Revisão do sistema de estadiamento tumor-nódulo-metástase para câncer de pulmão: mudanças e perspectivas

Abstract

The tumor-node-metastasis (TNM) staging system for lung cancer has been modified since its first edition in the late 1960s. Its seventh edition has been recently published and, for the first time, a truly worldwide database was analyzed in order to propose modifications in the staging. Significant changes have been made in the tumor and metastasis descriptors. Although the recommendations for the node descriptor have remained unchanged, the analysis of the factors related to this descriptor suggests that modifications will be made in the future. The forthcoming revisions of the TNM staging system might take the molecular aspects of lung cancer into consideration, aiming at a more refined staging system. Keywords: Lung neoplasms; Neoplasm staging; Epidemiologic methods. ResumoO sistema de estadiamento tumor-nódulo-metastase (TNM) para câncer de pulmão tem sido modificado desde sua primeira edição no final da década de 1960. Recentemente foi publicada sua sétima edição e, pela primeira vez, um banco de dados verdadeiramente mundial foi analisado para se propor modificações no estadiamento. Alterações significativas foram feitas nos descritores tumor e metástase. Embora as recomendações para o descritor nódulo permaneceram inalteradas, as análises dos fatores relacionados a esse descritor sugerem que modificações serão realizadas no futuro. As próximas revisões do sistema de estadiamento TNM podem levar em consideração aspectos moleculares do câncer de pulmão, objetivando um sistema de estadiamento mais refinado.Descritores: Neoplasias pulmonares; Estadiamento de neoplasias; Métodos epidemiológicos.* Study carried out in the

Autologous blood patch pleurodesis: An effective but underused method

“…Pleurodesis is a well-stablished procedure for malignant pleural effusion. [ 2 3 ] Classically, in patients with primary spontaneous pneumothorax, it can be done after the second episode. However, some studies support the procedure in the first episode, especially in cases of secondary spontaneous pneumothorax.…”

“…This is especially relevant in patients with malignant pleural effusion presenting with poor general status. [ 2 3 ] Importantly, besides less systemic inflammatory response, the effectiveness of pleural symphysis is the same as the other chemical agents.…”

“…[ 5 7 8 12 ] Our practice is clamping the drain only if there is not active air leak, usually for 1 h. If the leak exists, we just elevate the chest drain system during the procedure aiming that the fluid goes to the pleural cavity and not to the collector system. [ 2 3 ]…”