Análise molecular e genética complementar na investigação dos nódulos de tireoide: uma revisão integrativa da literatura
DOI:
https://doi.org/10.60104/revhugv11036Palavras-chave:
Marcadores moleculares, nódulos de tireoide, medicina personalizadaResumo
A utilização da medicina genômica se apresenta como promissora no manejo de diversas doenças e isso não difere para a investigação dos nódulos da tireoide, na qual a utilização dessa tecnologia direciona a desfechos diagnósticos, de conduta e prognósticos mais acurados, possibilitando diminuir, por exemplo, a incidência de procedimentos invasivos e com potenciais complicações ao paciente, como sucessivas punções aspirativas por agulha fina ou cirurgias em casos benignos. Assim sendo, sabe-se hoje que existe uma infinidade de marcadores moleculares relacionados aos nódulos da tireoide, inclusive com painéis de genes patenteados por empresas da indústria farmacêutica, no entanto, ainda se carece de estudos de revisão que busquem elencar a importância na prática médica de cada um desses marcadores e nos desfechos no manejo do paciente, principalmente sob a ótica de diagnóstico, conduta e prognóstico. Dessa forma, esta revisão de literatura buscou elucidar a importância médica dos marcadores moleculares com base em diversos estudos disponíveis com um bom tamanho amostral e relacionados com o tema, indicando os marcadores moleculares com a melhor evidência e significância para o manejo do paciente portador de nódulos tireoidianos, o que pode contribuir para fundamentar e incentivar a aplicação da medicina genômica, através, por exemplo, de políticas públicas. Assim sendo, em nossa revisão, foram observadas diferenças significativas em relação aos painéis genéticos comercialmente disponíveis no que tange à seu poder de estratificação de risco e, além disso, quando os marcadores moleculares são analisados de maneira individual, observou-se que as variáveis estatísticas de performance se diferenciavam muito nos estudos, apesar de mutações BRAF e do promotor TERT se apresentarem bastante relacionadas à malignidade, o que direciona a uma abordagem conjunta de marcadores ao se realizar a individualização dos nódulos tireoidianos de um paciente, seja do ponto de vista do diagnóstico, da conduta e do prognóstico.
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