Is Sentinel Lymph Node Biopsy Necessary In Ductal Carcinoma In Situ?

Yıl 2017, Cilt: 31 Sayı: 3, 147 - 151, 17.12.2017

Süleyman Özkan Aksoy Ali İbrahim Sevinç Merih Güray Pınar Balcı

Öz

Objective: Ductal carcinoma in situ (DCIS) is
a proliferation of mammary ductal epithelial cells that does not cross the
basal membrane and has no evidence of invasion. One of the recent arguments is
that a sentinel lymph node biopsy (SLNB) is required for high risk of invasive
disease in DCIS cases.

Material and method: We retrospectively reviewed SLNB results in a total
of 144 DCIS patients, 112 with microinvasive foci and 32 with mastectomy
indication between 1996 and 2016 in our clinic.

Results: The mean age of the patients was
53 (36-77) years. A total of 103 (71%) of the cases were treated with
wire-guided biopsy, 34 (24%) with wide local excision, and 7 (5%) with
subareolar exploration for histopathological diagnosis. Histopathological
examination showed no invasion of any sentinel lymph node specimen.
Radiotherapy and hormonotherapy were applied to patients with microinvasion and
only hormonotherapy was applied to the patients treated with mastectomy as
adjuvant therapy. There was no recurrence of axillary lesions in the average
follow-up of 48 months.

Conclusion: As axillary metastases were found
to be quite low (<1%) in DCIS, axillary lymph node sampling should not be
routinely performed in these patients. Axillary sampling may be done with SLNB
in DCIS patients with microinvasive foci or having mastectomy indication,
avoiding possible morbidity of axillary dissection.

Anahtar Kelimeler

Ductal Carsinoma in Situ, Sentinel Lymph Node Biopsy, Breast Cancer

Duktal karsinoma in situ da sentinel lenf nodu biyopsisi gerekli midir?

Öz

Amaç: Duktal karsinoma in situ (DKİS)
memede duktal epitelyum hücrelerinin bazal membranı aşmayan ve invazyon kanıtı olmayan
proliferasyonudur. Son tartışmalardan birisi de DKİS vakalarında yüksek invaziv
hastalık riski ile birlikte, sentinel lenf nodu biyopsisi (SLNB) gerekli olup
olmadığıdır.

Gereç ve yöntem: Kliniğimizde 1996-2016 yılları
arasında 112 mikroinvaziv odaklı ve 32 mastektomi endikasyonu olan toplam 144
DKİS hastasına uygulanan SLNB sonuçları geriye dönük olarak incelendi ve
literatür eşliğinde değerlendirildi.

Bulgular: Hastaların yaş ortalaması 53
(36-77) idi. Histopatolojik tanı olguların 103’ünde (%71) iğne işaretli meme
biyopsisi, 34’ünde (%24) eksizyonel biyopsi, 7’sinde ise (% 5) subareolar
eksplorasyon ile konuldu. Histopatolojik incelemede hiçbir sentinal lenf nodu
örneklemesinde invazyon görülmedi. Mikroinvazyonu olan olgulara radyoterapi ve
hormonoterapi, mastektomi yapılan olgulara ise sadece hormonoterapi adjuvan
tedavi olarak uygulandı. Ortalama 48 aylık takiplerinde olgularda aksiller
rekürrens saptanmadı.

Sonuç: DKİS saptanan hastalarda aksiller
metastaz oldukça düşük oranda (<%1) saptandığı için aksiller lenf nodu
örneklemesi bu hastaların hepsinde rutin olarak yapılmamalıdır. Mikroinvaziv
odağa sahip veya mastektomi yapılma endikasyonu bulunan hastalarda örnekleme
SLNB şeklinde yapılarak aksiller diseksiyonun olası morbiditelerinden kaçınılabilinir.

Anahtar Kelimeler

Duktal Karsinoma in Situ, Sentinel Lenf Nodu Biyopsisi, Meme Kanseri

Kaynakça

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