Hüseyin EKEN, İsmail ZİHNİ, Oktay KARAKÖSE, Hüseyin PÜLAT, Kazım Cağlar ÖZÇELİK, Hasan EROL

Pratiğimizde Son Bir Yılda Erken Evre Meme Kanserinde Uygulanan Sentinel Lenf Nodu Biyopsi Sonuçlarımız

Giriş: Erken evre meme kanserinde aksiller lenf nodu değerlendirilmesinderutin aksiller disseksiyon yerini sentinel lenf nodu disseksiyonuna bırakmıştır.Sentinel lenf nodu biyopsisi ile aksiller bölgenin yüksek doğruluk oranı iledeğerlendirilmesi sağlanırken aksiller disseksiyonuna bağlı komplikasyonlargelişmemektedir. Biz de çalışmamızda erken evre meme kanserinde sentinellenf nodu biyopsisi uygulamalarımızı inceledik.Gereç ve Yöntemler: Süleyman Demirel Üniversitesi Tıp FakültesiHastanesinde 2014 yılında tanı konulan erken evre meme kanserli 22 hastayasentinel lenf nodu biyopsisi uygulandı. Bu hastaların dosyaları retrospektifolarak incelendi.Bulgular: Sentinel lenf nodu biyopsisi uygulanan 22 hastanın %81,4’üne memekoruyucu cerrahi uygulanırken %18,2’sine basit mastektomi uygulandığıgörüldü. Sentinel lenf nodu biyopsisi ile medyan 1,9 adet lenf nodu (min:1-max:3) eksize edildi. Frozen inceleme sonucunda lenf nodlarının %81,8 benign,%18,2 malign raporlandı. Aksiller lenf nodu malign hastaların tamamındatümör üst dış kadran yerleşim göstermekte, %75’inde lenfovasküler invazyonmevcuttu. Bu hastalara tamamlayıcı aksiller disseksiyon uygulandı. Bir hastadasentinel lenf nodu hariç metastatik lenf nodu saptanmadı.Sonuç: Çalışmamızda kliniğimizde tespit edilen aksilla klinik olarak negatif olantüm erken evre meme kanserinde sentinel lenf nodu biyopsisi uygulandı.

Sentinel Lenf Node Biopsy Results Used in Early Stage Breast Cancer in a Practice in the Last Year

Aim: In the evaluation of axillary lymph nodes in early stage breast cancer, routine axillary dissection has been left to the sentinel lymph node dissection. When sentinel lymph node biopsy is performed with high accuracy of the axillary region, complications due to axillary dissection do not develop. We also examined our sentinel lymph node biopsy in early stage breast cancer in our study. Material and Methods: Sentinel lymph node biopsy was performed in 22 patients with early stage breast cancer diagnosed at Süleyman Demirel University Medical Faculty Hospital in 2014. The files of these patients were retrospectively reviewed. Results: A 81.2% of 22 patients who received sentinel lymph node biopsy underwent breast conserving surgery and 18.2% had simple mastectomy. Sentinel lymph node biopsy revealed a median of 1.9 lymph nodes (min: 1- max: 3). As a result of the frozen examination, 81.8% of the lymph nodes were benign and 18.2% were malignant. In all of the axillary lymph node malignancies, the tumor showed upper external quadrant placement and 75% had lymphovascular invasion. This disease was supplemented by axillary dissection. Metastatic lymph nodes were not detected in one patient except sentinel lymph node. Conclusion: In our study, sentinel lymph node biopsy was performed for all early stage breast cancer negative for axilla diagnosed in our clinic.

PDF

___

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blu- mencranz PW, Leitch AM, Saha S, McCall LM, Morrow M. Axillary dissection vs no axillary dissection in women with ınvasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 2011; 305:569-75.
Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994; 220:391-8.
Isik A, Demiryilmaz İ, Yılmaz İ, Fırat D,Çimen O, Eken H. Laparoskopik Apendektomide Manuel Düğümün Etkinliği GMJ 2016; 27: 19-20
Işık A, Fırat D, Soyturk M, Demiryilmaz I, Yilmaz I, İdiopatik Periportal Lenfadenopati Gazi Medical Journal, 2016;27:51-52.
Isik A, Eken H, Demiryilmaz İ, Yilmaz İ, Fırat D, Çimen O Rectal Lymphoma Kolon Rektum Hast Derg 2015;25:106-8
Kumar A, Puri R, Gadgil PV, Jatoi I. Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg 2012; 36:1453-9.
Veronesi U, Rilke F, Luini A, Sacchini V, Galimberti V, Campa T, Del Bei E, Greco M, Magni A, Merson M. Distribution of axillary node metastases by level of invasion. An analysis of 539 cases. Cancer 1987; 59:682-7.
Goyal A, Newcombe RG, Chhabra A, Mansel RE Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer--results of the ALMANAC validation phase. Breast Cancer Res Treat. 2006;99:203-8.
Veronesi U, Galimberti V, Paganelli G, Maisonneuve P, Viale G, Orecchia R, Luini A, Intra M, Veronesi P, Caldarella P, Renne G, Rotmensz N, Sangalli C, De Brito Lima L, Tullii M, Zurrida S. Axillary metastases in breast cancer patients with negative sentinel nodes: a follow-up of 3548 cases. Eur J Cancer. 2009;45:1381-8.
Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, Veronesi P, Intra M, Maisonneuve P, Zucca F, Gatti G, Mazzarol G, De Cicco C, Vezzoli D. Sentinel lymph node biopsy in breast cancer: ten year results of a randomized controlled study. Ann Surg. 2010;251:595- 600.
Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI,Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006 ;98:599-609.
David N. Krag, Stewart J. Anderson, Thomas B. Julian, Ann M. Brown, Seth P. Harlow, Joseph P. Costantino. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010; 11: 927–33.
Gradishar WJ, Anderson BO, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goldstein LJ, Hayes DF, Hudis CA, Isakoff SJ, Ljung BM,Marcom PK, Mayer IA, McCormick B, Miller RS, Pegram M, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Smith ML, Soliman H, Somlo G, Ward JH, Wolff AC, Zellars R, Shead DA, Kumar R. Breast cancer version 3.2014. J Natl Compr Canc Netw. 2014;12:542-90.
Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn HJ. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013;24:2206-23.