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Meme kanserinde sentinel lenf nodu uygulaması: 30 vakanın analizi

Yıl 2017, Cilt: 2 Sayı: 1, 9 - 14, 16.04.2017
https://doi.org/10.25000/acem.300411

Öz

Amaç: Sentinel lenf nodu uygulaması meme kanserinin tedavisinde uygulanmakta olup, aksiller cerrahi disseksiyon tekniğinin yerini almaya başlamıştır. Sonuçları güvenilir olup, aksiller cerrahi disseksiyona göre morbidite oranı daha düşük bir yöntemdir.

Yöntemler: Bu çalışmada meme kanseri cerrahi tedavisinde sentinel lenf nodu biyopsisi yapılan hastaların analizi yapılmıştır.

Bulgular: Sentinel lenf nodu saptanan 30 hastanın 14’ünde (%46,6) sentinel lenf nodu tutulumu saptandı. Diğer 16 hastada (%54,4) sentinel lenf nodu tutulumu saptanmadı ve bu hastalardan altı tanesine (%37,5) aksiller disseksiyon yapılmadı. Sentinel lenf nodu tutulumu saptanmayıp aksiller disseksiyon yapılan dokuz hastanın (%56,2) aksillasında tutulum saptanmadı, bir hastanın aksillasında ise tutulum saptandı. Çalışmamızda yer alan sentinel lenf nodu tutulumu saptanmayan fakat aksiller disseksiyon yapılan 10 hastanın (%62,5) hastanın sadece bir tanesinde yanlış negatiflik saptandı ve bu hastanın çalışmaya ilk dahil edilen ilk hasta olduğu görüldü. Sentinel lenf nodu bulma oranı %88,2, doğruluk oranı %76,6, duyarlılık oranı %88,2 ve yanlış negatiflik oranı %10 olarak bulundu.

Sonuç: Meme kanseri cerrahi tedavisinde sentinel lenf nodu biyopsisi güvenli bir yaklaşımdır.  

