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

Yıl 2019, Cilt: 4 Sayı: 3, 69 - 83, 30.09.2019

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.

Kaynakça

  • 1- From the Centers for Disease Control and Prevention. Breast cancer incidence and mortality— United States, 1992. JAMA. 1996 Oct 23-30;276(16):1293-4.2- Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin 2001 Jan-Feb;51(1):15-36.3- Boyer-Chammard A, Taylor TH, Anton-Culver H. Survival differences in breast cancer among racial/ethnic groups: a population-based study. Cancer Deteci Prev. 1999;23(6):463-73.4- Anderson DE, Badzioch MD. Familial breast cancer risks. Effects of prostate and other cancers. Cancer. 1993 Jul 1;72(1):114-9.5- Rebbeck TR, Wang Y, Kantoff PW, Krithivas K, Neuhausen SL, Godwin AK, Daly MB, Narod SA, Brunet JS, Vesprini D, Garber JE, Lynch HT, Weber BL, Brown M. Modification of BRCA1 and BRCA2-associated breast cancer risk by AlB1 genotype and reproductive history. Cancer Res 2001 Jul 15;61(14):5420-4.6- Holmberg E, Holm LE, Lundell M, Mattsson A, Wallgren A, Karisson P. Excess breast cancer risk and the role of parity, age at first childbirth and exposure to radiation in infancy. Br J Cancer 2001 Aug 3;85(3):362-6.7- Dupont WD, Pari FF, Hartmann WH, Brinton LA, Winfield AC, Worreli JA, Schuyler PA, Plummer WD. Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 1993 Feb 15;71(4):1258-65.8- Schnitt SJ, Morrow M. Lobular carcinoma in situ: current concepts and controversies. Semin Diagn Pathol. 1999 Aug;16(3):209-23.9- Özmen V. Küçük invaziv (ele gelmeyen) meme kanseri. Genel Cerrahi, Ed. Kalaycı G., syf 580- 585, Nobel Tıp Kitabevi, 2001 İstanbul.10- Costanza ME. The extent of breast cancer screening in older women. Cancer. 1994 Oct 1;74(7 Suppl):2046-50.11- Rosen PP, Groshen S, Kinne DW, Norton L. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol. 1993 Nov;11(11):2090-100.12- Rosen PP, Groshen S, Kinne DW. Prognosis in T2N0M0 stage 1 breast carcinoma: a 20-year follow-up study. J Clin Oncol. 1991 Sep;9(9):1650-61.13- Zonderland HM, Coerkamp EG, Hermans J, van de Vijver MJ, van Voorthuisen AE. Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Radiology. 1999 Nov;213(2):413-22.14- McKenna RJ Sr. The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis. Cancer. 1994 Jul 1;74(1 Suppl):244-55.15- Hollingsworth AB, Taylor LD, Rhodes DC. Establishing a histologic basis for false-negative mammograms. Am J Surg. 1993 Dec;166(6):643-7.16- Jeske JM, Bernstein JR, Stull MA. Screening and diagnostic Imaging. Amerikan Cancer Society, Atlas of clinical oncology, Breast Cancer, 2000.17- Cox BA, Kelly KM, Ko P, Hertzog L, Stain SC. Ultrasound characteristics of breast carcinoma. Am Surg 1998 Oct;64(10):934-8.18- Thibault F, Meunier M, Klijanienko J, El Khoury C, Nos C, Vincent-Salomon A, Asselain B, Neuenschwander S. Diagnostic accuracy of Sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions. J Clin Ultrasound 2000 Oct;28(8):387-398.19- Orel SG, Weinstein SP, Schnall MD, Reynolds CA, Schuchter LM, Fraker DL, Solin LJ. Breast MR imaging in patients with axillary node metastases and unknown primary malignancy. Radiology. 1999 Aug;212(2):543-9.20- Kinkel K, Vlastos G. MR imaging: breast cancer staging and screening. Semin Surg Oncol. 2001 Apr-May;20(3):187-96.21- Henderson MA, McCready DR. A simple technigue for fine needle aspiration cytology. J Am Coll Surg. 1994 Oct;179(4):471-3.22- Saxe A, Phillips E, Orfanou P, Husain M. Role of sample adequacy in fine needle aspiration biopsy of palpable breast lesions. Am J Surg. 2001 Oct;182(4):369-71.23- Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH, Chew K, Moore DH, Miller TR. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer. 2001 Aug 25;93(4):263-8.24- Renshaw AA. Adequate histologic sampling of breast core needle biopsies. Arch Pathol Lab Med. 2001 Aug;125(8):1055-7.25- Brenner RJ, Bassett LW, Fajardo LL, Dershaw DD, Evans WP, Hunt R, Lee C, Tocino l, Fisher P, McCombs M, Jackson VP, Feig SA, Mendelson EB, Margolin FR, Bird R, Sayre J. Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology 2001 Mar;218(3):866-72.26- Verkooijen HM, Peeters PH, Borel Rinkes IH, Pijnappel RM, Kaya A, Mali WP, van Vroonhoven TJ. Risk factors for cancellation of stereotactic large core needle biopsy on a prone biopsy table. Br J Radiol. 2001 Nov;74(887):1007-12.27- Buijs-van der Woude T, Verkooijen HM, Pijnappel RM, Klinkenbijl JH, Borel Rinkes IH, Peeters PH, Buskens E. Cost comparison between stereotactiç large-core-needle biopsy versus surgical excision biopsy in The Netherlands. Eur J Cancer. 2001 Sep;37(14):1736-45.28- Dowlatshahi K, Francescatti DS, Bloom KJ, Jewell WR, Schwartzberg BS, Singletary SE, Robinson D. Image-guided surgery of small breast cancers. Am J Surg. 2001 Oct;182(4):419-25.29- Feig SA. Increased benefit from shorter screening mammography intervals for women ages 40-49 years. Cancer. 1997 Dec 1;80(11):2035-9.30- Duffy SW, Chen HH, Tabar L, Fagerberg G, Paci E. Sojoum time, sensitivity and positive predictive value of mammography screening for breast cancer in women aged 40-49. Int J Epidemiol. 1996 Dec;25(6):1139-45.31- Bozfakioğlu Y. Memenin in situ kanserleri. Genel Cerrahi, Ed. Kalaycı G., syf 590-593, Nobel Tıp Kitabevi, 2001 İstanbul.32- McKinney CD, Frierson HF Jr, Fechner RE, Wilhelm MC, Edge SB. Pathologic findings in nonpalpable invasive breast cancer. 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Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri

