Prognostic and Predictive Value of Palpable or Non-Palpable Breast Cancer

Öz

Backround: As in all cancers including breast type, early diagnosis has a significant role in determining the treatment modality and survival. For this reason, women at the risky group screened by mammography for assessing the prognosis, natural course and the predicting value of the cancer detected in the non palpable period. Furthermore determining the optimal treatment options and examining the effect of the possible results with the other outcomes.

Materials and Methods: A total of 365 cases were examined, 78 of which were non-palpable (NP) and 287 were palpable (P) cancers. The relationship between the characteristics of the primary tumor and axillary metastasis were investigated. The parameters were age, palpability of tumor on examination, tumor diameter (under 1.5 cm and over 1.5 cm), histologic type (ductal and lobular), lymphovascular invasion, multicentricity, histologic grade (1,2 and 3) and nuclear degrees (1,2 and 3). In addition to these parameters, P and PE cancers were compared in terms of the pathologic size, histologic type, lymphovascular invasion, histologic grade (HG), nuclear grade (NG), axillary lymph node involvement, estrogen and progesterone hormone receptor status, local recurrence and systemic metastasis furtherly.

Results: The rate of in situ cancers in NP cancers was higher than the palpable ones. Axillary metastasis were detected in 10 out of 67 patients who underwent axillary dissection with NP cancers, and 95 out of 283 patients with P cancers . 13 of the P cancers were found to have more than 10 lymph nodes positive. Not more than 10 positive lymph nodes were detected in NP cancers. Although lymphovascular invasion was detected only in 3 of 67 NP cancers, it was 42 out of 283 in the P ones. The axillary involvement rate in patients with tumor size smaller than 1.5 cm was  5.5% and 44.2% in tumors larger than 1.5 cm. Axillary metastasis rates were 2.8% for patients with 4 positive parameters (NP, size<1.5 cm, LV1 (-) and NG (1-2), whereas it varies between 4.6-5.8% in group that have any three parameters.

Conclusions: NP cancers have lower numbers of axillary involvement because of the smaller tumor size and rare lymphovascular invasion,besides have higher in situ cancer rates than the P cancers. Hereby these findings, palpability is a significant prognostic factor, NP cancers are expected to have a better prognosis. In order to exclude unnecessary axillary dissections, inable palpation, tumoral diameter smaller than1.5 cm, negative lymphovascular invasion and low nuclear grade may used as a criterion for identifying the patients at low risk for axillary involvement. Then again avoiding axillary dissection or performing sentinel ganglion biopsy may be considered among these patients.

Anahtar Kelimeler

• Breast cancer,Palpable,Non-Palpable,Prognostic and Predictive Value

Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri

Öz

Amaç: Tüm kanserlerde olduğu gibi, meme kanserinde de erken tanının tedavi modalitesinin belirlenmesinde ve sağ kalımda etkisi önemlidir. Bu sebeple, riskli gruba giren kadınlarda yapılan mamografi taramalarında, kanserin henüz palpe edilmediği döneminde ortaya çıkarılmasının prognoz, doğal gidişat ve prediktif değerlerinin, uygulanacak tedavinin belirlenmesi ve alınacak sonuçların tahmin edilmesine olan etkisi araştırılmıştır.

Gereç ve Yöntem: Toplam 365 vaka incelenmiş olup bunların 78'i palpe edilemeyen (PE) , 287'si palpabl (P) kanserlern oluşmaktaydı. Taranan vakalarda, primer tümörün incelenen özellikleri ile aksiller metastaz arasındaki ilişki araştırıldı. Bu parametreler, yaş, fizik muayenede tümörün palpe edilebilmesi veya ele gelmemesi, patolojik tümör çapı (1,5 cm altı ve 1,5 cm üstü) , histolojik tip(duktal ve lobuler), lenfovasküler invazyon, multisentrisite, histolojik derece (1,2 ve 3), nükleer derece (1,2 ve 3) olarak incelendi. Ayrıca P ve PE kanserlerde tümörün patolojik boyutu, histolojik tümör tipi, lenfovasküler invazyon, histolojik derece (HG), nükleer derece (NG), aksiller lenf nodu tutulumu, östrojen ve progesteron reseptör durumu, lokal nüks, sistemik metastaz açısından karşılaştırıldılar.

Bulgular: İn situ kanserlerin PE kanserlerdeki oranı (n: 11/78) palpabl kanserlerdeki oranına (4/287) göre daha yüksek bulunmuştur. PE tümörlerde aksiller diseksiyon yapılan 67 hastadan 10'unda (%14,9) aksiller metastaz saptanırken, P tümörlerde 283 hastadan 95 ’inde (%33,6) aksiller metastaz saptanmıştır (p:0,00275), bunların da 13'ünde (%4,6) 10'dan fazla lenf nodu pozitif olduğu tespit edilmiştir. PE tümörlerde ise 10'dan fazla pozitif lenf nodu saptanmamıştır. PE kanserlerin %4,4 (3/67) oranında lenfovasküler invazyon saptanırken P kanserlerin %14.99 (42/283) oranındadır. PE ve P kanserler arasında lokal nüks, sağkalım ve uzak metastaz açısından yeterli takip süreleri olmadığından anlamlı bir fark bulunamamıştır. Aksiller metastaz oranı lenfovasküler invazyon gösteren hastalarda 36/45 (%80) iken, göstermeyen hastalarda 69/305 (%22,6)'dır (p<0,00001). Tümör çapı 1,5 cm'den küçük hastalarda %5,5 (7/128) olan aksiller tutulum oranı 1,5 cm'den büyük tümörlerde %44,2 (98/222) olarak belirlenmiştir (p<0,00001). Nükleer derecesi 3 olan vakalarda aksiller tutulum oranı 65/111 (%58,6) olurken, NG 1 ve 2 olanlarda 40/239 (%16,7) olarak ortaya çıkmıştır (p<0,00001). Aksiller metastaz oranları 4 olumlu parametrenin (PE, <1,5 cm, LV1(-) ve NG 1-2) var olduğu hastalar için %2,8 iken, herhangi üçünün var olduğu grupta %4,6-5,8 arasında değişmektedir.

Sonuç: PE kanserler küçük tümör boyutu ve düşük lenfovasküler invazyon nedeniyle daha az aksiller tutulum oranına sahiptirler ve in situ kanser oranı P kanserlerden daha yüksektir. Bu bulguların eşliğinde palpabl olup olmama, önemli bir prognostik faktör olarak kabul edilebilir ve böylece PE kanserlerin daha iyi prognoza sahip olmaları beklenir. Gereksiz aksiller diseksiyonu engellemek amacıyla palpe edilememe; 1,5 cm'in altında tümör çapı, negatif lenfovasküler invazyon ve düşük nükleer derece aksiller tutulum açısından düşük riskli hastaları belirlemede kriter olabilir. Aksiller diseksiyon yapılmaması veya sentinel ganglion biyopsisi de bu hastalarda gündeme gelebilir.

Anahtar Kelimeler

• Meme kanseri,palpe edilebilir,palpe edilemeyen,prognostik ve prediktif değer

Kaynakça

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