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

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

Remzi Aktürk , Serdar Serinsöz

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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