Mustafa KARACA, Banu ÖZTÜRK TURGUT, İrem BİLGETEKİN, Esin AVŞAR

Meme Kanserinin Erken Tanısında Klinik Bulgular mı? Mamografi mi?

Amaç: Mamografi ile tanı konulan veya semptomatik olarak doktora başvuran opere olmuş meme kanserli hastaların klinikopatolojik özeliklerinin karşılaştırılması ve hastalıksız sağkalım sürelerinin değerlendirilmesi planlandı. Gereç ve Yöntemler: 17.05.2000-19.06.2016 tarihleri arasında meme kanseri tanısı konulan, çok merkezli, 1004 opere meme kanseri hastasının verileri, dosya ve elektronik kayıt sistemlerinden retrospektif olarak analiz edildi. Verileri sağkalım analizi için uygun takip ve tedavi bilgilerine sahip 828 hasta çalışmaya dahil edildi. Hastaların tanısının mamografik tarama ya da semptomatik başvurmaya göre konulması, yaş, tanı anındaki kilosu, menapoz durumu, operasyon şekli, hormon reseptör durumu, HER2 reseptör durumu, patolojik evresi, grade, histolojik alt grup, lenfovasküler invaziyon, perinöral invaziyon durumu, adjuvan kemoterapi durumu, adjuvan herceptin alması durumu, adjuvan hormonal tedavi durumu, adjuvan radyoterapi durumu belirlendi. Hastaların nüks tarihi, yeri ve nüks olmayanların son vizit tarihleri belirlendi. Mamografi ile tanı konulan ve semptomatik olarak başvuran hastaların histopatolojik özellikleri karşılaştırıldı.Bulgular: Mamografik tarama ile 324 %39 hastaya meme kanseri tanısı konulmuştur. Mamografi ile tanı konulan ve semptomatik başvuran hastaların histopatolojik özellikleri karşılaştırıldığında; mamografi grubunda postmenopozal hasta yüzdesi %60,4 vs. %52; p=0,011 , grade 3 hasta sayısı %24,2 vs. %32,9; p=0,005 , pT1 oranı %48,5 vs. %26; p=0,0001 , aksiller lenf nodu pozitifliği %30 vs %53,7; p=0,0001 , LVİ lenfovasküler invazyon %13,7 vs %31,6; p=0,0001 , PNİ perinöral invazyon %7,2 vs. %18,1; p=0,0001 olarak saptandı. Ayrıca mamografi grubu ve diğer grup karşılaştırıldığında, adjuvan KT %67 vs. %85; p=0,0001 , hormonal tedavi %87,3 vs. %82; p=0,001 olarak saptandı. İki grup arasında nüks oranları yönünden fark saptanmadı %12 vs %12,6; p=0,4 . Medyan takip süresi 48 ay , medyan DFS hastalıksız sağkalım 37 ay olarak saptandı. DFS için yapılan ünivariate analizde prognostik parametreler de değerlendirildi. Patolojik evre p=0,002 , grade p=0,002 , PNİ p=0,027 , LVİ p=0,0001 , hormon reseptör durumu p=0,001 , triple negatif p=0,016 , luminal A hasta grubu p=0,048 ’nun DFS üzerine istatistiksel olarak anlamlı etkisi saptandı. Mamografik tarama ile tanı ve diğer parametrelerin DFS üzerine anlamlı etkisi saptanmadı p>0,05 Sonuç: Mamografik tarama grubundaki hastalar, daha erken evre, aksilla negatif oranı yüksek, postmenopozal durumda, düşük grade, daha az LVİ, PNİ oranına sahip, ayrıca yüksek oranda hormon reseptörü pozitifliğine sahip olarak saptandı. Ayrıca mamografi ile tanı konulan hastalar daha az kemoterapi ve daha çok hormonal tedavi almış olduğu görüldü. Mamografik tarama grubu, semptomla başvuran hasta grubuna göre iyi prognostik parametrelere sahip olmasına rağmen nüks oranları semptomatik grup ile benzerdi. Sağkalım analizinde bu grup hastaların nüks oranı semptomatik başvuran hastalarla benzer bulunmuştur

Anahtar Kelimeler:

Meme kanseri, Erken tanı, Mamografi, Klinik bulgular

Clinical Findings or Mammography in Early Diagnosis of Breast Cancer?

Objective: Our goal was to compare clinicopathological characteristics and disease free survival time among breast cancer patients diagnosed using mammographic scanning or after symptomatic medical advice seeking.Material and Methods: This was a retrospective analysis of 1004 cancer patients’ charts at a hospital in Turkey between 17.05.2000 and 19.12.2016. A total of 828 participants were considered eligible for the study. Diagnosis was made using either mammographic scanning or by symptomatic diagnosis considering the following parameters: age, weight at the time of diagnosis, menopause status, operation type, hormone and HER2 receptor status, pathological grade, histological subtype, lymphovascular and perineuronal invasion status, adjuvant chemotherapy use, adjuvant herceptin use, adjuvant hormonal therapy and adjuvant radiotherapy status.Results: Breast cancer was detected by mammographic scanning in 324 39% and by symptomatic diagnosis in 504. Among all the patients, 60.4 % of the women in the mammography group were in their postmenopausal period, while this rate was 52% for the symptomatic group, and the difference was statistically significant p=0.011 . The difference in most cases between the two methods employed was significant and found as below respectively: Grade 3 patient percentage 24.2% vs. 32.9% p=0.005 , pT1 percentage 48.5% vs. 26% p=0.0001 , positive axillary lymph node dissection 30% vs. 53.7% p=0.0001 , lymphovascular invasion 13.7% vs. 31.6% p=0.0001 , perineuronal invasion 7.2% vs. 18.1% p=0.0001 , adjuvant chemotherapy use 67% vs. 85% p=0.0001 and hormonal treatment use 87.3% vs. 82% p=0.001 . Nevertheless, recurrence rates did not differ significantly among the two groups 12% vs. 12.6% p=0.4 . The median follow-up time was 48 months and the median DFS time was 37 months . Prognostic parameters were also analyzed with univariate analysis, which was used to determine DFS. Pathologic staging p=0.002 , perineuronal invasion p=0.027 , lymphovascular invasion p=0.0001 , hormone receptor status p=0.0001 , triple negative disease p=0.016 , and luminal A patient group p=0.048 parameters were found to have a statistically significant effect on DFS. Diagnosis with mammographic scanning was found to have no statistically significant effect on DFS p>0.05 Conclusion: Patients diagnosed with mammographic scanning were found to have lower stages, higher axillary negativity rate, postmenopausal status, lower grades, less lymphovascular and perineuronal invasion and higher hormone receptor positivity, with lower chemotherapy and higher hormonal treatment use. Although patients diagnosed with mammographic scanning had better prognostic parameters, recurrence rates were similar to those symptomatic patients at the time of diagnosis. At survival analysis, recurrence rates were similar to those in the symptomatic patient group

Keywords:

Breast cancer, Early diagnosis, Mamography, Clinical findings,

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