Cilt kanserlerinde lenfosintigrafi ve cerrahi gama prob ile sentinel lenf nodu biyopsisinin minimal invaziv cerrahi yaklaşımındaki rolü

Amaç: Sentinel lenf nodu(SLN) biyopsisi prosedürü tümörün lenfatik sistem boyunca bir sıra içerisinde ilerlediği görüşünden gelişmiştir. SLN biyopsisinin uzun dönem terapötik kazancı henüz tam olarak aydınlanmamış olsa da bu prosedür lenfatik disseksiyon ve onun lenfödem gibi komplikasyonlarından korunulması gereken lenfatik metastazı olmayan hastaları, komple lenfadenektomi ve adjuvan kemoterapi gibi ek tedavilerden fayda görecek lenfatik metastazı olan hastalardan ayırmamızı sağlar. Bu çalışmada, lenfosintigrafi ile SLN biyopsisinin hasta yönetimindeki rolünü saptamayı amaçladık.Yöntemler: Çalışmamıza 25 cilt kanserli hasta (16 malign melanom, 9 epidermoid karsinom) dahil edildi. Operasyon günü tüm hastalara Tc-99m Nanokolloid intradermal enjeksiyon ile uygulandı. Preoperatif lenfosintigrafi sırasında sentinel lenf nodlarının derideki izdüşümleri işaretlendi. İşaretleme sonrası hastalar operasyona alındı. Cilt üzerinde izdüşümleri işaretlenmiş lenf nodları intraoperatif gama prob ile tespit edilip eksize edildi. Tüm sentinel nodlar histopatolojik inceleme için çıkartıldıktan sonra sentinel lenf nodlarının çıkartıldığı yataktaki rezidüel radyoaktivite sayımının rezeke edilen en yüksek aktiviteli nodun aktivitesinin %10’unun altına düşmesine dikkat edildi.Bulgular: Toplam 86 adet SLN, 54 adet non-SLN cerrahi olarak çıkartılıp, tüm nodlar histopatolojik inceleme için Patoloji Bölümüne gönderildi. Dört hastada sentinel lenf nodlarında metastaz tespit edildi. Bu hastalar geniş cerrahi için elektif şartlarda tekrar operasyona alındı.Sonuç:Lenfosintigrafi ve intraoperatif gamma prob ile lenfatik haritalama yöntemi yüksek bir spesifisite ve sensitivite oranına sahip olup morbiditeyi minimalize etmektedir. Bu yöntemin, mikrometastazları saptaması, olası metastaz yollarını ortadan kaldırması, evreleme ve adjuvan tedaviye yol göstermesi nedeniyle malign deri tümörlerinde rutin olarak uygulanması gereken bir yöntem olduğu düşünüldü.

Anahtar Kelimeler:

sentinel lenf nodu biyopsisi, melanoma, lenfosintigrafi

Role of lymphoscintigraphy and gamma probe guided intraoperative sentinel lymph node biopsy on minimally invasive surgical procedure in skin cancers

Objective:Sentinel lymph node (SLN) biopsy procedure is developed from the view that the tumor progresses in a row through the lymphatic system. Although the long-term therapeutic benefit of SLN biopsy has not yet been fully elucidated, this procedure allows us to differentiate patients without lymphatic metastasis who need to be protected from complications such as lymphatic dissection and its lymphedema from patients with lymphatic metastasis who may benefit from additional therapies such as complete lymphadenectomy and adjuvant chemotherapy. In this study, we aimed to determine the role of lymphoscintigraphy in patient management of SLN biopsy. Methods: 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma) were included in the study. Tc-99m Nanocolloid intradermal injection was applied to all patients on the day of operation. The projections of the sentinel lymph nodes on the skin were marked during preoperative lymphoscintigraphy. Patients were taken into operation after the marking. The lymph nodes with projections on the skin were detected by intraoperative gamma probe and excised. After removing all the sentinel nodes for histopathological examination, care was taken to reduce the residual radioactivity count in the bed, where sentinel lymph nodes were removed, to less than 10% of the activity of the most active activity of the resected node. Results: A total of 86 SLNs and 54 non-SLNs were surgically removed and all nodes were sent to the Department of Pathology for histopathological examination. Four patients had metastases in sentinel lymph nodes. These patients were reoperated under elective conditions for extensive surgery. Conclusion: Lymphatic mapping method with lymphoscintigraphy and intraoperative gamma probe have a high specificity and sensitivity ratio and minimize the morbidity. This method was thought to be a routine procedure in malignant skin tumors because of its determination of micrometastases, eliminating possible metastasis pathways, staging and guiding adjuvant therapy.

Keywords:

biopsy sentinel lymph node, malignant melanoma, lymphoscintigraph,

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