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İNTRAOPERATİF KONSÜLTASYONUN MEME CERRAHİSİ VE SENTİNEL LENF NODU BİYOPSİSİNDEKİ ÖNEMİ

Yıl 2017, Cilt: 1 Sayı: 3, 99 - 106, 18.12.2017

Öz

Amaç: ROLL mastektomi materyallerinde cerrahi sınır
değerlendirmesi ve sentinel lenf nodu biyopsisinin (SLNB) intraoperatif
konsültasyon ve frozen kesit ile değerlendirilmesinin güvenilirliği ve
kullanılabilirliğinin tespit edilmesi.
 

Yöntemler: 1 Temmuz 2015 – 1 Ağustos 2017 tarihleri
arasında laboratuarımızda raporlanan mastektomi materyalleri dökümante edilmiş,
frozen çalışılan olgular belirlenmiştir. Frozen raporları ile kalıcı kesit
raporları karşılaştırılarak SLNB durumu ve ROLL mastektomi materyallerinde
cerrahi sınır durumu arasındaki uyum ve tedaviye katkısı değerlendirilmiştir.
 

Bulgular: Belirlenen tarihler arasındaki 1278 mastektomi
olgusunun 657 tanesi ROLL mastektomidir. Bunların 30 tanesinde intraoperatif
cerrahi sınır değerlendirilmesi yapılmış; 1 tanesinde cerrahi sınırın pozitif
olduğu, 6 tanesinde tümörün cerrahi sınıra 1 mm’den daha yakın görülmüş
olduğundan re-eksizyon yapılmıştır. Sentinel lenf nodu ise 233 olguda frozen
kesitler ile değerlendirilmiş, %28’inde (n=72) metastaz görülmüş ve bu
olguların tamamına aksiller diseksiyon yapılmıştır.
 







Sonuç: Meme kanserli kadınlarda meme koruyucu cerrahi
(MKC) operasyonlarında frozen değerlendirme, daha iyi cerrahi sınır negatifliği
sağlar ve re-eksizyon operasyonlarını azaltır. Aynı şekilde SLNB’nin frozen
değerlendirmesi, olası aksiller diseksiyon operasyonu sıklığını azaltır. Bu
nedenle her iki yöntem de güvenilir ve önerilebilirdir.
 

Kaynakça

  • Sunil R. Lakhani, Ian O. Ellis, Stuart J. Schnitt et al. WHO Classification of Tumours of The Breast. 4th edition. Lyon, International Agency for Research on Cancer, 2012: 14.
  • SeungSang Ko, Yi Kyeong Chun, Sung Soo Kang et al. The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery. J Breast Cancer 2017 June; 20(2): 176-182
  • Young Sun, Sung-Won Kim, Chan Yeong Heo et al. Comparison of Quality of Life Based on Surgical Technique in Patients with Breast Cancer. Jpn J Clin Oncol 2014;44(1)22–27
  • Cabioglu N, Hunt KK, Sahin AA et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 2007;14:1458-71.
  • Camp ER, McAuliffe PF, Gilroy JS et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg 2005;201:855-61.
  • Cao D, Lin C, Woo SH et al. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol 2005;29:1625-32.
  • Jorns JM, Visscher D, Sabel M et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol 2012;138:657-69.
  • Osako T, Nishimura R, Nishiyama Y et al. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast cancer. Int J Clin Oncol 2015;20:1093-101.
  • Ayşegül Öz, Figen Başaran Demirkazık, Meltem Gülsün Akpınar et al. Efficiency of Ultrasound and Ultrasound-Guided Fine Needle Aspiration Cytology in Preoperative Assessment of Axillary Lymph Node Metastases in Breast Cancer. J Breast Cancer 2012 June; 15(2): 211-217
  • Riccardo A Audisio, Rana Nadeem, Olga Harris et al. Radioguided occult lesion localisation (ROLL) is available in the UK for impalpable breast lesions. Ann R Coll Surg Engl 2005; 87: 92–95
  • Julie M. Jorns, Daniel Visscher, Michael Sabel et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one year experience at an ambulatory surgical center. Am J Clin Pathol. 2012 November ;138(5): 657–669
  • Soo Kyung Ahn, Min Kyoon Kim, Jongjin Kim et al. Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery. Cancer Res Treat. 2017;49(4):1088-1096
  • Alessandro Fancellu, Pierina Cottu, Claudio F Feo et al. Sentinel node biopsy in early breast cancer: lessons learned from more than 1000 cases at a single institution. Tumori, 98: 413-420, 2012
  • S. P. Somashekhar, Zahoor Ahmed Naikoo, Shabber S. Zaveri. Intraoperative Frozen Section Evaluation of Sentinel Lymph Nodes in Breast Carcinoma: Single-Institution Indian Experience. Indian J Surg 2015 77(Suppl 2):S335–S340
  • F. Corsi, L. Sorrentino, D. Bossi et al. Preoperative Localization and Surgical Margins in Conservative Breast Surgery. International Journal of Surgical Oncology Volume 2013, Article ID 793819

IMPORTANCE OF INTRAOPERATIVE CONSULTATION IN BREAST SURGERY AND SENTINEL LYMPH NODE BIOPSY

Yıl 2017, Cilt: 1 Sayı: 3, 99 - 106, 18.12.2017

Öz

Objective: Evaluation of the surgical margins in ROLL mastectomy
materials, and assessment of the safety and the usability of the
intra-operative consultation and frozen section for the evaluation of the sentinel
lymph node biopsy (SLNB).  

