMRI. The WBMRI was performed including T1, STIR and diffusion sequences. All exams were performed at Imaging Department of ACCC. Results: The rates of sensitivity, specificity, PPV, NPV, and accuracy for N staging by PET-CT + skull MRI were 82,0%, 100.0%, 100.0%, 79.2% and 89.6%, respectively. For M staging the rates were 80.95%, 88.88%, 85.0%, 85.71% and 85.42%, respectively. The rates of sensitivity, specificity, PPV, NPV, and accuracy for N staging by WBMRI were 96.4%, 85.0%, 90.0%, 94.4% and 91.7%. For M staging were 87.50%, 88.0%, 87.50%, 91.7% and 89.6%, respectively. PET-CT was more specific (p=0.04) and WBMRI was more sensitive (p=0.04) for N evaluation. For M staging there were no statistically significant differences between these tools (p> 0.05). PET-CT plus brain MRI and WBMRI demonstrated a good correlation (Kappa = 0.63, 0.48-0.79) in the assessment of clinical staging groups IA, IB, IIA, IIB, IIIA, IIIB and IV. In the assessment of clinical staging subgroups classified as local disease (stages IA, IB, IIA, and IIB), locally advanced disease (IIIA and IIIB) and systemic disease (IV) the correlation was good (Kappa = 0.78, 0.62-0.93)...