POZİTİF SENTİNEL LENF DÜĞÜMÜ OLAN MEME KANSERLİ HASTALARDA TAMAMLAYICI AKSİLLER DİSEKSIYON GEREKLİLİĞİNİN NOMOGRAM YÖNTEMLERİNİN DEĞERLENDİRİLMESİYLE BELİRLENMESİ

Öz

AMAÇ: Amacımız meme kanseri nedeniyle ameliyat edilen hastalarda farklı nomogram yaklaşımları olan Memorial Sloan Kettering Kanser Merkezi (MSKCC), Stanford Üniversitesi, Tenon Hastanesi, Cambridge Üniversitesi ve TR yöntemlerininin etkinliklerini değerlendirmekti. YÖNTEM: Araştırmaya Ankara Numune Eğitim ve Araştırma Hastanesi A2 Genel Cerrahi Kliniği'nde 2007-2012 yılları arasında meme kanseri nedeniyle ameliyat olan 60 meme kanserli hasta dahil edildi. Tüm hastalar sentinel lenf nodu (SLN) pozitifti ve aksiller lenf nodu diseksiyonu (ALND) geçirmişti. Bu 60 hastaya retrospektif olarak beş farklı skorlama sistemi uygulandı. Nomogramlar için receiver operating characteristics (ROC) eğrileri oluşturulmuş ve eğri altında kalan alan (AUC), duyarlılık ve özgüllük sonuçları hesaplanmıştır. BULGULAR: Yirmi iki hastada (%37) aksiller SLN dışı metastaz vardı. MSKCC, Stanford, Cambridge, Tenon ve TR nomogramlarının AUC değerleri sırasıyla 0.646, 0.644, 0.62, 0.595 ve 0.660 olarak hesaplandı. SLN metastazı boyutu açısından SLN metastazı olan ve olmayan gruplar arasında anlamlı fark bulundu (p = 0.013). SONUÇ: MSKCC, Stanford, Cambridge, Tenon ve TR nomogram modellerinin, SLN pozitif meme kanserli hastalarda SLN dışı metastazları olan ve olmayan hastaları ayırt etmek için yetersiz güce sahip olduğu bulundu (AUC değerleri <0,70). Ancak TR nomogramının en yüksek özgüllüğe sahip olduğu saptandı.

Anahtar Kelimeler

• Meme kanseri
• Sentinel lenf nodu
• Sentinel olmayan lenf nodu
• Nomogram

DETERMINING THE NECESSITY OF COMPLEMENTARY AXILLARY DISSECTION IN BREAST CANCER PATIENTS WITH POSITIVE SENTINEL LYMPH NODE BY WAY OF ASSESSING NOMOGRAM METHODS

Öz

AIM: Our aim was to evaluate the efficacies of different nomogram approaches, including the Memorial Sloan Kettering Cancer Centre (MSKCC), Stanford University, Tenon Hospital, Cambridge University and TR methods, in patients operated for breast cancer. MATERIAL AND METHOD: The study included 60 breast cancer patients who were operated on for breast cancer at Ankara Numune Training and Research Hospital, A2 General Surgery Clinic, between 2007 and 2012. All patients were sentinel lymph node (SLN)-positive and had undergone axillary lymph node dissection (ALND). Five different scoring systems were applied retrospectively to these 60 patients. Receiver operating characteristics (ROC) curves were created for the nomograms and the area under the curve (AUC) sensitivity and specificity results were calculated. RESULTS: Twenty-two patients (37%) had axillary non-SLN metastases. AUC values of MSKCC, Stanford, Cambridge, Tenon and TR nomogram were calculated as 0.646, 0.644, 0.62, 0.595, and 0.66, respectively. A significant difference was found between the groups with and without non-SLN metastasis in terms of SLN metastasis size (p = 0.013). CONCLUSION: The MSKCC, Stanford, Cambridge, Tenon, and TR nomogram models were found to have insufficient power to discriminate between patients with and without non-SLN metastases in patients with SLN-positive breast cancer (AUC values <0.70).

Anahtar Kelimeler

• Breast cancer
• Sentinel lymph node
• Non-sentinel lymph node
• Nomogram

Kaynakça

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