 

Methods: Mastectomy materials reported in our
laboratories between July 1, 2015 and August 1, 2017 have been documented, and
the cases with frozen sections have been detected. Frozen section reports, and
permanent section reports were compared to evaluate the conformity between the SLNB
situation and the ROLL mastectomy surgical margins’ situation, and their
contribution to the treatment.  

 

Results: Out of the 1278 mastectomy cases in the
described time interval, there were 657 ROLL mastectomies. In 30 of them intraoperative
surgical margin assessment has been done. Because in one of them the surgical
margin was positive, and 6 of them had tumor closer than 1 mm to surgical
margins, re-excision had to be done. Sentinel lymph nodes were evaluated with
frozen section in 233 of the cases, metastasis was seen in 28% (n=72) of them
and axillary dissection was done to all of them. 

 













Conclusion: In women undergoing breast
conserving surgery for the treatment of the breast cancer, frozen section
evaluation provides better surgical margin negativity and reduces the need for
the re-excision operations. Similarly, frozen section evaluation of the SLNB
decreases the frequency of the axillary dissection reoperations. 

Kaynakça

  • Sunil R. Lakhani, Ian O. Ellis, Stuart J. Schnitt et al. WHO Classification of Tumours of The Breast. 4th edition. Lyon, International Agency for Research on Cancer, 2012: 14.
  • SeungSang Ko, Yi Kyeong Chun, Sung Soo Kang et al. The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery. J Breast Cancer 2017 June; 20(2): 176-182
  • Young Sun, Sung-Won Kim, Chan Yeong Heo et al. Comparison of Quality of Life Based on Surgical Technique in Patients with Breast Cancer. Jpn J Clin Oncol 2014;44(1)22–27
  • Cabioglu N, Hunt KK, Sahin AA et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 2007;14:1458-71.
  • Camp ER, McAuliffe PF, Gilroy JS et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg 2005;201:855-61.
  • Cao D, Lin C, Woo SH et al. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol 2005;29:1625-32.
  • Jorns JM, Visscher D, Sabel M et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol 2012;138:657-69.
  • Osako T, Nishimura R, Nishiyama Y et al. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast cancer. Int J Clin Oncol 2015;20:1093-101.
  • Ayşegül Öz, Figen Başaran Demirkazık, Meltem Gülsün Akpınar et al. Efficiency of Ultrasound and Ultrasound-Guided Fine Needle Aspiration Cytology in Preoperative Assessment of Axillary Lymph Node Metastases in Breast Cancer. J Breast Cancer 2012 June; 15(2): 211-217
  • Riccardo A Audisio, Rana Nadeem, Olga Harris et al. Radioguided occult lesion localisation (ROLL) is available in the UK for impalpable breast lesions. Ann R Coll Surg Engl 2005; 87: 92–95
  • Julie M. Jorns, Daniel Visscher, Michael Sabel et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one year experience at an ambulatory surgical center. Am J Clin Pathol. 2012 November ;138(5): 657–669
  • Soo Kyung Ahn, Min Kyoon Kim, Jongjin Kim et al. Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery. Cancer Res Treat. 2017;49(4):1088-1096
  • Alessandro Fancellu, Pierina Cottu, Claudio F Feo et al. Sentinel node biopsy in early breast cancer: lessons learned from more than 1000 cases at a single institution. Tumori, 98: 413-420, 2012
  • S. P. Somashekhar, Zahoor Ahmed Naikoo, Shabber S. Zaveri. Intraoperative Frozen Section Evaluation of Sentinel Lymph Nodes in Breast Carcinoma: Single-Institution Indian Experience. Indian J Surg 2015 77(Suppl 2):S335–S340
  • F. Corsi, L. Sorrentino, D. Bossi et al. Preoperative Localization and Surgical Margins in Conservative Breast Surgery. International Journal of Surgical Oncology Volume 2013, Article ID 793819
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Konular Klinik Tıp Bilimleri
Bölüm MAKALELER
Yazarlar

Ferah Tuncel Daloğlu

Emre Çağatay Köse Bu kişi benim

Ahmet Dağ Bu kişi benim

Yayımlanma Tarihi 18 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 1 Sayı: 3

Kaynak Göster

APA Tuncel Daloğlu, F., Köse, E. Ç., & Dağ, A. (2017). İNTRAOPERATİF KONSÜLTASYONUN MEME CERRAHİSİ VE SENTİNEL LENF NODU BİYOPSİSİNDEKİ ÖNEMİ. Balıkesir Medical Journal, 1(3), 99-106.