Kaynakça

  • 1. Özbaş S, Koçak S. Meme kanserinin cerrahi tedavisinde aksiller lenf nodu disseksiyonu. Meme Sağlığı Dergisi 2006; 2: 2.
  • 2. Çelik V. Sentinel lenf nodu biyopsisi. İT3 Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri. Meme Kanseri Sempozyum Dizisi 2006; 54: 99-103.
  • 3. Aktekin A, Güneş P, Sağlam A. Meme karsinomlu ve sentinel lenf nodu tutulumu olan hastalarda sentinel olmayan lenf nodu tutulumunu etkileyen faktörler. Meme Sağlığı Dergisi 2008; 4: 1.
  • 4. Demirbaş S, Filiz Al, Yıldırım Ş, Kurt Y, Akın ML, Çelenk T. Erken evre meme kanserinde sentinel lenf nodu biyopsisinin yeri; aksiller disseksiyonun yerini alabilir mi? Erciyes Tıp Dergisi 2004; 26: 119-125.
  • 5. Eser M, Kaptanoğlu L, Sıkar HE, Küçük HF, Menteş VC, Tutal F ve ark. Erken evre meme kanserinde sadece mavi boya klavuzluğunda yapılan sentinel lenf nodu biyopsisinin yeri: Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi 3. Cerrahi Kliniği'nin Geçerlik Çalışması. Meme Sağlığı Dergisi 2007; 3: 3.
  • 6. Barry W. Feig, David H. Berger, George M.Fuhrman. M. D. Anderson Cerrahi Onkoloji 4. Baskı Lippincot Williams and Wilkins. 2005; 241: 319-325.
  • 7. McCready DR, Hortobagy GN, Kau SW, et al. The prognostic signifıcance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer. Arc Surg. 1989; 124: 21-25.
  • 8. Beşe NŞ. Meme kanserinde sentinel lenf nodu biyopsisi ve postoperatif radyoterapi. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul, 2007; 149-156.
  • 9. Schrenk P, Rieger R, Shamiyeh A, et al. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissecion for patients with breast carcinoma cancer. 2000: 88; 608-614.
  • 10. Smeets A, Christianens MR. Implications of the sentinel lymph node procedure for local and systemic adjuvant treatment. Curr Opin Oncol. 2005: 17; 539-544.
  • 11. Bold RJ, Schlieman M, Fahy BN. Sentinel lymph node biopsy for breast cancer. Cancer Biother Radiopharm 2001; 16: 347-357.
  • 12. Giuliano AE, Kirgan DM, Guenter JM, Morton DL. Lymphatic Mapping and Sentinel Lymphadenectomy For Breast Cancer. Ann Surg 1994; 220: 391-401.
  • 13. Pelosi E, Bello M, Giors M, Ala A, Giani R, Bussone R, Bisi G. Sentinel lymph node detection in patients with early-stage Breast cancer: Comparison of periareolar and subdermallperitumoral injection techniques. J Nucl Med 2004; 45: 220-225.
  • 14. Bass SS, Cox CE, Salud CJ, et al. The effects of post injection massage on the sensivity of lymphatie mapping in breast cancer. J Am Coll Surg 2001; 192: 9- 16.
  • 15. Rosser RJ. A Point of View: Trauma is the Cause of Occult Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes. Breast J 2000: 6: 209-212.
  • 16. Klimberg VS, Rubio T, Henry R, Cowan C, Colvert M, Korourian S. Subareolar Versus Peritumoral Injection For Location Of sentinel Lymph Node. Ann Surg 1999; 229: 860-865.
  • 17. Özmen V, Karanlık H, Asoglu O, Müslümanoglu M, Keçer M, Tuzlalı S, Madun A, Parlak M. Sentinel lenf nodülünde mikrometastaz olan meme kanserli hastalarda aksiller diseksiyon gerekli midir? J Breast Health 2005; I: 12-17.
  • 18. Altınlı E. Sentinel lenf nodu biyopsisinde karşılaşılan komplikasyonlar. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul, 2007; 85-92.
  • 19. Turner RR, Giuliano AE, Hoon DS. Pathologic examination of sentinel node for breast carcinoma. World J Surg 2001; 25: 798-805.
  • 20. Haigh PI, Hansen NM, Qi K, Giuilano AE. Biopsy Method And Excision Volume Do Not Affect Success Rate Of Subsequent Sentinel Lymph Node Dissection In Breast Cancer. Ann Surg Oncol 2000; 7: 21-27.
  • 21. Rosen PP, Lesser ML, Kinne DW, Beattie EJ. Discontinuous or `skipn metastases in breast carcinoma. Analysis of 1228 axillary dissections. Ann Surg 1983; 197: 276-283.
  • 22. Ricardo R. Sentinel node biopsy in T2 breast cancer larger than 3cm and clinically negatif axilla compared with the Tl-T2<3cm standart indication. Science direct 2007; 567: 56-68.
  • 23. Maibenco DC, Weiss LK, Pawlish KS, Severson RK. Axillary Lymph Node Metastases Associated With Small invasive Breast Carcinomas, Cancer 1999; 85: 1530-1536.
  • 24. Gajdos C, Tartter PI, Bleiweiss IJ. Lymphatic Invasion, Tumor Size, And Age Are Independent Predictors Of Axillary Lymph Node Metastases In Women With Tl Breast Cancers. Ann Surg 1999; 230: 692-696.
  • 25. Cox CE, Bass SS, McCann CR, Ku NN, Berman C, Durand K, et al. Lymphatic Mapping And Sentinel Lymph Node Biopsy In Patients With Breast Cancer. Annu Rev Med 2000; 51: 525-542.
  • 26. Czerniecki BJ, Scheff AM, Callans LS, Spitz FR, Bedrosian I, Conant EF, et al. Immunohistochemistry With Pancytokeratins Improves The Sensitivity Of Sentinel Lymph Node Biopsy In Patiens With Breast Carcinoma. Cancer, 1999; 85: 1098-1103.
  • 27. İlvan Ş. Sentinel lenf nodlarmın patolojik değerlendirilmesi. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul. 2007; 77-83.
  • 28. Schrenk P, Wayand W. Sentinel-node biopsy in axillary lymph-node staging for patients with multicentric breast cancer. Lancet 2001; 357: 120-122.
  • 29. Yavuz E. Sentinel lenf gangliyonunun patolojik değerlendirilmesi. Cerrahi Onkoloji Dergisi 2002; 3: 34-37.
  • 30. Robert, CG, Martin II, et al. Clinicopathologic Factors Associated With False — Negative Sentinel Lymph Node Biopsy In Breast Cancer. Ann Surg 2005; 241: 1005-1015.
  • 31. Cody HS. Surgical aspects. Editor: HS Cody. Sentinel node biopsy. 1 st. Edition. Martin Dunitz Ltd, London, 2002; 177-183.
  • 32. Pusther K, McCall L, Blumcranz P, et al. Sentinel Node Skills Verification and Surgeon Performance: Data from a Multicenter for Early Stage Breast Cancer. Ann Surg. 2005; 242: 593-602.
  • 33. Taşmalı K. Meme kanserinde sentinel lenf nodu biyopsisinde öğrenme eğrisi. Editörler: C Uras, F Aydogan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık, Istanbul 2007; 69-75.
  • 34. Mc Masters KM, Wong SL, Chao C, et al. University of Louisville Breast Cancer Study Group. Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: a model for implementation of new surgical tachniques. Ann Surg. 2001; 234: 292-300.
  • 35. Singletary SE, Alired C, Ashley P. Revision of the American Joint Committee on Cancer staging system for breast cancer. J. Clin. Oncol. 2002; 17: 28-36.
  • 36. Viale G, Maiorano E, Mazzarol G, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving contraversises on the basis of the European Institute of Oncology experience. Wirchows Arch 2005; 241: 319-325.
  • 37. Şimşek Ş. European Institute of Oncology (Milano) Deneyimleri. Editörler: C Uras, F Aydogan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık, İstanbul 2007; 159-168.
  • 38. Veronesi U, Paganelli G, Galimberti V. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinicaliy negative lymph-nodes. Lancet 1997; 349: 1864-1867.
  • 39. Wada N, Imoto S, Hasebe T, Ochiai A. Ebihara S, Moriyama N. Evaluation Of Intraoperative Frozen Section Diagnosis Of Sentinel Lymph Nodes In Breast Cancer, Jpn J Clin Oncol, 2004; 34: 113-117.

