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as taxas de positividade verdadeira e falsa&#44; o impacto da feitura do exame no progn&#243;stico do paciente e as caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas associadas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo tipo coorte retrospectiva que analisa prontu&#225;rios m&#233;dicos de casos de melanoma tratados e acompanhados na institui&#231;&#227;o entre 1999 e 2016&#44; tendo sido exclu&#237;dos os tumores <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram desprezados os prontu&#225;rios nos quais o exame anatomopatol&#243;gico n&#227;o possibilitou o adequado estadiamento do tumor inicial&#46; Foram considerados como exames de estadiamento aqueles feitos em at&#233; tr&#234;s meses do diagn&#243;stico inicial&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foram avaliados os resultados de radiografias de t&#243;rax &#40;RT&#41; e tomografias de cabe&#231;a&#44; pesco&#231;o&#44; t&#243;rax&#44; abd&#244;men e pelve &#40;TC&#41; segundo os laudos radiol&#243;gicos&#46; A positividade foi considerada verdadeira quando obtida evid&#234;ncia histol&#243;gica da les&#227;o ou quando a evolu&#231;&#227;o do paciente manifestou recidiva clinicamente evidente&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Vari&#225;veis cont&#237;nuas foram analisadas bivariadamente pelos testes <span class="elsevierStyleItalic">t</span> de Student e Mann&#8208;Whitney&#44; dependendo da normalidade das distribui&#231;&#245;es&#44; avaliada pelo teste de Shapiro&#8208;Wilk&#46; As vari&#225;veis categ&#243;ricas foram comparadas pelos testes de qui&#8208;quadrado&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O impacto do exame radiol&#243;gico na sobrevida a partir do diagn&#243;stico inicial foi avaliado pela regress&#227;o de Cox&#46; Foram considerados significativos valores bicaudais de&#160;p &#60; 0&#44;05&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram identificados 93 casos inclu&#237;dos no estudo&#44; dos quais 57 fizeram exames de imagem iniciais&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> ilustra as caracter&#237;sticas basais dos pacientes inclu&#237;dos e os exames de imagem no estadiamento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Obteve-se uma amostra equilibrada entre os sexos com les&#245;es tratadas entre a sexta e oitava d&#233;cadas de vida&#44; seguidos por um per&#237;odo mediano de 4&#44;6 anos&#44; e tumores iniciais de espessura intermedi&#225;ria&#44; com 32&#37; de fatalidade durante o seguimento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Verificaram&#8208;se frequentes achados incidentais nos exames de imagem iniciais&#44; sem achados verdadeiramente positivos em RT iniciais&#46; Por outro lado&#44; os exames de imagem foram feitos seletivamente&#44; havendo uma regularidade maior para as RT&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos exames iniciais de estadiamento&#44; 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desde o diagn&#243;stico inicial&#44; de acordo com a feitura e altera&#231;&#227;o dos exames de imagem do seguimento&#44; ajustados por idade&#44; sexo&#44; espessura de Breslow e ulcera&#231;&#227;o&#44; em que se verifica o comportamento mais agressivo de tumores com doen&#231;a metast&#225;tica identificada clinicamente &#40;p &#60; 0&#44;01 &#8211; regress&#227;o de Cox&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Os presentes achados&#44; que corroboram outros estudos&#44; sugerem que a feitura de exames de imagem no estadiamento de pacientes assintom&#225;ticos &#233; pouco produtiva&#44; devem ser considerados apenas para casos localmente avan&#231;ados&#44; com tumores espessos e ulcerados&#46; Os estudos de Gj&#248;rup et al&#46; &#40;2016&#41; e Ferr&#225;ndiz et al&#46; &#40;2016&#41;&#44; juntos&#44; identificaram apenas tr&#234;s casos positivos entre RT e TC no estadiamento de 913 pacientes assintom&#225;ticos at&#233; est&#225;gio IIC&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">No seguimento&#44; a frequ&#234;ncia de achados positivos em pacientes assintom&#225;ticos aumentou&#44; por&#233;m frequentemente foi precedida de dissemina&#231;&#227;o regional do tumor&#46; De qualquer modo&#44; met&#225;stase &#224; dist&#226;ncia clinicamente manifesta indicou doen&#231;a de evolu&#231;&#227;o agressiva&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Apesar das limita&#231;&#245;es inerentes a estudos retrospectivos&#44; os resultados desfavorecem as RT no estadiamento de pacientes assintom&#225;ticos&#44; exceto para casos localmente avan&#231;ados&#46; J&#225; durante o seguimento&#44; a positividade aumenta&#44; por&#233;m geralmente ocorrem precedidas de recidiva locorregional e de sintomas da doen&#231;a metast&#225;tica &#224; dist&#226;ncia&#44; dentro dos tr&#234;s primeiros anos de seguimento&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Luiza Boava Souza&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Gabriel Peres&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflitos de interesse</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade ao diagn&#243;stico &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;22&#8208;88&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;17&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensivo superficial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acral lentiginoso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno melanoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presen&#231;a de ulcera&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;6&#8208;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#47;57 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#47;57 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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Carta ‐ Investigação
Exames de imagem no estadiamento do melanoma cutâneo: uma coorte retrospectiva
Luiza Boava Souzaa, Gabriel Peresb, Juliano Vilaverde Schmittb,
Autor para correspondência
julivs@gmail.com

Autor para correspondência.
a Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
b Departamento de Dermatologia e Radioterapia, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">N&#227;o h&#225; consenso no processo de estadiamento do melanoma&#44; existindo uma diversidade de protocolos entre pa&#237;ses e diferentes institui&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Levando&#8208;se em conta o cont&#237;nuo incremento na incid&#234;ncia do melanoma e na demanda financeira dos sistemas de sa&#250;de&#44; requer&#8208;se que o manejo desses pacientes promova bons resultados cl&#237;nicos e rela&#231;&#227;o custo&#8208;benef&#237;cio&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O presente estudo avaliou a frequ&#234;ncia de solicita&#231;&#227;o de exames de imagem no estadiamento do melanoma cut&#226;neo&#44; as taxas de positividade verdadeira e falsa&#44; o impacto da feitura do exame no progn&#243;stico do paciente e as caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas associadas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Trata&#8208;se de um estudo tipo coorte retrospectiva que analisa prontu&#225;rios m&#233;dicos de casos de melanoma tratados e acompanhados na institui&#231;&#227;o entre 1999 e 2016&#44; tendo sido exclu&#237;dos os tumores <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram desprezados os prontu&#225;rios nos quais o exame anatomopatol&#243;gico n&#227;o possibilitou o adequado estadiamento do tumor inicial&#46; Foram considerados como exames de estadiamento aqueles feitos em at&#233; tr&#234;s meses do diagn&#243;stico inicial&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foram avaliados os resultados de radiografias de t&#243;rax &#40;RT&#41; e tomografias de cabe&#231;a&#44; pesco&#231;o&#44; t&#243;rax&#44; abd&#244;men e pelve &#40;TC&#41; segundo os laudos radiol&#243;gicos&#46; A positividade foi considerada verdadeira quando obtida evid&#234;ncia histol&#243;gica da les&#227;o ou quando a evolu&#231;&#227;o do paciente manifestou recidiva clinicamente evidente&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Vari&#225;veis cont&#237;nuas foram analisadas bivariadamente pelos testes <span class="elsevierStyleItalic">t</span> de Student e Mann&#8208;Whitney&#44; dependendo da normalidade das distribui&#231;&#245;es&#44; avaliada pelo teste de Shapiro&#8208;Wilk&#46; As vari&#225;veis categ&#243;ricas foram comparadas pelos testes de qui&#8208;quadrado&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O impacto do exame radiol&#243;gico na sobrevida a partir do diagn&#243;stico inicial foi avaliado pela regress&#227;o de Cox&#46; Foram considerados significativos valores bicaudais de&#160;p &#60; 0&#44;05&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foram identificados 93 casos inclu&#237;dos no estudo&#44; dos quais 57 fizeram exames de imagem iniciais&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> ilustra as caracter&#237;sticas basais dos pacientes inclu&#237;dos e os exames de imagem no estadiamento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Obteve-se uma amostra equilibrada entre os sexos com les&#245;es tratadas entre a sexta e oitava d&#233;cadas de vida&#44; seguidos por um per&#237;odo mediano de 4&#44;6 anos&#44; e tumores iniciais de espessura intermedi&#225;ria&#44; com 32&#37; de fatalidade durante o seguimento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Verificaram&#8208;se frequentes achados incidentais nos exames de imagem iniciais&#44; sem achados verdadeiramente positivos em RT iniciais&#46; Por outro lado&#44; os exames de imagem foram feitos seletivamente&#44; havendo uma regularidade maior para as RT&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o aos exames iniciais de estadiamento&#44; apenas 4&#47;57 pacientes apresentaram achados que indicaram met&#225;stase sist&#234;mica de melanoma &#40;por meio de TC&#41;&#46; Todas as les&#245;es eram ulceradas&#44; com um Breslow mediano de 9&#44;8mm &#40;1&#44;5-15mm&#41;&#44; dos quais 1&#47;4 apresentava linfonodomegalia regional&#44; 1&#47;4 apresentava invas&#227;o &#243;ssea no tumor prim&#225;rio e 1&#47;4 apresentava microsatelitose&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Os pacientes que fizeram ou n&#227;o fizeram RT iniciais n&#227;o diferiram quanto a caracter&#237;sticas demogr&#225;ficas e de estadiamento tumoral &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Al&#233;m disso&#44; mortalidade geral e espec&#237;fica ajustadas por idade&#44; sexo&#44; espessura de Breslow e ulcera&#231;&#227;o n&#227;o foram diferentes entre esses grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;63 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;81 &#8211; regress&#227;o de