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Imunocitoquímica em amostras de líquido cefalorraquidiano: avaliação da qualidade e contributo diagnóstico
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O diagnóstico de patologias do sistema nervoso central, sobretudo em casos de suspeita de disseminação leptomeníngea, pode requerer a análise do líquido cefalorraquidiano. Embora a citologia apresente limitações em amostras hipocelulares, a imunocitoquímica surge como ferramenta complementar, permitindo a deteção de biomarcadores específicos e a identificação de metástases. Este estudo avaliou o desempenho, o contributo diagnóstico e a qualidade técnica da imunocitoquímica em 257 amostras de líquido cefalorraquidiano, entre 2020 e 2023. A qualidade foi aferida por critérios estruturados, o desempenho analisado por sensibilidade, especificidade e concordância global e o contributo classificado em quatro categorias distintas. A imunocitoquímica apresentou elevada especificidade (99,5%) e boa sensibilidade (86,8%). Contribuiu diretamente para o diagnóstico em 86,0% dos casos, ajudou em 6,6%, não contribuiu em 4,7% e foi discordante em 2,7%. O processamento por citocentrifugação revelou sensibilidade de 84,8% e especificidade de 99,5%, enquanto a preservação em polietilenoglicol atingiu 100,0% de sensibilidade, embora com menor especificidade (97,0%). A qualidade técnica global foi elevada (22,8 em 27 pontos), destacando-se a marcação específica e a intensidade de imunomarcação como parâmetros mais consistentes. Estes resultados, aliados à dimensão da amostra, reforçam a importância da imunocitoquímica como técnica complementar, essencial no diagnóstico citopatológico em amostras de líquido cefalorraquidiano.
The diagnosis of central nervous system pathologies, particularly in cases of suspected leptomeningeal dissemination, may require analysis of cerebrospinal fluid. Although cytology has limitations in hypocellular samples, immunocytochemistry emerges as a complementary tool, allowing the detection of specific biomarkers and the identification of metastases. This study evaluated the performance, diagnostic contribution, and technical quality of immunocytochemistry in 257 cerebrospinal fluid samples collected between 2020 and 2023. Quality was assessed using structured criteria, performance was analyzed by sensitivity, specificity, and overall concordance, and contribution was classified into four distinct categories. Immunocytochemistry demonstrated high specificity (99.5%) and good sensitivity (86.8%). It directly contributed to the diagnosis in 86.0% of cases, was helpful in 6.6%, did not contribute in 4.7%, and was discordant in 2.7%. Cytocentrifugation processing revealed a sensitivity of 84.8% and a specificity of 99.5%, while polyethylene glycol preservation achieved 100.0% sensitivity, albeit with lower specificity (97.0%). Overall technical quality was high (22.8 out of 27 points), with specific staining and immunostaining intensity standing out as the most consistent parameters. These results, combined with the sample size, reinforce the importance of immunocytochemistry as a complementary technique, essential for cytopathological diagnosis in cerebrospinal fluid samples.
The diagnosis of central nervous system pathologies, particularly in cases of suspected leptomeningeal dissemination, may require analysis of cerebrospinal fluid. Although cytology has limitations in hypocellular samples, immunocytochemistry emerges as a complementary tool, allowing the detection of specific biomarkers and the identification of metastases. This study evaluated the performance, diagnostic contribution, and technical quality of immunocytochemistry in 257 cerebrospinal fluid samples collected between 2020 and 2023. Quality was assessed using structured criteria, performance was analyzed by sensitivity, specificity, and overall concordance, and contribution was classified into four distinct categories. Immunocytochemistry demonstrated high specificity (99.5%) and good sensitivity (86.8%). It directly contributed to the diagnosis in 86.0% of cases, was helpful in 6.6%, did not contribute in 4.7%, and was discordant in 2.7%. Cytocentrifugation processing revealed a sensitivity of 84.8% and a specificity of 99.5%, while polyethylene glycol preservation achieved 100.0% sensitivity, albeit with lower specificity (97.0%). Overall technical quality was high (22.8 out of 27 points), with specific staining and immunostaining intensity standing out as the most consistent parameters. These results, combined with the sample size, reinforce the importance of immunocytochemistry as a complementary technique, essential for cytopathological diagnosis in cerebrospinal fluid samples.
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Líquido cefalorraquidiano Imunocitoquímica Citopatologia Sistema nervoso central Metástases