Sentinel lymph node biopsy in breast cancer: Analysis of 30 cases

Yıl 2017, Cilt: 2 Sayı: 1, 9 - 14, 16.04.2017
https://doi.org/10.25000/acem.300411

Öz

Aim: Sentinel lymph node biopsy is performed in the treatment of breast cancer, and it has started to replace the axillary lymph node dissection technique. The results are reliable and it has lower morbidity comparing with axillary dissection.

Methods: In this study, we analyzed the patients with sentinel lymph node biopsy in breast cancer surgery.

Results: Sentinel lymph node involvement was detected in 14 (46.6%) of 30 patients. In the other 16 patients (54.4%), no involvement of the sentinel lymph nodes was detected and six of these patients (37.5%) did not undergo axillary dissection. None of the nine patients (56.2%) without sentinel lymph node involvement had also no axillary involvement. Axillary involvement was detected only in one patient. In our study, 10 patients (62.5%) who had no sentinel lymph node involvement but had axillary dissection showed false negativity in one patient and it was seen that this patient was the first patient to be included in the study. Sentinel lymph node detection rate was 88.2%, accuracy rate was 76.6%, sensitivity rate was 88.2% and false negative rate was 10%.

Conclusion: The use of sentinel lymph node biopsy in the surgical treatment of breast cancer is a safe approach.

