Meme Kanserinin Erken Tanısında Klinik Bulgular mı? Mamografi mi?

Yıl 2019, Cilt: 5 Sayı: 3, 510 - 515, 01.01.2019

Mustafa Karaca İrem Bilgetekin Esin Avşar Banu Öztürk

Öz

Amaç: Mamografi ile tanı konulan veya semptomatik olarak doktora başvuran opere olmuş meme kanserli hastaların klinikopatolojik özeliklerinin karşılaştırılması ve hastalıksız sağkalım sürelerinin değerlendirilmesi planlandı. Gereç ve Yöntemler: 17.05.2000-19.06.2016 tarihleri arasında meme kanseri tanısı konulan, çok merkezli, 1004 opere meme kanseri hastasının verileri, dosya ve elektronik kayıt sistemlerinden retrospektif olarak analiz edildi. Verileri sağkalım analizi için uygun takip ve tedavi bilgilerine sahip 828 hasta çalışmaya dahil edildi. Hastaların tanısının mamografik tarama ya da semptomatik başvurmaya göre konulması, yaş, tanı anındaki kilosu, menapoz durumu, operasyon şekli, hormon reseptör durumu, HER2 reseptör durumu, patolojik evresi, grade, histolojik alt grup, lenfovasküler invaziyon, perinöral invaziyon durumu, adjuvan kemoterapi durumu, adjuvan herceptin alması durumu, adjuvan hormonal tedavi durumu, adjuvan radyoterapi durumu belirlendi. Hastaların nüks tarihi, yeri ve nüks olmayanların son vizit tarihleri belirlendi. Mamografi ile tanı konulan ve semptomatik olarak başvuran hastaların histopatolojik özellikleri karşılaştırıldı.Bulgular: Mamografik tarama ile 324 %39 hastaya meme kanseri tanısı konulmuştur. Mamografi ile tanı konulan ve semptomatik başvuran hastaların histopatolojik özellikleri karşılaştırıldığında; mamografi grubunda postmenopozal hasta yüzdesi %60,4 vs. %52; p=0,011 , grade 3 hasta sayısı %24,2 vs. %32,9; p=0,005 , pT1 oranı %48,5 vs. %26; p=0,0001 , aksiller lenf nodu pozitifliği %30 vs %53,7; p=0,0001 , LVİ lenfovasküler invazyon %13,7 vs %31,6; p=0,0001 , PNİ perinöral invazyon %7,2 vs. %18,1; p=0,0001 olarak saptandı. Ayrıca mamografi grubu ve diğer grup karşılaştırıldığında, adjuvan KT %67 vs. %85; p=0,0001 , hormonal tedavi %87,3 vs. %82; p=0,001 olarak saptandı. İki grup arasında nüks oranları yönünden fark saptanmadı %12 vs %12,6; p=0,4 . Medyan takip süresi 48 ay , medyan DFS hastalıksız sağkalım 37 ay olarak saptandı. DFS için yapılan ünivariate analizde prognostik parametreler de değerlendirildi. Patolojik evre p=0,002 , grade p=0,002 , PNİ p=0,027 , LVİ p=0,0001 , hormon reseptör durumu p=0,001 , triple negatif p=0,016 , luminal A hasta grubu p=0,048 ’nun DFS üzerine istatistiksel olarak anlamlı etkisi saptandı. Mamografik tarama ile tanı ve diğer parametrelerin DFS üzerine anlamlı etkisi saptanmadı p>0,05 Sonuç: Mamografik tarama grubundaki hastalar, daha erken evre, aksilla negatif oranı yüksek, postmenopozal durumda, düşük grade, daha az LVİ, PNİ oranına sahip, ayrıca yüksek oranda hormon reseptörü pozitifliğine sahip olarak saptandı. Ayrıca mamografi ile tanı konulan hastalar daha az kemoterapi ve daha çok hormonal tedavi almış olduğu görüldü. Mamografik tarama grubu, semptomla başvuran hasta grubuna göre iyi prognostik parametrelere sahip olmasına rağmen nüks oranları semptomatik grup ile benzerdi. Sağkalım analizinde bu grup hastaların nüks oranı semptomatik başvuran hastalarla benzer bulunmuştur

Anahtar Kelimeler

Meme kanseri, Erken tanı, Mamografi, Klinik bulgular

Clinical Findings or Mammography in Early Diagnosis of Breast Cancer?

