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Öğe Comparison of inflammatory breast cancer and noninflammatory breast cancer in Western Turkey(Karger, 2008) Saydam, Birsen Karaca; Goksel, Gamze; Korkmaz, Esra; Zekioglu, Osman; Kapkac, Murat; Sanli, Ulus Ali; Uslu, Ruchan; Sezgin, CanfezaObjective: The study was aimed at investigating the clinical and biological features and survival outcomes of patients who were treated for metastatic inflammatory and noninflammatory breast carcinoma. Subjects and Methods: One hundred and sixty-seven metastatic breast cancer patients were enrolled into this study and divided into two groups: inflammatory (n = 46) and noninflammatory (n = 121). The clinical and hormone receptor status, c-erbB-2, Ki-67, and p53 expression, based on the immunohistochemical staining patterns, were compared between the two groups. Results: The inflammatory breast carcinoma group had a younger patient population, higher rate of adjuvant anthracycline therapy, number of lymph node metastases, rates of extranodal extension and c-erbB-2 overexpression than noninflammatory breast cancer patients (p < 0.05). With regard to survival, there were slightly better outcomes in the noninflammatory breast carcinoma group (30 months) compared to the inflammatory breast carcinoma group (23 months), but the difference was not statistically significant (p = 0.08). While survival results of p53-negative inflammatory and noninflammatory breast carcinoma patients were similar, p53-positive survival was significantly worse (p < 0.05) in inflammatory breast cancer carcinoma patients. Conclusion: Because of c-erbB-2 overexpression in inflammatory breast carcinoma patients, treatment options including trastuzumab could have given better survival outcomes. Survival of inflammatory breast carcinoma patients with a low p53 immunohistochemistry staining appeared similar to that for noninflammatory breast carcinoma. For this reason, new treatment options are needed especially in inflammatory breast carcinoma patients with high p53 positivity. Copyright (C) 2008 S. Karger AG, Basel.Öğe Comparison of the clinical and pathological features between patients with recurrent metastatic breast carcinoma and patients with initially metastatic breast carcinoma(Saudi Med J, 2008) Saydam, Birsen K.; Goksel, Gamze; Korkmaz, Esra; Kapkac, Murat; Ozdemir, Necmettin; Sezgin, Canfeza; Uslu, RuchanObjective: To compare initial metastatic breast carcinoma (MBC) with recurrent MBC and assess their biologic phenotypes and clinical behaviors. Methods: A comparison of clinical and biological characteristics and median overall survival times were assessed in the 251 patients with MBC at the Division of Medical Oncology, Ege University School of Medicine, and the Division of Radiation Oncology, Tepecik Government Hospital, Izmir, Turkey between 1995 and 2004. Hormone receptors, c-erbB-2, Ki-67, and p53 expressions were performed by immunohistochemistry. Results: Out of 251 MBC patients, 206 patients had recurrent MBC, and 45 had initial MBC. Regarding survival, there was no difference between the recurrent MBC group and the initial MBC group. The initial MBC group had a higher proportion of T4 tumors (46% versus 27%), a lower proportion of T1-2 tumors (31% versus 55%; p=0.01), and a higher percentage of patients with high Ki-67 expression (64% versus 49%; p=0.05). Multivariate analysis showed that T stage was an independent prognostic factor (p=0.02). Conclusion: Patients with initial MBC tended to present with larger tumors. This relationship can be explained by delayed diagnosis. The potential for reducing death rates from breast cancer is contingent on educational improvement and increased screening rates.Öğe Complete Response after Chemotherapy in Metastatic Involvement of the Orbita in Breast Cancer(Wiley-Blackwell Publishing, Inc, 2009) Makay, Ozer; Gurcu, Baris; Sanli, Ulus Ali; Zekioglu, Osman; Oktay, Aysenur; Goker, Erdem; Kapkac, MuratÖğe Complete Response after Chemotherapy in Metastatic Involvement of the Orbita in Breast Cancer(Wiley-Blackwell Publishing, Inc, 2009) Makay, Ozer; Gurcu, Baris; Sanli, Ulus Ali; Zekioglu, Osman; Oktay, Aysenur; Goker, Erdem; Kapkac, MuratÖğe The Effect of Freezing on the Immunoprofile of Breast Carcinoma Cells(Galenos Yayincilik, 2014) Argon, Asuman; Sener, Alper; Zekioglu, Osman; Kapkac, Murat; Ozdemir, NecmettinBackground: Intraoperative frozen section procedure may be required in some operations performed for breast masses. Aims: We investigated the effect of frozen section procedure on the immunoprofile of breast carcinoma cells. Study Design: Cross-sectional study. Methods: A total of 53 breast carcinoma cases evaluated with intraoperative frozen sections were included in this study. Immunohistochemically, oestrogen (ER), progesterone (PR) and HER2 primary antibodies were evaluated in both frozen and non-frozen sections of each tumour sample. Results: No difference was found between the frozen and non-frozen sections in 33 cases in terms of staining rate and intensity of ER, PR and HER2. A decrease was found in the ER, PR and HER2 staining rate (in 10 cases, 9 cases and 6 cases, respectively). Likewise, a decrease was detected in ER, PR and HER2 staining intensity in 6 patients for each. Although there was no staining in frozen sections, immunopositivity was observed in 3 non-frozen sections for ER, in 2 for PR and in 5 for HER2. Statistically, a significant difference was found between the frozen and non-frozen sections in terms of staining rate and intensity for each of the three markers. Conclusion: In this study, the frozen section procedure in breast carcinoma had a negative effect on the immunoprofile. However, considering the importance of hormone receptor status in the treatment, these results should be supported with larger series.