Meme Kitlelerinde Eksizyonel ve İnsizyonel Biyopsi İşlemlerinin Seçim Kriterleri ve Sonuçları

Öz

Amaç: Bu çalışmanın temel amacı, biopsi endikasyonu görülen olgularda biopsi yöntemlerini ve biopsi sonrası cerrahi tedavi seçimleriyle patoloji sonuçlarını ortaya koyarak biopsi seçim kriterlerini netleştirmektir. Gereç ve Yöntemler: Çalışma haziran 2020 ve haziran 2022 tarihleri arasında Genel Cerrahi Kliniğine başvuran ve biopsi endikasyonu konulan olgularda gerçekleştirildi. Esas olarak; Eksizyonel biopsi, tru-cut veya insizyonel biyopsi sonrası benign veya malign kitle tanıları konulan 18-70 yaş arası 62 hasta kayıtları retrospektif olerek incelemeye alınmış olup, verileri eksik ya da belirsiz olan olgular çalışmaya dahil edilmemiştir. Bu tanımlayıcı istatistikler ortalama±standart sapma, yüzde ve frekans olarak verilmiştir. İkili grupların karşılaştırılmasında sürekli değişkenler için bağımsız gruplarta student t test, ikili değişkenlerin karşılaştırılmasında χ2 testi kullanılmış ve %95 güven aralığındaki p<0,05 değeri istatistiksel olarak anlamlı kabul edilmiş olup nihai sonuçlara regresyon analizi yapılarak ulaşılmıştır. Bulgular: Toplam olgu sayısı 62 idi. Çalışmaya alınan hastaların yaş ortalaması 41,11±14,74 idi. Diğer yandan biopsi sonrası malignite tanısı alan olguların yaş ortalaması, benign olgulura göre daha yüksek saptandı[(49,46±15,38) vs (39,31±14,10) (p<0.05)].BI-RADS 4 gelen olgu sayısı trucut veye iniszyonel biopisi yapılan grupta belirgin biçimde yüksek olarak bulundu[(n=11(91.6%)]. Biopsi insidansları; n= 12(19.4%) insizyonel veya trucut biopsisi yapılmış olup, geri kalan 50 (80.6%) olguya eksizyonel biopsi yapılmıştır.İnsizyonel veya trucut işlemi uygulanan hastaların istatistiki olarak anlamlı biçimde malign geldiği görülmüştür [n=11( %91.6) vs 1(8.4%)(p<0.05)].Toplam hasta sayısına göre de insizyonel veya trucut biopsi yapılan olguların malignite ile sonuçlanmaları eksizyonel biopsi yapılan olgulara göre anlamlı olarak yüksektir[ n=11(17.7%)vs 51(82.3%) (p<0.0001)]. Sonuç: Meme kanseri tanısı konan olguların genel olarak preoperatif dönemde yapılan mammografi tetkikleri neticesinde ele gelmeyen kitleler olduğu ve bu sebeple eksizyonel biopisi yapılan olguların belirgin olarak benigin geldiğini ,preoperatif görüntülemenin, fizik muayane gibi çok önemli olduğunu düşünüyoruz.

Anahtar Kelimeler

• Eksizyonel biyopsi
• insizyonel biyopsi
• meme
• kitle
• biyopsi seçimi

The Comparison of Selection Criteria and Results for Incisional and Excisional Biopsy in Breast Masses

