Meme Kanserinde İntraoperatif Gama Prob ile Sentinel Lenf Nodu Örneklemesi: KEAH Deneyimimiz

Year 2017, Volume: 2 Issue: 2, 25 - 35, 23.08.2017

Saliha Karagöz Eren , Hümeyra Gençer , Güler Silov Yılmaz , Seyhan Karaçavuş , Ayşe Esra Arslan Tamer Ertan Ömer Topuz

Abstract

Amaç: Bu çalışmada, klinik olarak
aksilla negatif meme kanseri için intraoperatif gama prob uygulaması ile
SLNB  yapılan hastaların
sonuçlarının literatür eşliğinde değerlendirilmesi amaçlanmıştır.

Metod: Kayseri
Eğitim Araştırma Hastanesinde, Aralık 2016 – Ağustos 2017 tarihleri arasında
meme kanseri nedeniyle cerrahi tedavi uygulanan, klinik olarak aksillası
negatif olan, intraoperatif gama prob yöntemi ile sentinel lenf nodu
örneklemesi yapılan 17 olgu çalışmaya dahil edildi. Tüm hastalara Tc-99m
nanocolloid kullanılarak gama prob ile sentinel lenf nodu (SLN) biyopsisi
yapıldı.

Bulgular:
Tüm hasta serisinde ortalama 2 (1-4) SLN bulundu. toplam dokuz hastaya ALND
yapıldı. Ortalama çıkarılan ALN sayısı 12 (5-20) idi. ALND yapılan iki hastada
yalnızca SLN’lerde metastaz saptandı. SLN saptanma oranı % 100, tanısal
doğruluk oranı % 94 olarak belirlendi.

Sonuç:
Aksiller diseksiyon kararı vermede gama prob ile SLN örneklemesi, lenf
nodlarının lokalizasyonlarını ve insizyon yerini saptamada ve metastatik
durumlarını belirlemede güvenilir, etkili bir yöntemdir.

Keywords

Sentinel lenf nodu, gama prob, meme kanseri

References

• 1. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
• 2. http://kanser.gov.tr/daire-faaliyetleri/kanser-istatistikleri/2106-2014-yılı-türkiye-kanser-istatistikleri.html.
• 3. Özbaş S, Koçak S. Meme kanserinin cerrahi tedavisinde aksiller lenf nodu disseksiyonu. Meme Sağlığı Dergisi 2006; 2: 2.
• 4. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994 Sep;220(3):391-8; discussion 398-401.
• 5. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–933.
• 6. Cabanas RM: An approach for the treatment of penile carcinoma. Cancer 39: 456–466, 1977.
• 7. Kayıran O, De La Cruz C, Tane K, Soran A. Lymphedema: From diagnosis to treatment. Turk J Surg. 2017 Jun 1;33(2):51-57.
• 8. Galimberti V, Botteri E, Chifu C, et al. Can we avoid axillary dissection in the micrometastatic sentinel node in breast cancer? Breast Cancer Res Treat. 2012 Feb;131(3):819-25.
• 9. McIntosh SA, Purushotham AD. Lymphatic mapping and sentinel node biopsy in breast cancer. Br J Surg 1998 Oct;85(10):1347-56.
• 10. Radovanovic Z, Golubovic A, Plzak A, Stojiljkovic B, Radovanovic D. Blue dye versus combined blue dye-radioactive tracer technique in detection of sentinel lymph node in breast cancer. Eur J Surg Oncol 2004; 30: 913-917.
• 11. Noguchi M. Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients. J Surg Oncol. 2001 Feb;76(2):144-56.
• 12. Noguchi M, Motomura K, Imoto S, et al. A multicenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society. Breast Cancer Res Treat. 2000 Sep;63(1):31-40.
• 13. Aydoğan F, Arıkan AE, Aytaç E, ve ark. Sentinel lymph node biopsy under fluorescent indocyanin green guidance: Initial experience. Ulus Cerrahi Derg. 2015 Aug 18;32(1):50-3.
• 14. Ji Y, Luo N, Jiang Y, et al. Clinical utility of the additional use of blue dye for indocyanine green for sentinel node biopsy in breast cancer. J Surg Res. 2017 Jul;215:88-92. 15. Ozmen V, Muslumanoglu M, Cabioglu N et al. Sentinel lymph node biopsy in patient with invasive breast cancer. İs multifocality a contrindication to sentinel lmph node biopsy. Breast Cancer Research and Treatment 2002; 65:1-8.
• 16. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer-a multicenter validation study. N Engl J Med. 1998 Oct 1;339(14):941-6.
• 17. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymphnode biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006; 106:4-16.
• 18. Sanlı Y, Berberoglu K, Turkmen C, et al. TheValue of compined peritumoral and subdermal injectiontechniques for lymphoscintigraphy in detection of sentinel lymph node in breast cancer. Clin Nucl Med 2006;31:690-693.
• 19. Lin KM, Patel TH, Ray A, et al. Intradermal radioisotopes superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes. J Am Coll Surg 2004;199:561-566.
• 20. Kumar R, Jana S, Heiba SI, et al. Retrospective analysis of sentinel node localization in multifocal multicentric, palpable, or non palpable breast cancer. J Nucl Med 2003;44:7-10.
• 21. Mansel R.E, Fallowfield L, Kissin M, et al. Randomised multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst, 2006 May 3;98(9):599-609.
• 22. The Ludwig Breast Cancer Study Group. Prolonged disease free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer. N Engl J Med, 1989; 320:491.
• 23. International (Ludwig) Breast cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet, 1990; 335:1565-1568.
• 24. LymanGH, Somerfield MR, Bosserman LD, et al. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical PracticeGuideline Update. J Clin Oncol. 2016 Dec 12:JCO2016710947.
• 25. Somashekhar SP, Zaveri Shabber S , Udupa Venkatesh K, et al. Sentinel lymphnode biopsy in early breast cancer using methylene blue dye and radioactive sulphur colloid - a single institution Indian experience. Indian J Surg. 2008 Jun;70(3):111-9.
• 26. Mignotte H, Treilleux I, Faure C, et al. Axillary lymphnode dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol. 2002; 28: 623-626.
• 27. Krag DN, Weaver DL, Alex JL, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2:335-9.