Linfonodomegalias cervicais: análise de dados epidemiológicos e estratégia de diagnóstico diferencial. Uso da punção aspirativa com agulha fina como primeiro exame complementar em pacientes portadores de metástases de carcinoma epidermoide do trato aerodigestivo superior.

Abstract

Cervical nodules are a common clinical situation and their diagnosis may represent a challenge to the healthcare professionals involved in these cases. Knowing the existing structures in the neck and the diseases that most commonly affect these organs is essential to take advantage of time and diagnostic resources, as well as to reduce the morbidity generated by invasive procedures, often unnecessary. The first article presents the epidemiology and strategy employed in the differential diagnosis of lymph node disease in a group of 201 patients from the private practice of the head and neck surgeon Eduardo de Freitas Gomes (EFG) during the period from 2001 to 2015. The second article refers to the identification of cervical ganglion metastases of upper aerodigestive squamous cell carcinoma using Fine Needle Aspiration (FNA) as the first complementary examination in a group of 24 patients with a major cervical nodule complaint, whether or not accompanied by other cancerrelated symptoms in the different subsites. of the upper aerodigestive tract, coming from the Head and Neck Surgery outpatient clinic of the School of Medicine of the Federal University of Pelotas (FAMED-UFPel). The results of the first study showed that most of the investigated patients had benign or normal lymph node changes in all age groups. Malignant lesions were represented by lymphomas (the smallest part) and metastasis from primary tumors of head and neck organs, especially upper aerodigestive tract squamous cell carcinomas in smoking men over 50 years of age. The diagnostic strategy prioritized the appreciation of the semiological aspects prior to the request or performance of any complementary exam. Ultrasonography (US) was used to identify lymph nodes within or around the major salivary glands and evaluate ultrasound aspects that indicated malignancy of the lymph nodes, that would indicate the performance of fine-needle aspiration puncture (FNA). FNA was effective in identifying metastatic lymph nodes from primary tumors of the head and neck region and other body segments. In the second study, the results presented FNA as a resource of high sensitivity and diagnostic specificity in cases of patients with lymph nodes with clinical appearance of squamous cell carcinoma metastasis from upper aerodigestive tract that can be performed without ultrasound assistance and at the time of the first consultation of the patient. Diagnostic confirmation by cytological examination provides information of the stage and location of the primary tumor site and, in addition to other anamnesis and physical examination resources, videolaryngoscopy (VL) and computed tomography (CT), reduce the waiting time for the beginning of treatment.