N. ÖZSAN, B. SARSIK, B DOĞANAVŞARGİL, O. ZEKİOĞLU, N. ÖZDEMİR

Meme karsinomlarında sentinel lenf nodülü biyopsilerinin histopatolojik ve immunohistokimyasal özellikleriyle değerlendirilmesi

Amaç: Meme karsinomu kadınlarda en sık görülen malignite olup, günümüzde kadınlarda kansere bağlı ölüm nedenlerinin başında yer alır. Sentinel lenf nodülü biopsisi (SLNB), meme karsinomlu hastanın lenf nodülü tutulumunun değerlendirilmesinde minimal invaziv bir uygulamadır. Çalışmamızda SLNB’nin aksiller metastazı öngörme gücü, sentinel lenf nodu (SLN) incelemesinde intraoperatif histopatolojik değerlendirmenin etkinliği ve primer tümöre bağlı histopatolojik ve immunhistokimyasal (İHK) özelliklerin metastazla ilişkisini araştırmayı hedefledik. Gereç ve Yöntem: Çalışmaya, bölümümüzde SLNB değerlendirilen 86 olgu dahil edildi. Olgular intraoperatif histopatolojik değerlendirme sonuçları, SLNB sonrasında aksiller lenf nodülü diseksiyonu (ALND) uygulanmış olgularda aksillaya ait materyalleri yanısıra primer tümör eksizyon materyalleriyle birlikte incelendi, tümörde uygulanan İHK inceleme (östrojen reseptörü, progesteron reseptörü, Her2, p53, Ki67) sonuçlarının metastazla ilişkisi retrospektif olarak araştırıldı. Bulgular: SLN’de makrometastaz saptanması nedeniyle ALND uygulanan 16 olgunun 9’unda aksillada metastatik lenf nodülleri saptandı. Mikrometastaz ve izole tümör hücreleri saptanan 16 hastadan ALND uygulanan dokuz olgunun sadece birinde aksiller metastaz gözlendi. İntraoperatif değerlendirme sonucunda malignite saptanan 15 hastanın tümünde parafin kesitlerinde de makrometastaz gözlendi. Tümörü iyi prognostik grupta yer alan hastalarda SLN metastaz oranı daha düşük bulundu. SLNB’de metastaz saptanan hastaların primer tümörlerinde uygulanan İHK belirleyicilerden sadece Ki67 ortalaması metastatik grupta daha yüksek bulundu. Sonuç: SLNB uygulanan olgu grubunu değerlendirdiğimiz çalışmamızda literatürle uyumlu sonuçlar elde ettik. SLNB, negatif saptanması durumunda, tek başına uygun, güvenilir ve ALND’ye göre kol morbiditesinde azalma ve daha iyi yaşam kalitesi sağlayan etkin bir yöntemdir. SLNB’de metastaz saptanan hastaların tümünde ALND uygulaması yapılmalı mıdır sorusunun yanıtı için geniş serilerde uzun süre takipli çalışmalara ihtiyaç bulunmaktadır.

Histopathological and immunohistochemical evaluation of sentinel lymph node biopsies in breast cancer

Aim: Breast cancer is the most common malignity and cancer-related cause of death for women. Sentinel lymph node biopsy (SLNB) is a minimally invasive method for the evaluation of lymph node involvement. We aimed to determine the success of SLNB in predicting axillary lymph node (ALN) metastasis, the efficacy of intraoperative diagnosis of SLNB, and investigate a correlation with the characteristics of the primary tumour. Materials and Methods: Eighty-six patients with breast cancer who had undergone SLNB were included. Cases were re-evaluated with intraoperative histopathological diagnosis, axillary lymph node dissection (ALND), and primary tumour excision materials. The correlation between immunohistochemical characteristics (ER, PR, Her2, p53, and Ki67) of the primary tumour, and status of axillary metastasis were also investigated retrospectively. Results: Nine of 16 patients who had received ALND following the diagnosis of macrometastasis in SLNB intraoperatively, had ALN metastasis. Sixteen cases were diagnosed as micrometastasis or submicrometastasis in SLNB, and among them, only one out of 9 patients with completion of ALND, had metastasis in ALN. All 15 metastatic cases diagnosed intraoperatively had macrometastasis in paraffin sections. Cases within the good prognostic tumour group had low rates of metastasis in SLNB. Among the immunohistochemical markers performed for primary tumours, only Ki67 was found to be higher in cases with metastasis in SLNB. Conclusion: Our findings are in agreement with previous studies. If SLNB is negative for metastasis, SLNB is the reliable, appropriate and adequate way of axillary management with reduced arm-morbidity. Larger studies with long follow-up periods are needed to find out if completion of ALND is necessary for all patients with metastasis in SLNB.

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