Acurácia do diagnóstico clínico de lesões orais malignas em um Centro de Referência do Nordeste Brasileiro
Authors: Oliveira Maressa Cedraz de , Queiroz Bruno Oliveira , Pereira Lais Reis , Freitas Valéria Souza , Freitas Ramos Tarsila De Carvalho , Martins Joana Dourado 
Published: December 2020

<p class="western" align="justify"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><strong>Objetivo:</strong></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> Avaliar a acurácia</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">do</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">diagnóstico</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">clínico comparando com o diagnóstico histopatológico</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">lesões</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">malignas</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">analisadas</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">no</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Laboratório</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Patologia</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Oral</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">do</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Centro</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Referências</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Lesões</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Orais</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">da</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Universidade</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Estadual</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Feira</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Santana</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">.</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><strong>Metodologia: </strong></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Foi realizado um estudo de validade de diagnóstico em uma amostra</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">composta</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">por</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 1.926</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">casos</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">que</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foram</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">submetidos</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">à</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">biópsias orais</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">no</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">período</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 2005 </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 2017.</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><strong>Resultados: </strong></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Observou</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">-</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">se</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">que</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">sensibilidade</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">do</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">diagnóstico</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">clínico</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">na</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">detecção</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">lesões</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">malignas</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foi</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 75% </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">e</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">especificidade</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foi</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 97%. </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">O</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">valor</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">preditivo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">positivo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foi</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 77% </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">e</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">o</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">valor</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">preditivo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">negativo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foi</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 95%. </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">O</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">valor</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">da</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">acurácia</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">foi</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 95%, </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">correspondendo assim</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">uma</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">acurácia</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">alta. Os indivíduos com lesões malignas eram do</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">sexo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">masculino</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> (65,9%) </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">e acima de 40 anos</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> (93,2%). </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">Ao analisar as características clínicas das lesões, foi observado que a localização mais frequente foi a língua</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> (29,4%), com coloração </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">vermelha</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> (54,9%), </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">sendo</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">úlcera</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> (50%) </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">a</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">lesão</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">fundamental</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">mais</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">comum. As</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">lesões</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">se</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">apresentaram</span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">maiores</span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">que</span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 10</span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">cm</span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">(</span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">72,7%) </span></span></span><span style="color: #000000;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">e</span></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">54,4% </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">das</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">lesões</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">estiveram</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">presentes</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">há mais</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">de</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> 12 </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">meses</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">na cavidade</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">oral</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">.</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><strong>Conclusões: </strong></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">O exame clínico demonstrou uma alta precisão na identificação de lesões malignas em cavidade oral, demonstrando assim a importância do conhecimento prévio das características das lesões por estudantes e profissionais da Odontologia. Entretanto, apesar de sua validade, não se deve abrir mão do exame histopatológico para a confirmação da suspeita clínica.</span></span></p>