Ferah TUNCEL DALOĞLU, Emre Çağatay KÖSE, Ahmet DAĞ

İNTRAOPERATİF KONSÜLTASYONUN MEME CERRAHİSİ VE SENTİNEL LENF NODU BİYOPSİSİNDEKİ ÖNEMİ

Amaç: ROLL mastektomi materyallerinde cerrahi sınır değerlendirmesi ve sentinel lenf nodu biyopsisinin (SLNB) intraoperatif konsültasyon ve frozen kesit ile değerlendirilmesinin güvenilirliği ve kullanılabilirliğinin tespit edilmesi. Yöntemler: 1 Temmuz 2015 – 1 Ağustos 2017 tarihleri arasında laboratuarımızda raporlanan mastektomi materyalleri dökümante edilmiş, frozen çalışılan olgular belirlenmiştir. Frozen raporları ile kalıcı kesit raporları karşılaştırılarak SLNB durumu ve ROLL mastektomi materyallerinde cerrahi sınır durumu arasındaki uyum ve tedaviye katkısı değerlendirilmiştir. Bulgular: Belirlenen tarihler arasındaki 1278 mastektomi olgusunun 657 tanesi ROLL mastektomidir. Bunların 30 tanesinde intraoperatif cerrahi sınır değerlendirilmesi yapılmış; 1 tanesinde cerrahi sınırın pozitif olduğu, 6 tanesinde tümörün cerrahi sınıra 1 mm’den daha yakın görülmüş olduğundan re-eksizyon yapılmıştır. Sentinel lenf nodu ise 233 olguda frozen kesitler ile değerlendirilmiş, %28’inde (n=72) metastaz görülmüş ve bu olguların tamamına aksiller diseksiyon yapılmıştır. Sonuç: Meme kanserli kadınlarda meme koruyucu cerrahi (MKC) operasyonlarında frozen değerlendirme, daha iyi cerrahi sınır negatifliği sağlar ve re-eksizyon operasyonlarını azaltır. Aynı şekilde SLNB’nin frozen değerlendirmesi, olası aksiller diseksiyon operasyonu sıklığını azaltır. Bu nedenle her iki yöntem de güvenilir ve önerilebilirdir.

Anahtar Kelimeler:

Sentinel lenf nodu, ROLL, Frozen

IMPORTANCE OF INTRAOPERATIVE CONSULTATION IN BREAST SURGERY AND SENTINEL LYMPH NODE BIOPSY

Objective: Evaluation of the surgical margins in ROLL mastectomy materials, and assessment of the safety and the usability of the intra-operative consultation and frozen section for the evaluation of the sentinel lymph node biopsy (SLNB). Methods: Mastectomy materials reported in our laboratories between July 1, 2015 and August 1, 2017 have been documented, and the cases with frozen sections have been detected. Frozen section reports, and permanent section reports were compared to evaluate the conformity between the SLNB situation and the ROLL mastectomy surgical margins’ situation, and their contribution to the treatment. Results: Out of the 1278 mastectomy cases in the described time interval, there were 657 ROLL mastectomies. In 30 of them intraoperative surgical margin assessment has been done. Because in one of them the surgical margin was positive, and 6 of them had tumor closer than 1 mm to surgical margins, re-excision had to be done. Sentinel lymph nodes were evaluated with frozen section in 233 of the cases, metastasis was seen in 28% (n=72) of them and axillary dissection was done to all of them. Conclusion: In women undergoing breast conserving surgery for the treatment of the breast cancer, frozen section evaluation provides better surgical margin negativity and reduces the need for the re-excision operations. Similarly, frozen section evaluation of the SLNB decreases the frequency of the axillary dissection reoperations.

Keywords:

Sentinel Lymph Node, ROLL, Frozen,

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