İNTRADUKTAL PAPİLLOM OLGULARININ CERRAHİ SONRASI DEĞERLENDİRİLMESİ; RADYOLOJİK VE PATOLOJİK BULGULARIN KORELASYONU

Year 2019, Volume: 82 Issue: 2, 69 - 74, 19.06.2019

Muhammet Ferhat Çelik Ravza Yılmaz Ahmet Cem Dural , Fatma Çelik Yabul Halil Fırat Baytekin Selin Kapan Halil Alış

https://doi.org/10.26650/2018.0029

Abstract

Amaç: İntraduktal lezyon ön tanısıyla biyopsi yapılan olguların radyolojik ve patolojik bulgularının değerlendirilmesini, ayrıca postoperatif intraduktal papillom (İDP) tanısı alan olguların cerrahi gereksiniminin tartışılmasını amaçladık. Gereç ve Yöntem: Kliniğimizde 2012-2014 arasında intraduktal papiller lezyon tanısıyla biyopsi yapılan hastalar retrospektif değerlendirildi. Çalışmaya dahil edilen hastalar ultrason (US), endikasyon varlığında mamografi (MMG) veya manyetik rezonans görüntüleme (MRG) ile değerlendirildi. Hastalara tru-cut biyopsi veya ince iğne aspirasyon biyopsisi (İİAB) uygulandı. Cerrahi eksizyon planlamasında; atipi, radyoloji-patoloji uyumsuzluğu, risk faktörü ve hasta isteği göz önüne alındı. Bulgular: Çalışmaya 73 hasta dahil edildi, 59’u ≥40 yaş idi. Hastaların tümüne ultrasonografi, ≥40 yaş 59 hastaya MMG yapıldı, 8 hastaya MRG yapıldı. İİAB yapılan 11 hastadan birinde İDP, trucut biyopsi yapılan 40 hastanın 10’unda İDP saptandı. Eksizyon yapılan 22 hastadan 3’ü histopatolojik olarak malign, 5’i pre-invaziv veya pre-neoplastik olarak değerlendirildi. konsensus bulunmamaktadır. Atipili papiller lezyonların karsinom riski ile ilişkili olduğu kabul edilmekte ve cerrahi eksizyon planlanmaktadır. Yayımlanan son çalışmalarda, hastaların beşte birinde tanısal sınıflamanın yukarı doğru (upgrade) değiştiği ve tedavi yaklaşımının da cerrahi lehine değiştiği gösterilmiştir. Serimizde, literatüre benzer şekilde, upgrade oranı %10,9’dur. Papiller lezyon tanılı hastalarda radyolojik görüntüleme iyi değerlendirilmelidir, radyoloji-patoloji uyumsuzluğunda total eksizyon yapılması önerilebilir.

Keywords

Benign papiller lezyon, İntraduktal papillom, tru-cut biyopsi, ince iğne aspirasyon biyopsisi

THE ASSESSMENT OF CASES WITH INTRADUCTAL PAPILLOMAS AFTER SURGERY; THE CORRELATION OF RADIOLOGICAL AND PATHOLOGICAL FINDINGS

Abstract

Objective: The aims of this study were firstly to evaluate the radiology and histopathology findings of patients diagnosed with intraductal lesions and who had undergone biopsies. The second objective was to investigate the surgery requirements in those cases diagnosed with intraductal papilloma (IDP) post operatively. Material and Methods: Patients diagnosed with intraductal papillary lesions and who then underwent biopsy were retrospectively reviewed. An ultrasound (US) was performed on all patients, if required; a mammography (MMG) and Magnetic resonance imaging (MRI) was also performed on patients. A Tru-cut biopsy or fine needle aspiration biopsy (FNAB) was performed on patients. Atipia, any discordance between the radiology and pathology findings, risk factors and patient requests were taken into account for deciding on surgical excision. Results: Of the seventy-three patients included in the study, 59 of them were ≥40 years. An ultrasound was performed on all patients, an MMG was performed on the 59 patients ≥40 years, and an MRI was performed on 8 patients. FNAB was performed on 11 patients, IDP was diagnosed in one of them, a tru-cut biopsy was performed on 40 patients and 10 of them were diagnosed with IDP. Three lesions were histopatologically malignant and 5 lesions were pre-invasive or pre-neoplastic in 22 of the patients who underwent surgical resection. Conclusion: There is still no consensus on the management of patients diagnosed with benign papillary lesions after Tru-cut biopsy or FNAB. Lesions with atipia usually underwent surgical resection due to their malignant potential. Recent studies showed an upgrade in one-fifth of the patients’ histopathological results and the treatment strategy was shifted in favor of surgery. In our series, the upgrade rate was 10.9 % which is similar to the literature. Imaging studies in patients diagnosed with papillary lesions should be evaluated carefully, and in the case of discordance between radiology and histopathology, total excision should be considered.

Keywords

Benign papillary lesion, Intraductal papilloma, trucut biopsy, fine needle aspiration biopsy

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