Yıl 2019, Cilt: 4 Sayı: 3, 69 - 83, 30.09.2019

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.

Kaynakça

  • 1- From the Centers for Disease Control and Prevention. Breast cancer incidence and mortality— United States, 1992. JAMA. 1996 Oct 23-30;276(16):1293-4.2- Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin 2001 Jan-Feb;51(1):15-36.3- Boyer-Chammard A, Taylor TH, Anton-Culver H. Survival differences in breast cancer among racial/ethnic groups: a population-based study. Cancer Deteci Prev. 1999;23(6):463-73.4- Anderson DE, Badzioch MD. Familial breast cancer risks. Effects of prostate and other cancers. Cancer. 1993 Jul 1;72(1):114-9.5- Rebbeck TR, Wang Y, Kantoff PW, Krithivas K, Neuhausen SL, Godwin AK, Daly MB, Narod SA, Brunet JS, Vesprini D, Garber JE, Lynch HT, Weber BL, Brown M. Modification of BRCA1 and BRCA2-associated breast cancer risk by AlB1 genotype and reproductive history. Cancer Res 2001 Jul 15;61(14):5420-4.6- Holmberg E, Holm LE, Lundell M, Mattsson A, Wallgren A, Karisson P. Excess breast cancer risk and the role of parity, age at first childbirth and exposure to radiation in infancy. Br J Cancer 2001 Aug 3;85(3):362-6.7- Dupont WD, Pari FF, Hartmann WH, Brinton LA, Winfield AC, Worreli JA, Schuyler PA, Plummer WD. Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer. 1993 Feb 15;71(4):1258-65.8- Schnitt SJ, Morrow M. Lobular carcinoma in situ: current concepts and controversies. Semin Diagn Pathol. 1999 Aug;16(3):209-23.9- Özmen V. Küçük invaziv (ele gelmeyen) meme kanseri. Genel Cerrahi, Ed. Kalaycı G., syf 580- 585, Nobel Tıp Kitabevi, 2001 İstanbul.10- Costanza ME. The extent of breast cancer screening in older women. Cancer. 1994 Oct 1;74(7 Suppl):2046-50.11- Rosen PP, Groshen S, Kinne DW, Norton L. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol. 1993 Nov;11(11):2090-100.12- Rosen PP, Groshen S, Kinne DW. Prognosis in T2N0M0 stage 1 breast carcinoma: a 20-year follow-up study. J Clin Oncol. 1991 Sep;9(9):1650-61.13- Zonderland HM, Coerkamp EG, Hermans J, van de Vijver MJ, van Voorthuisen AE. Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Radiology. 1999 Nov;213(2):413-22.14- McKenna RJ Sr. The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis. Cancer. 1994 Jul 1;74(1 Suppl):244-55.15- Hollingsworth AB, Taylor LD, Rhodes DC. Establishing a histologic basis for false-negative mammograms. Am J Surg. 1993 Dec;166(6):643-7.16- Jeske JM, Bernstein JR, Stull MA. Screening and diagnostic Imaging. Amerikan Cancer Society, Atlas of clinical oncology, Breast Cancer, 2000.17- Cox BA, Kelly KM, Ko P, Hertzog L, Stain SC. Ultrasound characteristics of breast carcinoma. Am Surg 1998 Oct;64(10):934-8.18- Thibault F, Meunier M, Klijanienko J, El Khoury C, Nos C, Vincent-Salomon A, Asselain B, Neuenschwander S. Diagnostic accuracy of Sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions. J Clin Ultrasound 2000 Oct;28(8):387-398.19- Orel SG, Weinstein SP, Schnall MD, Reynolds CA, Schuchter LM, Fraker DL, Solin LJ. Breast MR imaging in patients with axillary node metastases and unknown primary malignancy. Radiology. 1999 Aug;212(2):543-9.20- Kinkel K, Vlastos G. MR imaging: breast cancer staging and screening. Semin Surg Oncol. 2001 Apr-May;20(3):187-96.21- Henderson MA, McCready DR. A simple technigue for fine needle aspiration cytology. J Am Coll Surg. 1994 Oct;179(4):471-3.22- Saxe A, Phillips E, Orfanou P, Husain M. Role of sample adequacy in fine needle aspiration biopsy of palpable breast lesions. Am J Surg. 2001 Oct;182(4):369-71.23- Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH, Chew K, Moore DH, Miller TR. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer. 2001 Aug 25;93(4):263-8.24- Renshaw AA. Adequate histologic sampling of breast core needle biopsies. Arch Pathol Lab Med. 2001 Aug;125(8):1055-7.25- Brenner RJ, Bassett LW, Fajardo LL, Dershaw DD, Evans WP, Hunt R, Lee C, Tocino l, Fisher P, McCombs M, Jackson VP, Feig SA, Mendelson EB, Margolin FR, Bird R, Sayre J. Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology 2001 Mar;218(3):866-72.26- Verkooijen HM, Peeters PH, Borel Rinkes IH, Pijnappel RM, Kaya A, Mali WP, van Vroonhoven TJ. Risk factors for cancellation of stereotactic large core needle biopsy on a prone biopsy table. Br J Radiol. 2001 Nov;74(887):1007-12.27- Buijs-van der Woude T, Verkooijen HM, Pijnappel RM, Klinkenbijl JH, Borel Rinkes IH, Peeters PH, Buskens E. Cost comparison between stereotactiç large-core-needle biopsy versus surgical excision biopsy in The Netherlands. Eur J Cancer. 2001 Sep;37(14):1736-45.28- Dowlatshahi K, Francescatti DS, Bloom KJ, Jewell WR, Schwartzberg BS, Singletary SE, Robinson D. Image-guided surgery of small breast cancers. Am J Surg. 2001 Oct;182(4):419-25.29- Feig SA. Increased benefit from shorter screening mammography intervals for women ages 40-49 years. Cancer. 1997 Dec 1;80(11):2035-9.30- Duffy SW, Chen HH, Tabar L, Fagerberg G, Paci E. Sojoum time, sensitivity and positive predictive value of mammography screening for breast cancer in women aged 40-49. Int J Epidemiol. 1996 Dec;25(6):1139-45.31- Bozfakioğlu Y. Memenin in situ kanserleri. Genel Cerrahi, Ed. Kalaycı G., syf 590-593, Nobel Tıp Kitabevi, 2001 İstanbul.32- McKinney CD, Frierson HF Jr, Fechner RE, Wilhelm MC, Edge SB. Pathologic findings in nonpalpable invasive breast cancer. Am J Surg Pathol. 1992 Jan;16(1):33-6.33- Gage I, Schnitt SJ, Nixon AJ, Silver B, Recht A, Troyan SL, Eberlein T, Love SM, Gelman R, Harris JR, Connolly JL. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer 1996 Nov 1:78(9):1921-8.34- Haffty BG, Lee C, Philpotts L, Horvath L, Ward B, McKhann C, Tocino I. Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients. Cancer J Sci Am 1998 Jan-Feb;4(1):35-40.35- Recht A, Houlihan MJ. Conservative Surgery Without radiotherapy in the treatment of patients with eariy-stage invasive breast cancer. Ann Surg 1995 Jul;222(1):9-18.36- Davidson NE, Abeloff MD. Adjuvant therapy of breast cancer. World J Surg. 1994 Jan-Feb;18(1):112-6.37- Donegan WL. Prognostic factors; stage and reseptor status in breast cancer. Cancer 1992; 70:1755-1764.38- Jackson JS, Olivotto lA, Wai M D E, Grau C, Mates D, Ragaz J. 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Significance and staging of nonpalpable carcinomas of the breast. Surg Gynecol Obstet. 1988 Jan;166(1):6-10.55- Donegan W.L., Staging and primary treatment. Cancer of the breast, Ed. Donegan W.L., Chapter 17, W.B. Saunders Co. Philadelphia 1995.56- Leinung S, Schneider JP, Wurl P, Gutz U, Schmidt F, Preusse C, Bomer P, Schonfelder M. The radiological and surgical management of nonpalpable breast lesions. Radiology 2000 Jun;40(6):568-73.57- Pagana TJ, Lubbe WJ, Schwartz SM, Sprechini GD. A comparison of palpable and nonpalpable breast cancers. Arch Surg. 1989 Jan;124(1):26-8.58- Veronesi U, Zucali R, Luini A. Local control and survival in early breast cancer; the Milan trial. Int J Radiat Oncol Biol Phys. 1986 May;12(5):717-20.59- Chadha M, Chabon AB, Friedmann P, Vikram B. Predictors of axillary Iymph node metastasis in patients with T1 breast cancer. Cancer 1994 Jan 15;73(2):350-3.60- Chadha M, Axelrod D. Is axillary dissection always indicated in invasive breast cancer? 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Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm Araştırma Makaleleri
Yazarlar