Öz

Objective: Our goal was to compare clinicopathological characteristics and disease free survival time among breast cancer patients diagnosed using mammographic scanning or after symptomatic medical advice seeking.Material and Methods: This was a retrospective analysis of 1004 cancer patients’ charts at a hospital in Turkey between 17.05.2000 and 19.12.2016. A total of 828 participants were considered eligible for the study. Diagnosis was made using either mammographic scanning or by symptomatic diagnosis considering the following parameters: age, weight at the time of diagnosis, menopause status, operation type, hormone and HER2 receptor status, pathological grade, histological subtype, lymphovascular and perineuronal invasion status, adjuvant chemotherapy use, adjuvant herceptin use, adjuvant hormonal therapy and adjuvant radiotherapy status.Results: Breast cancer was detected by mammographic scanning in 324 39% and by symptomatic diagnosis in 504. Among all the patients, 60.4 % of the women in the mammography group were in their postmenopausal period, while this rate was 52% for the symptomatic group, and the difference was statistically significant p=0.011 . The difference in most cases between the two methods employed was significant and found as below respectively: Grade 3 patient percentage 24.2% vs. 32.9% p=0.005 , pT1 percentage 48.5% vs. 26% p=0.0001 , positive axillary lymph node dissection 30% vs. 53.7% p=0.0001 , lymphovascular invasion 13.7% vs. 31.6% p=0.0001 , perineuronal invasion 7.2% vs. 18.1% p=0.0001 , adjuvant chemotherapy use 67% vs. 85% p=0.0001 and hormonal treatment use 87.3% vs. 82% p=0.001 . Nevertheless, recurrence rates did not differ significantly among the two groups 12% vs. 12.6% p=0.4 . The median follow-up time was 48 months and the median DFS time was 37 months . Prognostic parameters were also analyzed with univariate analysis, which was used to determine DFS. Pathologic staging p=0.002 , perineuronal invasion p=0.027 , lymphovascular invasion p=0.0001 , hormone receptor status p=0.0001 , triple negative disease p=0.016 , and luminal A patient group p=0.048 parameters were found to have a statistically significant effect on DFS. Diagnosis with mammographic scanning was found to have no statistically significant effect on DFS p>0.05 Conclusion: Patients diagnosed with mammographic scanning were found to have lower stages, higher axillary negativity rate, postmenopausal status, lower grades, less lymphovascular and perineuronal invasion and higher hormone receptor positivity, with lower chemotherapy and higher hormonal treatment use. Although patients diagnosed with mammographic scanning had better prognostic parameters, recurrence rates were similar to those symptomatic patients at the time of diagnosis. At survival analysis, recurrence rates were similar to those in the symptomatic patient group