Kaynakça

  • 1. Özbaş S, Koçak S. Meme kanserinin cerrahi tedavisinde aksiller lenf nodu disseksiyonu. Meme Sağlığı Dergisi 2006; 2: 2.
  • 2. Çelik V. Sentinel lenf nodu biyopsisi. İT3 Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri. Meme Kanseri Sempozyum Dizisi 2006; 54: 99-103.
  • 3. Aktekin A, Güneş P, Sağlam A. Meme karsinomlu ve sentinel lenf nodu tutulumu olan hastalarda sentinel olmayan lenf nodu tutulumunu etkileyen faktörler. Meme Sağlığı Dergisi 2008; 4: 1.
  • 4. Demirbaş S, Filiz Al, Yıldırım Ş, Kurt Y, Akın ML, Çelenk T. Erken evre meme kanserinde sentinel lenf nodu biyopsisinin yeri; aksiller disseksiyonun yerini alabilir mi? Erciyes Tıp Dergisi 2004; 26: 119-125.
  • 5. Eser M, Kaptanoğlu L, Sıkar HE, Küçük HF, Menteş VC, Tutal F ve ark. Erken evre meme kanserinde sadece mavi boya klavuzluğunda yapılan sentinel lenf nodu biyopsisinin yeri: Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi 3. Cerrahi Kliniği'nin Geçerlik Çalışması. Meme Sağlığı Dergisi 2007; 3: 3.
  • 6. Barry W. Feig, David H. Berger, George M.Fuhrman. M. D. Anderson Cerrahi Onkoloji 4. Baskı Lippincot Williams and Wilkins. 2005; 241: 319-325.
  • 7. McCready DR, Hortobagy GN, Kau SW, et al. The prognostic signifıcance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer. Arc Surg. 1989; 124: 21-25.
  • 8. Beşe NŞ. Meme kanserinde sentinel lenf nodu biyopsisi ve postoperatif radyoterapi. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul, 2007; 149-156.
  • 9. Schrenk P, Rieger R, Shamiyeh A, et al. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissecion for patients with breast carcinoma cancer. 2000: 88; 608-614.
  • 10. Smeets A, Christianens MR. Implications of the sentinel lymph node procedure for local and systemic adjuvant treatment. Curr Opin Oncol. 2005: 17; 539-544.
  • 11. Bold RJ, Schlieman M, Fahy BN. Sentinel lymph node biopsy for breast cancer. Cancer Biother Radiopharm 2001; 16: 347-357.
  • 12. Giuliano AE, Kirgan DM, Guenter JM, Morton DL. Lymphatic Mapping and Sentinel Lymphadenectomy For Breast Cancer. Ann Surg 1994; 220: 391-401.
  • 13. Pelosi E, Bello M, Giors M, Ala A, Giani R, Bussone R, Bisi G. Sentinel lymph node detection in patients with early-stage Breast cancer: Comparison of periareolar and subdermallperitumoral injection techniques. J Nucl Med 2004; 45: 220-225.
  • 14. Bass SS, Cox CE, Salud CJ, et al. The effects of post injection massage on the sensivity of lymphatie mapping in breast cancer. J Am Coll Surg 2001; 192: 9- 16.
  • 15. Rosser RJ. A Point of View: Trauma is the Cause of Occult Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes. Breast J 2000: 6: 209-212.
  • 16. Klimberg VS, Rubio T, Henry R, Cowan C, Colvert M, Korourian S. Subareolar Versus Peritumoral Injection For Location Of sentinel Lymph Node. Ann Surg 1999; 229: 860-865.
  • 17. Özmen V, Karanlık H, Asoglu O, Müslümanoglu M, Keçer M, Tuzlalı S, Madun A, Parlak M. Sentinel lenf nodülünde mikrometastaz olan meme kanserli hastalarda aksiller diseksiyon gerekli midir? J Breast Health 2005; I: 12-17.
  • 18. Altınlı E. Sentinel lenf nodu biyopsisinde karşılaşılan komplikasyonlar. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul, 2007; 85-92.
  • 19. Turner RR, Giuliano AE, Hoon DS. Pathologic examination of sentinel node for breast carcinoma. World J Surg 2001; 25: 798-805.
  • 20. Haigh PI, Hansen NM, Qi K, Giuilano AE. Biopsy Method And Excision Volume Do Not Affect Success Rate Of Subsequent Sentinel Lymph Node Dissection In Breast Cancer. Ann Surg Oncol 2000; 7: 21-27.
  • 21. Rosen PP, Lesser ML, Kinne DW, Beattie EJ. Discontinuous or `skipn metastases in breast carcinoma. Analysis of 1228 axillary dissections. Ann Surg 1983; 197: 276-283.