Cox&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Dos pacientes com exames iniciais negativos&#44; 24&#44;5&#37; &#40;13&#47;53&#41; evolu&#237;ram para doen&#231;a metast&#225;tica identificada em exames de imagem no seguimento &#8211; 61&#44;5&#37; &#40;8&#47;13&#41; ap&#243;s manifesta&#231;&#227;o cl&#237;nica da recidiva&#46; Cinco dos 13 casos de recidiva &#40;38&#44;5&#37;&#41; apresentaram doen&#231;a metast&#225;tica em RTs no seguimento&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Dos cinco pacientes que apresentaram achados de met&#225;stase assintom&#225;tica em exames de imagem&#44; tr&#234;s haviam evolu&#237;do previamente para est&#225;gio III&#46; O tempo mediano de seguimento para a identifica&#231;&#227;o pr&#233;&#8208;cl&#237;nica de doen&#231;a metast&#225;tica &#224; dist&#226;ncia nos exames de imagem foi de 24 &#40;9&#8208;29&#41; meses&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> ilustra as curvas de sobrevida geral dos pacientes&#44; desde o diagn&#243;stico inicial&#44; de acordo com a feitura e altera&#231;&#227;o dos exames de imagem do seguimento&#44; ajustados por idade&#44; sexo&#44; espessura de Breslow e ulcera&#231;&#227;o&#44; em que se verifica o comportamento mais agressivo de tumores com doen&#231;a metast&#225;tica identificada clinicamente &#40;p &#60; 0&#44;01 &#8211; regress&#227;o de Cox&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Os presentes achados&#44; que corroboram outros estudos&#44; sugerem que a feitura de exames de imagem no estadiamento de pacientes assintom&#225;ticos &#233; pouco produtiva&#44; devem ser considerados apenas para casos localmente avan&#231;ados&#44; com tumores espessos e ulcerados&#46; Os estudos de Gj&#248;rup et al&#46; &#40;2016&#41; e Ferr&#225;ndiz et al&#46; &#40;2016&#41;&#44; juntos&#44; identificaram apenas tr&#234;s casos positivos entre RT e TC no estadiamento de 913 pacientes assintom&#225;ticos at&#233; est&#225;gio IIC&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">No seguimento&#44; a frequ&#234;ncia de achados positivos em pacientes assintom&#225;ticos aumentou&#44; por&#233;m frequentemente foi precedida de dissemina&#231;&#227;o regional do tumor&#46; De qualquer modo&#44; met&#225;stase &#224; dist&#226;ncia clinicamente manifesta indicou doen&#231;a de evolu&#231;&#227;o agressiva&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Apesar das limita&#231;&#245;es inerentes a estudos retrospectivos&#44; os resultados desfavorecem as RT no estadiamento de pacientes assintom&#225;ticos&#44; exceto para casos localmente avan&#231;ados&#46; J&#225; durante o seguimento&#44; a positividade aumenta&#44; por&#233;m geralmente ocorrem precedidas de recidiva locorregional e de sintomas da doen&#231;a metast&#225;tica &#224; dist&#226;ncia&#44; dentro dos tr&#234;s primeiros anos de seguimento&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Luiza Boava Souza&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Gabriel Peres&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflitos de interesse</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sobrevida geral de acordo com a feitura e altera&#231;&#227;o dos exames de imagem no seguimento do melanoma&#44; incluindo radiografias de t&#243;rax e tomografias axiais&#46; Os exames eram feitos seletivamente&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas basais&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade ao diagn&#243;stico &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62 &#40;49&#8208;75&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;22&#8208;88&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#211;bito por melanoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;17&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensivo superficial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acral lentiginoso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;17&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lentigo maligno melanoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cabe&#231;a e pesco&#231;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Membros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presen&#231;a de ulcera&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;6&#8208;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                      "titulo" => "Cost&#44; production&#44; efficiency&#44; or effectiveness&#58; where should we focus&#63;"
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                      "titulo" => "Routine X&#8208;Ray of the chest is not justified in staging of cutaneous melanoma patients"
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ISSN: 26662752
Idioma original: Português
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