Öz

The main purpose of this study is to clarify the biopsy selection criteria by revealing the biopsy methods and post-biopsy surgical treatment choices and pathology results in cases with biopsy indication. Material and Methods:The study was carried out in cases who applied to the General Surgery Clinic between June 2020 and June 2022 and had biopsy indication.In fact;The records of 62 patients aged 18-70 years who were diagnosed with benign or malignant masses after excisional biopsy, tru-cut or incisional biopsy were retrospectively reviewed, and cases with incomplete or uncertain data were not included in the study.Descriptive statistics are given as mean±standard deviation, percentage and frequency.Student t test was used for continuous variables in the comparison of binary groups, χ2 test was used for comparison of binary variables, and the p<0.05 value in the 95% confidence interval was considered statistically significant. Results:The total number of cases was 62.The mean age of the patients included in the study was 41.11±14.74.On the other hand, the mean age of the cases diagnosed as malignant after biopsy was found to be higher than the benign cases[(49.46±15.38)vs(39.31±14.10)(p<0.05)].The number of cases with BI-RADS 4 was found to be significantly higher in the group who underwent trucut or incisional biopsy[(n=11(91.6%)].Biopsy incidences;n=12(19.4%) incisional or trucut biopsies were performed, and the remaining 50(80.6%) cases underwent excisional biopsy.It was seen that patients who underwent incisional or trucut procedure were statistically significantly malignant [n=11(91.6%) vs 1(8.4%)(p<0.05)].According to the total number of patients, the results of malignancy in cases who underwent incisional or trucut biopsy were significantly higher than those who underwent excisional biopsy[n=11(17.7%)vs51(82.3%)(p<0.0001)]. Conclusion:We think that the cases diagnosed with breast cancer generally have masses that are not palpable as a result of mammography examinations performed in the preoperative period, and therefore, the cases with excisional biopsy are usually benign, and preoperative imaging is very important like physical examination.

Anahtar Kelimeler

• Excisional biopsy
• incisional biopsy
• breast
• mass
• biopsy selection

Kaynakça

1. 1.Salvatore L. Versaggi, Alessandro De Leucio. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Breast Biopsy
2. 2.Giaquinto, A.N., Sung, H., Miller, K.D., Kramer, J.L., Newman, L.A., Minihan, A., Jemal, A. and Siegel, R.L. (2022), Breast Cancer Statistics, 2022. CA A Cancer J Clin, 72: 524-541. https://doi.org/10.3322/caac.21754
3. 3. Bodine, A. M., Holahan, B., & Mixon, A. (2017). Benign Breast Conditions. The Journal of the American Osteopathic Association, 117(12), 755. doi:10.7556/jaoa.2017.147
4. 4. Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, Ku NN, Lyman GH, Berman C, Haddad F, Reintgen DS. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998 May;227(5):645-51; discussion 651-3. doi: 10.1097/00000658-199805000-00005. PMID: 9605656; PMCID: PMC1191339.
5. 5.Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68:31-54.
6. 6. Li, X., Ma, Z., Styblo, T.M. et al. Management of high-risk breast lesions diagnosed on core biopsies and experiences from prospective high-risk breast lesion conferences at an academic institution. Breast Cancer Res Treat 185, 573–581 (2021). https://doi.org/10.1007/s10549-020-05977-9
7. 7. Giaquinto, A.N., Sung, H., Miller, K.D., Kramer, J.L., Newman, L.A., Minihan, A., Jemal, A. and Siegel, R.L. (2022), Breast Cancer Statistics, 2022. CA A Cancer J Clin, 72: 524-541. https://doi.org/10.3322/caac.21754
8. 8. Montrognon F, Clatot F, Berghian A, Douvrin F, Quieffin F, Defta D, Buquet A, Ferret M, Lequesne J, Leheurteur M, Fontanilles M, Georgescu D, Callonnec F. Impact of preoperative staging with contrast-enhanced mammography for localized breast cancer management. Br J Radiol. 2022 Jun 1;95(1134):20210765. doi: 10.1259/bjr.20210765. Epub 2022 Mar 9. PMID: 35195454.

9. 9.American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice bulletin no. 179: Breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(1):e1-e16. doi:10.1097/AOG.0000000000002158
10. 10. American College of Obstetricians and Gynecologists. Practice Bulletin no. 122: breast cancer screening. Obstet Gynecol. 2011;118(2 pt 1):372-378.
11. 11. For women facing a breast biopsy. The American Cancer Society website. http://www.cancer.org/acs/groups/cid/documents/webcontent/003176-pdf.pdf. Updated October 9, 2017. Accessed April 6, 2016
12. 12. Cancer among women. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/dcpc/data/women.htm. Updated June 5, 2017. Accessed November 10, 2017.