{"id":115354,"date":"2014-07-03T00:00:00","date_gmt":"2014-07-03T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/biopsia-selectiva-del-ganglio-centinela-bsgc-en-melanoma-comparacion-de-dos-metodos-de-procesamiento-histologico\/"},"modified":"2014-07-03T00:00:00","modified_gmt":"2014-07-03T00:00:00","slug":"biopsia-selectiva-del-ganglio-centinela-bsgc-en-melanoma-comparacion-de-dos-metodos-de-procesamiento-histologico","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/dermatologia\/biopsia-selectiva-del-ganglio-centinela-bsgc-en-melanoma-comparacion-de-dos-metodos-de-procesamiento-histologico\/","title":{"rendered":"Biopsia selectiva del ganglio centinela (bsgc) en melanoma. comparaci\u00f3n de dos m\u00e9todos de procesamiento histol\u00f3gico"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Teresa Martinez Menchon <\/strong><\/h2>\n<p>El melanoma es un tumor de estirpe melanoc\u00edtica con un elevado potencial metast\u00e1tico y una incidencia en aumento. La t\u00e9cnica de la biopsia selectiva del ganglio centinela (bsgc) se acepta como la forma m\u00e1s espec\u00edfica, sensible y con menor morbilidad para realizar la estadificaci\u00f3n patol\u00f3gica ganglionar. Objetivos:1) analizar la capacidad de detecci\u00f3n de un protocolo extenso, frente a un m\u00e9todo simple de procesamiento del ganglio centinela comparando dos cohortes de pacientes; 2) buscar relaci\u00f3n entre el resultado de la t\u00e9cnica de bsgc y otras variables con valor pron\u00f3stico establecido, tanto cl\u00ednicas como histol\u00f3gicas; 3) realizar un estudio de supervivencia y de falsos negativos; 4) estudiar subgrupos de pacientes (melanomas ?1 mm de breslow, &lt;1 mm de breslow y melanomas en extremidades);y 5) comparar ambas t\u00e9cnicas desde el punto de vista econ\u00f3mico. Metodolog\u00eda: realizamos un estudio de cohortes con un dise\u00f1o observacional anal\u00edtico longitudinal. Se seleccionaron a los pacientes sometidos a la t\u00e9cnica desde el a\u00f1o 1998 hasta el 2010. La muestra a su vez se subdividi\u00f3 en dos series: la serie correspondiente a los a\u00f1os 1998-2004 y, la serie 2007-2010. En la primera de ellas se realiz\u00f3 un procesamiento simple (secci\u00f3n \u00fanica de hematoxilina-eosina) mientras que en la segunda se realiz\u00f3 un estudio extenso (protocolo transhiliar bivalvo con secciones seriadas cada 250 \u00c2\u00b5m y m\u00faltiples tinciones inmunohistoqu\u00edmicas (hmb 45, melan a y s100)). Conclusiones: el protocolo histopatol\u00f3gico extenso de an\u00e1lisis ganglionar ha demostrado mejorar la capacidad de detecci\u00f3n de la t\u00e9cnica en nuestro medio. No hay diferencias en la tasa de falsos negativos, pero eliminando el factor de confusi\u00f3n correspondiente a los drenajes m\u00faltiples, la tasa disminuye a la mitad. El procesamiento por niveles al menos duplica el coste econ\u00f3mico de la serie anterior. El porcentaje de pacientes sometidos a la t\u00e9cnica con melanomas delgados (\u00edndice de breslow menor a 1 mm) es cada vez mayor (40%), aunque el rango de positividad es bajo (2%). La aparici\u00f3n de nuevas opciones de tratamiento en el melanoma metast\u00e1sico obliga a optimizar la t\u00e9cnica con objeto de identificar el subgrupo de pacientes que podr\u00edan beneficiarse de estas nuevas terapias. Palabras clave: melanoma, ganglio centinela.  melanoma is a melanocytic lineage tumor with high metastatic potential and increasing incidence. Sentinel lymph node biopsy (slnb) is accepted as the most specific, sensitive and with less morbidity technique for pathologic nodal staging. Objectives: 1) to analyze the detection capability of an extensive protocol, versus a simple method of lymph node processing, comparing two cohorts of patients; 2) to seek a relationship between the outcome of the slnb technique and other variables with established prognostic value, both clinical and histological; 3) to conduct a survival and false negatives study; 4) to study subgroups of patients (melanomas with breslow thickness of 1 mm or more,  &lt;1 mm breslow melanomas and extremity melanomas) and 5) to compare both lymph node processing methods from the economic point of view. Methods: cohort study with a longitudinal observational analytic design was conducted. Patients undergoing slnb in our institution from 1998 to 2010 were selected. The sample was divided into two cohorts, patients treated from 1998 to 2004 and those from 2007 to 2010. In the first subgroup, a simple method of processing was performed (single hematoxylin-eosin slide), while in the second, an extensive protocol (transhiliar bivalving 250\u00c2\u00b5m serial sectioning with multiple immunohistochemical stains (hmb 45, melan a and s100)) was carried out. Conclusions: extensive histopathologic protocol for assessing sentinel node has shown an improved detection capability of the technique in our institution. No differences in false negatives rate were detected, but removing multiple drains confusion factor, this rate decreases by half. Extensive histopathologic protocol at least double the economic cost of the previous method. Percentage of patients undergoing slnb technique with thin melanomas (less than 1 mm of breslow thickness) is growing (40%), although positivity range is low (2%). New emerging treatment options in metastatic melanoma force to optimize the technique in order to identify the subgroup of patients who might benefit from these new therapies. Keywords: melanoma, sentinel node.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Biopsia selectiva del ganglio centinela (bsgc) en melanoma. comparaci\u00f3n de dos m\u00e9todos de procesamiento histol\u00f3gico<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Biopsia selectiva del ganglio centinela (bsgc) en melanoma. comparaci\u00f3n de dos m\u00e9todos de procesamiento histol\u00f3gico <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Teresa Martinez Menchon <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 07\/03\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Carlos De Torre Minguela<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: vicente Vicente ortega <\/li>\n<li>vicente Oliver mart\u00ednez (vocal)<\/li>\n<li>Jos\u00e9 Miguel Fortea baixauli (vocal)<\/li>\n<li>Antonio  ra\u00fal Corbal\u00e1n v\u00e9lez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Teresa Martinez Menchon El melanoma es un tumor de estirpe melanoc\u00edtica con un elevado potencial metast\u00e1tico y [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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