Meme Kanserinde Aksilla Negatif Olguları Doğru Belirlemek İçin En Az 10 Lenf Nodu Çıkarılması Yeterli midir?

Year 2006, Volume: 39 Issue: 2, 80 - 84, 01.08.2006

Kaptan Gülben Mustafa Yiğit Uğur Berberoğlu

Abstract

Background: The aim of this study is to determine the minimum number of lymph nodes that confidently represents the complete axilla in an axillary dissection. Methods: The medical records of 411 patients vvith early breast cancer treated betvveen October 1999 andAugust 2002 were evaluated retrospectively. Total number of axillary lymph nodes removed, number of metastatic nodes, tumoursize, grade, and presence of lymphovascular invasion were revievved. Results: Axillary node metastases were detected in 60% of patients. The mean number of nodes collected was 20.2±0.4, vvith a mean of 3.6 ± 0.3 metastatic nodes. There was a significant difference in terms of the rate of metastatic nodes betvveen the patients vvith 6-15 nodes removed and those vvith 16 or more removed, 45% and 78%, respectively. The highest rate of metastatic nodes was determined in patients vvith 16-20 nodes removed (68%). The rate of axillary metastasis was not higher in group vvith more than 20 nodes removed. Conclusions: Although it is generaiiy considered that minimum 10 lymph nodes should be removed in an axillary dissectin to confidently determine the patients vvith breast cancer who had negative axiiiary node status, according to the results of this study, hovvever, it might be stated that the number of lymph nodes collected should be minimum 16.

Keywords

Breast cancer, lymph nodes, axillary dissection, metastasis.

Is Minimum 10 Nodes Removed to Correctly Determine The Breast Cancer Patients Who Had Negative Axillary Status Sufficient?

Abstract

Arka Plan: Bu çalışmanın amacı, aksiller disseksiyonda tüm aksillayı güvenli bir şekilde temsil edecek minimum lenf nodu sayısını beiiriemektir. Yöntem: Ekim 1999-Ağustos 2002 tarihleri arasında tedavi edilen 411 erken evre meme kanserli hastanın kayıtları retrospektif olarak değerlendirildi. Çıkarılan toplam aksiller lenf nodu sayısı, metastatik lenf nodu sayısı, tümör boyutu, grad ve lenfovasküler invazyon varlığı incelendi. Bulgular: Hastaların %60'ında aksiller lenf nodu metastazı saptandı. Çıkarılan ortalama lenf nodu sayısı 20.2 ± 0.4, metastatik lenf nodu sayısı ise 3.6 ± 0.3 olarak bulundu. Aksillasından toplam 6-15 lenf nodu ile 16 ve üzeri lenf nodu disseke edilen hastalar arasında metastatik lenf nodu oranı bakımından anlamlı fark olduğu tespit edildi (sırasıyla %45 ve %78). En yüksek aksiller metastaz oranı, 16-20 lenf nodu çıkarılan hastalarda saptandı (%68). Yirmi'den fazla lenf nodu çıkarılan grupta aksiller metastaz oranı daha yüksek değildi. Sonuçlar: Genel olarak aksi İlası negatif meme kanserli hastaları güvenle belirlemek için, aksiller disseksiyonla minimum 10 lenf nodu çıkarılması gerektiği kabul edilmekle beraber, bu çalışmanın sonuçlarına göre bu sayının en az 16 olması gerektiği ileri sürülebilir.

Keywords

Meme kanseri, lenf nodu, aksiller disseksiyon, metastaz.

References

• Clinical practice guidelines for the çare and treatment of breast cancer: A Canadian consensus document. Can Med Assoc J 1998;158:22-26.
• Golshirsh A, Wood WC, Senn H-J, et al. Meeting highlights International consensus panel on the treatment of primary breast cancer. J Natl Cancer Inst 1995;87:1441-5. 3.
• Henson De, Ries L, Freedman LS, et al. Relationship
• among outcome, stage of disease and histologic grade for
• 616 cases of breast cancer: The basis for a prognostic
• index. Cancer 1991;68:2142-9.
• Fisher ER, Anderson S, Redmond C, et al. Pthologic find- ings from the National Surgical Adjuvant Breast Project Protocol B-06: 10 year pathologic and clinical prognostic discriminants. Cancer 1993;71:2507-14.
• Veronesi U, Galimberti V, Zurrida S, et al. Prognostic signif- icance of number and level of axillary nodal metastases in breast cancer. Breast 1993;2:224-8.
• Maunsell E, Brisson J, Deshenes I. Arm problems and psy- chological distress after surgery for breast cancer. Can J Surg 1993;36:315-20.
• Singletary SE. Management of the axilla in early stage breast cancer. İn: Perry MC (ed.) American Society of Clinical Oncology educational book. Alexandria, VA: American Society of Clinical Oncology, 1998:132-41.
• Carter CL, Ailen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24.740 breast cancer cases. Cancer 1989;63:181-7.
• Fitzgibbons PL, Page DL, VVeaver D, et al. Prognostic fac
• tors in breast cancer. College of American Pathologists con­ sensus statement 1999. Arch Pathol Lab Med 2000;124:966-78.
• Olivotto I, ColdmanA, Hislop G, et al. Compliance with prac­ tice guidelines for node-negative breast cancer. J Clin Oncol 1997;15:216-22.
• Sawka C, Olivotto I, Coldman A, et al. The association between population-based treatment guidelines and adju­ vant therapy for node-negative breast cancer. Br J Cancer 997:75:1534-42.
• Steele R, ForrestA, Gibson T, et al. The efficacy iovver axil- lary sampling in obtaining lymph node status in breast can­ cer: A controlled randomized trial. Br J Surg 1985;72:368- 69.
• ForrestA, Everington D, Mc Donald C, et al. The Edinburgh randomized trial ofaxillary sampling or clearance after mas- tectomy. B rJ Surg 1995;82:1504-8.
• Baslaim MM, Al Malik OA, Al-Sobhi SS, et al. Decreased axillary lymph node retrieval in patients after neoadjuvant chemotherapy. Am J Surg 2002;184:299-301.
• Weir L, Speers C, D’yachkova Y, et al. Prognostic signifi- cance of the number of axillary lymph nodes removed in patients with node-negative breast cancer. J Clin Oncol 2002;20:1793-9.
• Van der Wal BC, Butzelaar RM, van der Meij S, et al. Axillary lymph node ratio and total number o f redmoved lymph nodes: Predictors of survival in stage I and II breast cancer. Eur J Surg Oncol 2002;28:481-9.
• Sosa JA, Diener-West M, usev Y, et al. Association betvveen tent of axillary node clearance and survival in patients with stage I breast cancer. Ann Surg Oncol 1998;5:140-9.
• Somner A, Dixon J, Thomas J. Node retrieval in axillary node dissections: Recommendations for minimum numbers to be confident about node negative status. J Clin Pathol 2004;57:845-8.
• Kutiyanawala MA, Sayed M, Stotter A, et al. Staging the axilla in breast cancer: An audit of lymph-node retrieval in one U.K. regional centre. Eur J Surg Oncol 1998;24:280-2.
• VoogdAC, Coebergh JW, Repelaer van Driel OJ, et al. The risk of nodal metastases in breast cancer patients with clin- ically negative lymph nodes: A population-based analysis. Breast Cancer Res Treat 2000;62:63-9.