ERKEN EVRE MEME KANSERİNDE SENTİNEL LENF NODU TESPİTİNDE SADECE MAVİ BOYA KULLANIMI İLE MAVİ BOYA VE RADYOKOLLOİD BİRLİKTE KULLANIMININ KARŞILAŞTIRILMASI

Abstract

Amaç: 1990’lı yılların ortalarında sentinel lenf nodu biyopsisi , meme kanserli hastalarda aksiller lenf nodu durumunun değerlendirilmesinde kullanılmaya başlanmış ve günümüzde klinik olarak aksillası negatif meme kanserli hastalarda aksiller evreleme için tercih edilen bir prosedür haline gelmiştir. Sentinel lenf nodu tespitinde sadece mavi boya yöntemi veya sadece radyokolloid madde yöntemi ve her ikisinin birlikte kullanıldığı kombine yöntem uygulanmaktadır. Gereç ve Yöntemler: 01/07/2013-01/07/2014 tarihleri arasında meme kanseri nedeniyle opere edilen hastaların dosyaları retrospektif olarak incelendi. Klinik olarak aksilla negatif erken evre meme kanseri nedeniyle sentinel lenf nodu biyopsisi yapılan hastalar çalışmaya dahil edildi. Klinik olarak aksillası pozitif olan, lokal ileri ve ileri evre meme kanseri olan, neoadjuvan tedavi alan hastalar çalışmaya dahil edilmedi. Klinik olarak aksilla negatif erken evre meme kanseri nedeniyle sentinel lenf nodu biyopisi yapılan toplam 68 hasta çalışmaya dahil edildi. Hastalar sentinel lenf nodu biyopsisi mavi boya yöntemi ile yapılanlar ve kombine yöntemle (mavi boya+ radyokolloid) yapılanlar olmak üzere iki gruba ayrıldı. Mavi boya grubunda 41 hasta, kombine grupta 27 hasta mevcuttu. Çıkartılan sentinel lenf nodları intraoperatif frozen inceleme ile değerlendirildi ve metastaz görülen hastalara aksiller lenf nodu diseksiyonu yapıldı. Bulgular: Metilen mavi grubundaki 41 hastanın 6 tanesinde sentinel lenf nodu bulunamamış ve sentinel lenf nodu %85 oranında tespit edilmiştir. On hastanın sentinel lenf nodunda metastaz görülmüş ve pozitiflik oranı %24 olarak bulunmuştur. Kombine gruptaki 27 hastanın tamamında sentinel nodu bulunmuş ve sentinel lenf nodu %100 oranında tespit edilmiştir. On hastada sentinel lenf nodunda metastaz görülmüş ve pozitiflik oranı %37 olarak bulunmuştur. Sonuç: Bu çalışmada klinik olarak aksilla negatif erken evre meme kanserinde perop sentinel lenf nodu tespitinde kombine yöntemin sadece mavi boya yönteminden anlamlı olarak üstün olduğu tespit edilmiştir.

Keywords

• Sentinel lenf nodu biyopsisi
• mavi boya
• radyokolloid
• meme kanseri

Comparison of the Use of Blue Dye Only and the Use of Blue Dye and Raiocolloid Together in Sentinel Lymph Node Detection in Early Stage Breast Cancer

Abstract

Objective: In the mid-1990s, sentinel lymph node biopsy began to be used in the evaluation of axillary lymph node status in breast cancer patients and has now become the procedure of choice for axillary staging in clinically axilla-negative breast cancer patients. In the detection of sentinel lymph node, only the blue dye method or only the radiocolloid material method and the combined method where both are used together are applied. Material and Methods: The files of patients who were operated on for breast cancer between 01/07/2013 and 01/07/2014 were examined retrospectively. Patients who underwent sentinal lymph node biopsy due to clinically axilla-negative early stage breast cancer were included in the study. Patients with clinically positive axilla, locally advanced and advanced stage breast cancer, and patients receiving neoadjuvant treatment were not included in the study. A total of 68 patients who underwent sentinel lymph node biopsy due to clinically axilla-negative early stage breast cancer were included in the study. The patients were divided into two groups: those whose sentinel lymph node biopsy was performed using the blue dye method and those whose combined method (blue dye + radiocolloid) was performed. There were 41 patients in the blue dye group and 27 patients in the combined group. The removed sentinel lymph node was evaluated by intraoperative frozen examination, and axillary lymph node dissection was performed in patients with metastases. Results: Sentinel lymph nodes were not found in 6 of 41 patients in the methylene blue group, and sentinal lymph nodes were detected at a rate of 85%. Metastasis was observed in the sentinel lymph nodes of ten patients and the positivity rate was found to be 24%. Sentinal nodes were found in all 27 patients in the combined group, and sentinel lymph nodes were detected in 100%. Sentinel lymph node metastasis was observed in ten patients and the positivity rate was found to be 37%. Conclusion: In this study, it was determined that the combined method was significantly superior to the blue dye method alone in preoperative sentinel lymph node detection in clinically axilla-negative early stage breast cancer.

Keywords

• Sentinal lymph node biopsy
• blue dye
• radiocolloid
• breast cancer

References

1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74-108.
2. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300.
3. Halsted WS. I. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894. Ann Surg. 1894;20(5):497-555.
4. Halsted WS. I. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907;46(1):1- 19.
5. Patey DH, Dyson WH. The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer. 1948;2(1):7-13.
6. Auchincloss H. Modified radical mastectomy: Why not?. Am J Surg. 1970;119(5):506-509.
7. Fisher B, Wolmark N, Fisher ER, Deutsch M. Lumpectomy and axillary dissection for breast cancer: Surgical, pathological, and radiation considerations. World J Surg. 1985;9(5):692-698.
8. Fisher B, Anderson S, Bryant J, et al. Twenty-year followup of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241.

9. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breastconserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-1232.
10. Ozmen V (Ed). Meme Hastalıkları Federasyonu, Meme Hastalıkları Kitabı, İstanbul, Güneş Tıp Kitabevi, 2012:3- 385.
11. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456-466.
12. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392-399.
13. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220(3):391-401.
14. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996;276(22):1818-1822.
15. Latosinsky S, Dabbs K, Moffat F. Evidence-Based Reviews in Surgery Group. Canadian Association of General Surgeons and American College of Surgeons evidence-based reviews in surgery. 27. Quality-of-life outcomes with sentinel node biopsy versus standard axillary treatment in patients with operable breast cancer. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC Trial. Can J Surg. 2008;51(6):483-485.
16. Uras C (Ed). Sentinel Lenf Nodu Biyopsisi. İstanbul. İstanbul Medikal Yayıncılık, 2007:45-67.
17. Sadeghi R, Alesheikh G, Zakavi SR, et al. Added value of blue dye injection in sentinel node biopsy of breast cancer patients: Do all patients need blue dye?. Int J Surg. 2014;12(4):325-328.
18. Díaz Brito JA, Navarrete SV, Muñoz JA, et al. Sentinel node biopsy in early breast cancer at the Hospital Comarcal La Linea (Spain). Ecancermedicalscience. 2013;7:353.
19. Koukouraki S, Sanidas E, Askoxilakis J, et al. Is there any benefit from sentinel lymph node biopsy using the combined radioisotope/dye technique in breast cancer patients with clinically negative axilla? Nucl Med Commun. 2009;30(1):48-53.
20. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-187.
21. Moreth M, Herröder N, Hödl P, et al. Clinical axillary staging in breast cancer patients using ultrasound imaging. Breast Care (Basel). 2024;19(3):149-154.
22. Pepels MJ, Vestjens JH, de Boer M, et al. Models predicting non-sentinel node involvement also predict for regional recurrence in breast cancer patients without axillary treatment. Eur J Surg Oncol. 2013;39(12):1351- 1357.
23. Pal A, Provenzano E, Duffy SW, Pinder SE, Purushotham AD. A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg. 2008;95(3):302-309.
24. Liu YS, Zhang LS, Ma F, Guo BL. The surgical management of axillary lymph node disease in breast cancer patients. Zhonghua Wai Ke Za Zhi. 2024;62(8):731-736.
25. Keshtgar MR, Baum M. Axillary dissection over the years: Where to from here?. World J Surg. 2001;25(6):761-766.
26. Khout H, Richardson C, Toghyan H, Fasih T. The role of combined assessment in preoperative axillary staging. Ochsner J. 2013;13(4):489-494.
27. Gilani SM, Fathallah L, Al-Khafaji BM. Preoperative fine needle aspiration of axillary lymph nodes in breast cancer: Clinical utility, diagnostic accuracy and potential pitfalls. Acta Cytol. 2014;58(3):248-254.
28. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461.
29. Sezer A, Alas RC, Cicin I, et al. Breast conserving surgery and sentinel lymph node biopsy in locally advanced breast cancer: Single Center Experience. Balkan Med J. 2011; 28: 138-142.
30. Lin KM, Patel TH, Ray A, et al. Intradermal radioisotope is superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes. J Am Coll Surg. 2004;199(4):561-566.
31. Caruso G, Cipolla C, Costa R, et al. Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients. Acta Radiol. 2014;55(1):39-44.
32. Yadav SK, Bharath S, Sharma D, et al. A systematic review and meta-analysis of diagnostic performance of fluorescein-guided sentinel lymph node biopsy in early breast cancer. Breast Cancer Res Treat. 2024;206(1):19- 30.
33. Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg. 2005;189(2):236-239.
34. King TA, Fey JV, Van Zee KJ, et al. A prospective analysis of the effect of blue-dye volume on sentinel lymph node mapping success and incidence of allergic reaction in patients with breast cancer. Ann Surg Oncol. 2004;11(5):535-541.
35. Perenyei M, Barber ZE, Gibson J, Hemington-Gorse S, Dobbs TD. Anaphylactic reaction rates to blue dyes used for sentinel lymph node mapping: Systematic review and meta-analysis. Ann Surg. 2021;273(6):1087-1093.
36. Schrenk P, Rehberger W, Shamiyeh A, Wayand W. Sentinel node biopsy for breast cancer: Does the number of sentinel nodes removed have an impact on the accuracy of finding a positive node? J Surg Oncol. 2002;80(3):130-136.
37. Goyal A, Newcombe RG, Mansel RE. Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) Trialists Group. Clinical relevance of multiple sentinel nodes in patients with breast cancer. Br J Surg. 2005;92(4):438-442.
38. Cserni G, Amendoeira I, Apostolikas N, et al. Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer. 2003;39(12):1654-1667.
39. Sauer T, Engh V, Holck AM, et al. Imprint cytology of sentinel lymph nodes in breast cancer. Experience with rapid, intraoperative diagnosis and primary screening by cytotechnologists. Acta Cytol. 2003;47(5):768-773.