Anahtar Kelimeler

Breast cancer, Early diagnosis, Mamography, Clinical findings

Kaynakça

• Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010; 28(10):1684-91.
• Schonberg MA, Ramanan RA, McCarthy EP, Marcantonio ER. Decision making and counseling around mammography screening for women aged 80 or older. J Gen Intern Med 2006; 21(9):979-85.
• Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol 2008; 26(15):2482-8.
• Solin LJ, Gray R, Baehner FL. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013; 105(10):701- 10.
• Houssami N, Ciatto S, Martinelli F, Bonardi R, Duffy SW. Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol 2009; 20:1505-10.
• Houssami N, Ciatto S. Mammographic surveillance in women with a personal history of breast cancer: How accurate? How effective? Breast 2010; 19:439-45.
• Kim MJ, Kim EK, Kwak JY, Park BW, Kim SI, Sohn J. Role of sonography in the detection of contralateral metachronous breast cancer in an Asian population. AJR Am J Roentgenol 2008; 190:476-80.
• Grunfeld E, Noorani H, McGahan L, Paszat L, Coyle D, van Walraven C. Surveillance mammography after treatment of primary breast cancer: A systematic review. Breast 2002; 11:228-35.
• Karam AK. Breast cancer posttreatment surveillance: Diagnosis and management of recurrent disease. Clin Obstet Gynecol 2011; 54:157-63.
• Rissanen TJ, Mäkäräinen HP, Mattila SI, Lindholm EL, Heikkinen MI, Kiviniemi HO. Breast cancer recurrence after mastectomy: Diagnosis with mammography and US. Radiology 1993; 188:463-7.
• Voogd AC, van Tienhoven G, Peterse HL, Crommelin MA, Rutgers EJ, van de Velde CJ. Local recurrence after breast conservation therapy for early stage breast carcinoma: Detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer 1999; 85:437-46.
• Kemperman H, Borger J, Hart A, Peterse H, Bartelink H, van Dongen J. Prognostic factors for survival after breast conserving therapy for stage I and II breast cancer. The role of local recurrence. Eur J Cancer 1995; 31:690-8.
• Paszat L, Sutradhar R, Grunfeld E, Gainford C, Benk V, Bondy S, et al. Outcomes of surveillance mammography after treatment of primary breast cancer: A population- based case series. Breast Cancer Res Treat 2009; 114:169- 78.
• Lu WL, Jansen L, Post WJ, Bonnema J, Van de Velde JC, De Bock GH. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: A meta-analysis. Breast Cancer Res Treat 2009; 114:403-12.
• Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307:1394-404.
• Tabar L, Vitak B, Chen TH, et al. Swedish twocountry trial: Impact of mamographic screening on Breast cancer mortality during 3 decades. Radiology 2011; 260(3):658- 63.
• Alexander FE, Anderson TJ, Brown HK. 14 years of follow-up from the Edinburg randomised trial of breast- cancer screening. Lancet 1999; 353(9168):1903-8.
• Elwood JM, Cox B, Richardson AK. The effectiveness of breast cancer screening by mammography in younger women. Online Journal of Current Clinical Trials 1993; Doc No 32:[23,227 words; 195 paragraphs].
• Crispo A, Barba M, D’Aiuto G, De Laurentiis M, Grimaldi M, Rinaldo M, CaoloG, D’Aiuto M, Capasso I. Molecular profiles of screen detected vs. symptomatic breast cancer and their impact on survival: Results from a clinical series BMC Cancer 2013; 13:15.
• Shen Y, Yang Y, Inoue LY, Munsell MF, Miller AB, Berry DA. Role of detection method in predicting breast cancer survival: Analysis of randomized screening trials. J Natl Cancer Inst 2005; 97:1195-203.
• Fancher CE, Scott A, Allen A, Dale P. Mammographic screening at age 40 or 45? What difference does it make? The potential impact of american cancer society mammography screening guidelines. AmSurg 2017; 83(8):847-9.
• Sihto H, Lundin J, Lehtimaki T, Sarlomo-Rikala M, Butzow R, Holli K, Sailas L, Kataja V, Lundin M, Turpeenniemi-Hujanen T, Isola J, Heikkila P, Joensuu H. Molecular subtypes of breast cancers detected in mammography screening and outside of screening. Clin Cancer Res 2008; 14:4103-10.
• Youk JH, Son EJ, Chung J, Kim JA, Kim EK. Triple- negative invasive breast cancer on dynamic contrast- enhanced and diffusion-weighted MR imaging: Comparison with other breast cancer subtypes. Eur Radiol 2012; 22(8):1724-34.