  • 22. Ricardo R. Sentinel node biopsy in T2 breast cancer larger than 3cm and clinically negatif axilla compared with the Tl-T2<3cm standart indication. Science direct 2007; 567: 56-68.
  • 23. Maibenco DC, Weiss LK, Pawlish KS, Severson RK. Axillary Lymph Node Metastases Associated With Small invasive Breast Carcinomas, Cancer 1999; 85: 1530-1536.
  • 24. Gajdos C, Tartter PI, Bleiweiss IJ. Lymphatic Invasion, Tumor Size, And Age Are Independent Predictors Of Axillary Lymph Node Metastases In Women With Tl Breast Cancers. Ann Surg 1999; 230: 692-696.
  • 25. Cox CE, Bass SS, McCann CR, Ku NN, Berman C, Durand K, et al. Lymphatic Mapping And Sentinel Lymph Node Biopsy In Patients With Breast Cancer. Annu Rev Med 2000; 51: 525-542.
  • 26. Czerniecki BJ, Scheff AM, Callans LS, Spitz FR, Bedrosian I, Conant EF, et al. Immunohistochemistry With Pancytokeratins Improves The Sensitivity Of Sentinel Lymph Node Biopsy In Patiens With Breast Carcinoma. Cancer, 1999; 85: 1098-1103.
  • 27. İlvan Ş. Sentinel lenf nodlarmın patolojik değerlendirilmesi. Editörler: C Uras, F Aydoğan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık. İstanbul. 2007; 77-83.
  • 28. Schrenk P, Wayand W. Sentinel-node biopsy in axillary lymph-node staging for patients with multicentric breast cancer. Lancet 2001; 357: 120-122.
  • 29. Yavuz E. Sentinel lenf gangliyonunun patolojik değerlendirilmesi. Cerrahi Onkoloji Dergisi 2002; 3: 34-37.
  • 30. Robert, CG, Martin II, et al. Clinicopathologic Factors Associated With False — Negative Sentinel Lymph Node Biopsy In Breast Cancer. Ann Surg 2005; 241: 1005-1015.
  • 31. Cody HS. Surgical aspects. Editor: HS Cody. Sentinel node biopsy. 1 st. Edition. Martin Dunitz Ltd, London, 2002; 177-183.
  • 32. Pusther K, McCall L, Blumcranz P, et al. Sentinel Node Skills Verification and Surgeon Performance: Data from a Multicenter for Early Stage Breast Cancer. Ann Surg. 2005; 242: 593-602.
  • 33. Taşmalı K. Meme kanserinde sentinel lenf nodu biyopsisinde öğrenme eğrisi. Editörler: C Uras, F Aydogan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık, Istanbul 2007; 69-75.
  • 34. Mc Masters KM, Wong SL, Chao C, et al. University of Louisville Breast Cancer Study Group. Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: a model for implementation of new surgical tachniques. Ann Surg. 2001; 234: 292-300.
  • 35. Singletary SE, Alired C, Ashley P. Revision of the American Joint Committee on Cancer staging system for breast cancer. J. Clin. Oncol. 2002; 17: 28-36.
  • 36. Viale G, Maiorano E, Mazzarol G, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving contraversises on the basis of the European Institute of Oncology experience. Wirchows Arch 2005; 241: 319-325.
  • 37. Şimşek Ş. European Institute of Oncology (Milano) Deneyimleri. Editörler: C Uras, F Aydogan. Sentinel lenf nodu biyopsisi. İstanbul Medikal Yayıncılık, İstanbul 2007; 159-168.
  • 38. Veronesi U, Paganelli G, Galimberti V. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinicaliy negative lymph-nodes. Lancet 1997; 349: 1864-1867.
  • 39. Wada N, Imoto S, Hasebe T, Ochiai A. Ebihara S, Moriyama N. Evaluation Of Intraoperative Frozen Section Diagnosis Of Sentinel Lymph Nodes In Breast Cancer, Jpn J Clin Oncol, 2004; 34: 113-117.
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Emin Köse

Ergün Erdem Bu kişi benim

Yayımlanma Tarihi 16 Nisan 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 2 Sayı: 1

Kaynak Göster

Vancouver Köse E, Erdem E. Sentinel lymph node biopsy in breast cancer: Analysis of 30 cases. Arch Clin Exp Med. 2017;2(1):9-14.