SÜLEYMAN ÖZKAN AKSOY, ALİ İBRAHİM SEVİNÇ, MERİH GÜRAY DURAK, PINAR BALCI

Duktal karsinoma in situ da sentinel lenf nodu biyopsisi gerekli midir?

Amaç: Duktal karsinoma in situ (DKİS) memede duktal epitelyum hücrelerinin bazal membranı aşmayan ve invazyon kanıtı olmayan proliferasyonudur. Son tartışmalardan birisi de DKİS vakalarında yüksek invaziv hastalık riski ile birlikte, sentinel lenf nodu biyopsisi (SLNB) gerekli olup olmadığıdır. Gereç ve yöntem: Kliniğimizde 1996-2016 yılları arasında 112 mikroinvaziv odaklı ve 32 mastektomi endikasyonu olan toplam 144 DKİS hastasına uygulanan SLNB sonuçları geriye dönük olarak incelendi ve literatür eşliğinde değerlendirildi. Bulgular: Hastaların yaş ortalaması 53 (36-77) idi. Histopatolojik tanı olguların 103’ünde (%71) iğne işaretli meme biyopsisi, 34’ünde (%24) eksizyonel biyopsi, 7’sinde ise (% 5) subareolar eksplorasyon ile konuldu. Histopatolojik incelemede hiçbir sentinal lenf nodu örneklemesinde invazyon görülmedi. Mikroinvazyonu olan olgulara radyoterapi ve hormonoterapi, mastektomi yapılan olgulara ise sadece hormonoterapi adjuvan tedavi olarak uygulandı. Ortalama 48 aylık takiplerinde olgularda aksiller rekürrens saptanmadı. Sonuç: DKİS saptanan hastalarda aksiller metastaz oldukça düşük oranda (<%1) saptandığı için aksiller lenf nodu örneklemesi bu hastaların hepsinde rutin olarak yapılmamalıdır. Mikroinvaziv odağa sahip veya mastektomi yapılma endikasyonu bulunan hastalarda örnekleme SLNB şeklinde yapılarak aksiller diseksiyonun olası morbiditelerinden kaçınılabilinir.

Anahtar Kelimeler:

Duktal Karsinoma in Situ, Sentinel Lenf Nodu Biyopsisi, Meme Kanseri

Is Sentinel Lymph Node Biopsy Necessary In Ductal Carcinoma In Situ?

Objective: Ductal carcinoma in situ (DCIS) is a proliferation of mammary ductal epithelial cells that does not cross the basal membrane and has no evidence of invasion. One of the recent arguments is that a sentinel lymph node biopsy (SLNB) is required for high risk of invasive disease in DCIS cases. Material and method: We retrospectively reviewed SLNB results in a total of 144 DCIS patients, 112 with microinvasive foci and 32 with mastectomy indication between 1996 and 2016 in our clinic.Results: The mean age of the patients was 53 (36-77) years. A total of 103 (71%) of the cases were treated with wire-guided biopsy, 34 (24%) with wide local excision, and 7 (5%) with subareolar exploration for histopathological diagnosis. Histopathological examination showed no invasion of any sentinel lymph node specimen. Radiotherapy and hormonotherapy were applied to patients with microinvasion and only hormonotherapy was applied to the patients treated with mastectomy as adjuvant therapy. There was no recurrence of axillary lesions in the average follow-up of 48 months.Conclusion: As axillary metastases were found to be quite low (<1%) in DCIS, axillary lymph node sampling should not be routinely performed in these patients. Axillary sampling may be done with SLNB in DCIS patients with microinvasive foci or having mastectomy indication, avoiding possible morbidity of axillary dissection.

Keywords:

Ductal Carsinoma in Situ, Sentinel Lymph Node Biopsy, Breast Cancer,

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