Abidin TÜZÜN, Erkan DALBAŞI, Ercan GEDİK

Meme Koruyucu Cerrahide İntraoperatif Ultrason ve Frozen Patoloji Kullanımının Güvenli Cerrahi Sınır Üzerindeki Etkinliği

Amaç: Meme kanseri 40 yaş üstü kadınlarda en sık görülen kanserdir. Yaşam boyu risk %12 civarındadır. Günümüzde tarama programları sayesinde meme kanseri hastalarına erken tanı konulmakta ve bu sayede ölüm oranları %25-30 civarına düşmektedir. Meme Koruyucu Cerrahi'de cerrahi sınırların pozitifliği veya yakınlığı %5-60 arasında değişmektedir. İleride tekrar meme kanseri oluşmasını önlemek, tekrarlayan ameliyatları önlemek ve ek tedavilerin önüne geçmek için cerrahi sınırların negatifliği çok önemlidir. Bu çalışmada Meme Koruyucu Cerrahi ile tedavi edilen meme kanserlerinde intraoperatif ultrasonografi ve frozen kesit kullanımının güvenli cerrahi sınır elde etmede ve postoperatif kozmetik açıdan etkinliğini araştırmayı amaçladık. Materyal ve Metod: Bu çalışma, Ocak 2015 ile Ocak 2019 tarihleri arasında meme kanseri tanısı alan ve Meme Koruyucu Cerrahi ile tedavi edilen 150 hastayı içermektedir. Memelerde uzak metastaz varlığı ve multifokal ya da santral yerleşimli tümör tutulumu araştırıldı. Tüm hastalarda tümörün lokalizasyonu preoperatif ultrasonografi ile anatomik olarak işaretlendi. Tümör tamamen eksize edildi ve altta yatan kas fasyası da dahil olmak üzere ameliyat öncesi işaretli alanda deri de dahil olmak üzere tümörün çevresinde en az 1 cm sağlam doku bırakıldı. Medial ve superior sınırlar ip ile işaretlendi. Eksize edilen bu doku bloğu intraoperatif ultrasonografi ile incelendi. Bulgular: Hastaların yaş ortalaması 48,3± 9,7 idi. Tümör hastaların 83 (%55,3)'ünde sağ memede yerleşirken, 67 (%44,7) hastada sol memede yerleşmişti. Tümör 67 (%44,7) hastada üst dış kadranda, 53 (%35,3) hastada üst iç kadranda, 30 (%20) hastada alt dış kadranda yerleşmişti. Hastaların 21'ine (%14) sentinel lenf nodu pozitifliği nedeniyle aksiller diseksiyon uygulandı. Histolojik tiplendirmede 141 (%94) hasta duktal karsinom ve 9 (%6) hasta lobüler karsinomdu. Sonuç: Çalışmamız ve literatür taraması sonucunda intraoperatif ultrasonografi ile birlikte frozen incelemenin Meme Koruyucu Cerrahi'de güvenli cerrahi sınırı belirlemede basit, kolay uygulanabilir ve kozmetik açıdan iyi bir yöntem olduğunu düşünüyoruz.

Anahtar Kelimeler:

meme kanseri, ultrasonografi, cerrahi sınır, frozen

The Efficacy of Using Intraoperative Ultrasound and Frozen Pathology in Breast Conserving Surgery on Safe Surgical Boundary

Background: Breast cancer is the most common cancer in women over the age of 40. The lifetime risk is around 12%. Today, breast cancer patients are diagnosed at an early stage thanks to screening programs, and thus mortality has decreased to around 25-30%. The positivity or closeness of surgical margins in breast conserving surgery varies between 5-60%. Negativity of surgical margins is very important to prevent future recurrent breast cancer, to pre-vent recurrent surgeries, and to prevent additional treatments. In this study, we aimed to investigate the efficacy of intraoperative ultrasonography and frozen section use in breast cancers treated with breast conserving surgery in obtaining safe surgical margins and in postoperative cosmetic terms. Materials and Methods: This study includes 150 patients diagnosed with breast cancer and treated with breast con-serving surgery in between January 2015 and January 2019. The presence of distant metastases and multifocal or centrally located tumor involvement in the breasts were investigated. The localization of the tumor was marked anatomically by preoperative ultrasonography in all patients. The operation was started 15 minutes after the injec-tion. The tumor was completely excised, leaving at least 1 cm of intact tissue around the tumor, including the skin, on the preoperatively marked area, including the underlying muscle fascia. Medial and superior borders were marked with string. This excised tissue block was examined with intraoperative ultrasonography. Results: The mean age of the patients was 48,3± 9.7 years. While the tumor was located in the right breast in 83 (55.3%) of the patients, it was located in the left breast in 67 (44.7%) patients. The tumor was located in the upper outer quadrant in 67 (44.7%) patients, in the upper inner quadrant in 53 (35.3%) patients, and in the lower outer quadrant in 30 (20%) patients. Axillary dissection was performed in 21 (14 %) of the patients because sentinel lymph node was positive. In histological typing, 141 (94 %) patients were ductal carcinoma and 9 (6 %) patients were lobular carcinoma. Conclusions: As a result of our study and literature review, we think that frozen examination together with intraope-rative ultrasonography is a simple, easily applicable and cosmetically good method to determine the safe surgical margin in breast conserving surgery.

Keywords:

breast cancer, ultrasonography, surgical margin, frozen,

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