Ahmet Cem İYİBOZKURT, Süleyman AKHAN, Yavuz SALİHOĞLU, Ergin BENGİSU, Sinan BERKMAN, Samet TOPUZ, Ahmet İYİBOZKURT, At ALL.

LENFATİK HARİTALAMANIN SERVİKS KANSERİ YÖNETİMİNDEKİ ÖNEMİ

Serviks kanseri tüm dünyada 40 yaş altı kadınlar arasında görülen ikinci en sık kanserdir. Erken evre serviks kanserlerinde en sık uygulanan tedavi radikal histerektomi ve pelvik lenf adenektomidir. Radikal cerrahi uygulanan hastaların %90’ında lenf nodu (LN) metastazı bulunmamaktadır. Dolayısıyla pek çok hastada yapılan lenf adenektominin hastanın prognozuna olumlu katkısı olmaz, diğer yandan lenf adenektomiye bağlı morbiditenin artma riski vardır. Günümüzde preoperatif dönemde LN metastazını kesin olarak belirleyecek bir yöntem bulunmamaktadır. Ancak son yıllarda serviks kanseri olgularında lenfatik haritalama yöntemi kullanılarak seçilmiş hastalarda cerrahiye lenf adenektomi eklenip, diğer hastalarda lenf adenektomi komplikasyonlarından kaçınmayı amaçlayan çalışmalar yapılmıştır. Bu derlemede serviks kanseri yönetiminde lenfatik haritalamanın önemi araştırılmıştır. Değişik araştırmacılar lenfatik haritalama tekniğinde mavi boya, sintigrafi ve kombine yöntemler kullanılarak sentinel lenf nodu araştırılması yapmış en başarılı sonuçlar kombine yöntemde elde edilmiştir. Teorik olarak SLN biyopsisi negatif ise lenf adenektomi yapılmamalı, radikal histerektomi yapılmalıdır. SLN biyopsisi pozitif ise lenf adenektomi yapılmalı, radikal histerektomi yapılmamalıdır. Lenfatik haritalama ve SLN identifikasyonu uygulaması kolay ve iyi tolere edilen, erken evre serviks kanserlerinde uygulanabilir bir yöntem gibi gözükmektedir. Bu gruptaki hastalar LN metastaz oranları düşük olduğu için selektif nodların araştırılmasından yarar görebilirler.

Anahtar Kelimeler:

Lenfatik haritalama, serviks kanseri, yönetim

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