Nódulo pulmonar solitario: enfoque, diagnóstico y tratamiento
Nódulo pulmonar solitario: enfoque, diagnóstico y tratamiento
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Introducción: la detección del nódulo pulmonar solitario (NPS) suele ser casual. Se deben diferenciar las lesiones benignas de las malignas, para establecer el seguimiento y las intervenciones terapéuticas adecuadas.
Objetivo: revisar el estado actual del diagnóstico y el tratamiento del NPS.
Metodología: se revisaron las bases de datos PubMed, Science Direct, OvidSP, EBSCOhost y Scielo, en búsqueda de revisiones sistemáticas, metaanálisis, guías, consensos y revisiones con palabras claves tomadas del Mesh: solitary pulmonary nodule, lung neoplasm, diagnosis, therapy. Se consideraron publicaciones de 1986 a 2011.
Resultados: se obtuvieron 329 artículos, de los cuales 55 permitían cumplir el objetivo de la revisión. Existen recomendaciones para estudiar a los pacientes que presentan NPS. Está disponible la guía propuesta por American College of Chest Physician (ACCP). La mayoría de los nódulos son de etiología benigna. El riesgo de malignidad del NPS se evalúa según factores de riesgo del paciente y características radiológicas de la lesión, incluyendo: tamaño, tasa de crecimiento, calcificaciones, atenuación, márgenes, realce con contraste y tasa metabólica. Las ayudas imagenológicas son: radiografía de tórax, TAC de tórax y PET/CT. Los NPS de alto grado de malignidad deben ser intervenidos quirúrgicamente, prefiriendo técnicas mínimamente invasivas. El seguimiento de los nódulos indeterminados y benignos se debe realizar con TAC de alta resolución y PET/ CT, si está indicado.
Conclusión: un abordaje adecuado del NPS permite diagnósticos oportunos de cáncer de pulmón, mejora la sobrevida global y limita las intervenciones innecesarias. Rev. Cienc.biomed. 2013; 4(1): 125-133
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