Remzi Aktürk

Serdar Serinsöz

Yayımlanma Tarihi 30 Eylül 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 4 Sayı: 3

Kaynak Göster

APA Aktürk, R., & Serinsöz, S. (2019). Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri. Journal of Immunology and Clinical Microbiology, 4(3), 69-83.
AMA Aktürk R, Serinsöz S. Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri. J Immunol Clin Microbiol. Eylül 2019;4(3):69-83.
Chicago Aktürk, Remzi, ve Serdar Serinsöz. “Meme Kanserinin Palpable Olması Veya Palpe Edilmemesinin Prognostik Ve Prediktif Değeri”. Journal of Immunology and Clinical Microbiology 4, sy. 3 (Eylül 2019): 69-83.
EndNote Aktürk R, Serinsöz S (01 Eylül 2019) Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri. Journal of Immunology and Clinical Microbiology 4 3 69–83.
IEEE R. Aktürk ve S. Serinsöz, “Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri”, J Immunol Clin Microbiol, c. 4, sy. 3, ss. 69–83, 2019.
ISNAD Aktürk, Remzi - Serinsöz, Serdar. “Meme Kanserinin Palpable Olması Veya Palpe Edilmemesinin Prognostik Ve Prediktif Değeri”. Journal of Immunology and Clinical Microbiology 4/3 (Eylül 2019), 69-83.
JAMA Aktürk R, Serinsöz S. Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri. J Immunol Clin Microbiol. 2019;4:69–83.
MLA Aktürk, Remzi ve Serdar Serinsöz. “Meme Kanserinin Palpable Olması Veya Palpe Edilmemesinin Prognostik Ve Prediktif Değeri”. Journal of Immunology and Clinical Microbiology, c. 4, sy. 3, 2019, ss. 69-83.
Vancouver Aktürk R, Serinsöz S. Meme Kanserinin Palpable Olması veya Palpe Edilmemesinin Prognostik ve Prediktif Değeri. J Immunol Clin Microbiol. 2019;4(3):69-83.

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