Rabiye USLU ERDEMİR, Güldeniz KARADENİZ ÇAKMAK

Çift Dedektörlü Gama Prob Cihazı ile Eş Zamanlı İndosiyanin Yeşili ve Radyokolloid Madde Kullanılarak Sentinel Lenf Nodu Belirlenmesi: Türkiye’de İlk Deneyimimiz

Amaç: Meme kanserinde sentinel lenf nodu(SLN) biyopsisisinde indosiyanin yeşili(ICG) ile yapılan floresan tespiti yeni uygulanan bir yöntemdir. Bu çalışmada erken evre meme kanserinin aksiller evrelemesi için SLN’nin belirlenmesinde, ICG ve radyokolloid maddenin birlikteliğinin yararlılığını göstermek ve ilk deneyimlerimizi paylaşmak istedik. Gereç ve Yöntemler: Çalışmamızda erken evre meme kanserli 15 hasta yer aldı. SLN tespitinde, Gama ve Floresan ışınlarının dedeksiyonu için tasarlanmış İntraoperatif Cerrahi Gama Prob cihazı kullanıldı. Hastalara cerrahi öncesi nükleer tıp bölümünde radyokolloid madde ve genel anestezi sonrası ICG verildi. Sonra çift dedektörlü gama probla önce ICG, ardından radyokolloid tutulumu izlenen lenf nodları eksize edildi. Tek başına ICG, tek başına radyokolloid ve ikisinin birlikte tutulumu olan SLN sayıları kayıt altına alındı. Ameliyat esnasında çıkarılan SLN frozen incelemesi metastatik olarak bildirilen olgularda aksiller lenf nodu diseksiyonu yapıldı. Bulgular: Hastaların yaş ortalaması 56 (32-82) idi. 14 hastada ICG ve radyokolloid, 1 hastada ise sadece radyokolloidle SLN tespiti yapıldı. Eksize edilen ortanca SLN sayısı ICG ile 4, radyokolloidle ise 3 hesaplandı. SLN tespit etme oranı ICG ile %93.3, radyokolloid ile %100 olarak bulundu. Hastaların %26.6 da SLN’de metastaz saptandı. Metastatik lenf nodu tespit etme oranı ICG ile %28.5, radyokolloid ile %26.6 bulundu. Lenf nodu metastazı olan 4 hastaya aksiller diseksiyon yapıldı ve sentinel dışındaki lenf nodlarında metastaz görülmedi. Ameliyat sırasında ve sonrasında yöntemlere bağlı komplikasyon görülmedi. Sonuç: Sınırlı tecrübemize göre ülkemizde ilk olarak kliniğimizde kullanılmaya başlanan çift dedektörlü gama prob ile eş zamanlı tespit edilme avantajına sahip olan ICG ve radyokolloid madde rehberliğinde yapılan SLN biyopsisi teknik olarak uygulanabilir ve metastatik sentinel lenf nodunun doğru olarak tespitinde yararlı görülmektedir.

Sentinel Lymph Node Detection Using A Dual-Dedector Gamma Probe Device and Simultaneous Indocyanine Green and Colloid Substance: First Experience in Turkey

Aim: Fluorescence detection using indocyanine green (ICG) in sentinel lymph node (SLN) biopsy in breast cancer is a newly described method. In this study, we wanted to show the usefulness of the combination of ICG and radiocolloid material in the determination of SLN for axillary staging of early breast cancer and to share our initial experiences. Material and Methods: Our study included 15 patients with early stage breast cancer. Intraoperative Surgical Gamma Probe device designed for the detection of Gamma and Fluorescent rays was used for SLN detection. The patients were given radiocolloid material in the nuclear medicine department before surgery and ICG after general anesthesia. Then, lymph nodes with ICG and then radiocolloid uptake were excised with a double-detector gamma probe. The numbers of ICG alone, radiocolloid alone and SLN with both involvement were recorded. Axillary lymph node dissection was performed in cases with metastatic SLN frozen examination removed during the operation. Results: The mean age was 57±25. ICG and radiocolloid were detected in 14 patients, and SLN was detected in 1 patient with only radiocolloid. The median number of excised SLNs was calculated as 4 with ICG and 3 with radiocolloid. The detection rate of SLN was 93.3% with ICG and 100% with radiocolloid. Metastasis was detected in the SLN in 26.6% of the patients. Metastatic lymph node detection rate was 28.5% with ICG and 26.6% with radiocolloid. Axillary dissection was performed in 4 patients with lymph node metastasis and no metastases were observed in lymph nodes other than sentinel. There were no complications related to the methods during and after the operation. Conclusion: According to our limited experience, sentinel lymph node biopsy performed under the guidance of indocyanine green and radiocolloid substance, which has the advantage of being detected simultaneously with the dual-detector gamma probe device, which was first used in our clinic in our country, seems to be technically feasible and useful.

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