Öğe The effect of radiocolloid preference on major parameters in sentinel lymph node biopsy practice in breast cancer(Elsevier Science Inc, 2010) Yararbas, Ulkem; Argon, A. Murat; Yeniay, Levent; Zengel, Baha; Kapkac, MuratIntroduction: The possible effects of ractiocolloid preference on sentinel lymph node biopsy (SLNB) were investigated. Methods: A total of 200 patients with T1-2N0M0 breast cancer were evaluated. The first 100 patients underwent SENB using (99m)Tc tin colloid (TC) and the next 100 using (99m)Tc nanocolloid (NC). Radiocolloid was injected intradermally at four quadrants of the periareolar region the day before surgery. All patients underwent lymphoscintigraphy 1 h after injection. All nodes having fourfold activity of the background were harvested using gamma probe. Results: Sentinel lymph node (SLN) identification rate by gamma probe was 98% in each group. The number of SLNs identified by lymphoscintigraphy, gamma probe and pathological evaluation was 1.39+/-0.7, 1.70+/-1.0 and 2.23+/-1.70 in the TC and 2.03+/-0.94, 2.60+/-1.36 and 3.05+/-1.90 in the NC group, respectively (P<.05). Metastatic SLN was found in 24 (24.4%) of 98 patients in the TC group and 41 (41.8%) of 98 patients in the NC group (P=.04). None of the patients showed dispersion to internal mammarian lymph nodes. Lymphatic vessel visualization was observed in eight (8.1%) of 98 TC patients and in 47 (47.9%) of 98 NC patients (P=.000). SLNs were the only metastatic node(s) in 54.1% of TC and 73.1% of NC patients. Conclusion: The periareolar intradermal injection technique gives a high detection rate in the localization of SLNs independently from the choice of the tracer. Mean SLN numbers and lymphatic vessel visualization frequency were significantly higher using a smaller albumin Tc-99m nanocolloid as compared to a stannous fluoride Tc-99m tin colloid. The results of our study support the idea that the influence of increased number of SLNs on positive SLN frequency is critical. (C) 2010 Elsevier Inc. All rights reserved.Öğe Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies(Oxford Univ Press, 2015) Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Nuh Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah; Tireli, Mustafa; Ihtiyar, Enver; Demircan, Orhan; Baskan, Mazhar Semih; Koyuncu, Ayhan; Tasdelen, Ismet; Dumanli, Esra; Ozdener, Fatih; Zaborek, PiotrBackground: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.Öğe Factors affecting time to seeking medical advice and start of treatment in breast cancer (BC) patients in Turkey(Amer Soc Clinical Oncology, 2013) Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah; Tireli, Mustafa; Ihtiyar, Enver; Demircan, Orhan; Baskan, Mazhar Semih; Koyuncu, Ayhan; Tasdelen, Ismet; Dumanli, Esra; Ozdener, FatihÖğe Fine Needle Aspiration Cytologic Features of Medullary Carcinoma of the Breast A Study of 20 Cases with Histologic Correlation(Karger, 2009) Akbulut, Metin; Zekioglu, Osman; Kapkac, Murat; Ozdemir, NecmettinObjective To analyze fine needle aspiration cytology (FNAC) mater material from 20 cases of histologically verified medullary carcinoma (MC) of the breast and correlate the cytomorphologic features with histologic appearance to improve the diagnostic sensitivity and specificity of FNAC. Study Design We reviewed the cytologic features of 20 cases of MC of the breast in the archives of Ege University Hospital between 1994 and 2006. Results Twenty patients with an aspirate and confirmed diagnosis of MC were identified. Patient age was 30-74 years (mean, 48). The initial cytologic diagnoses were positive for cancer in 17 cases, atypical/suspicious for cancer in 2 cases and negative for cancer in 1 case. The cytologic picture was characterized by cellular smears composed of highly atypical epithelial tumor cells in loosely cohesive sheets and lying singly, admixed with polymorphous lymphocytes, plasma cells and neutrophils. Tumor cells had predominantly abundant finely granular, eosinophilic cytoplasm and moderate to marked nuclear pleomorphism with prominent nucleoli. Histologic examination confirmed that 11 cases were atypical MC and 9 were pure MC. Conclusion Breast MC is a rare, distinct category that appears to have rather characteristic cellular features. Familiarity with the cell components is a prerequisite in cytologic accuracy. (Acta Cytol 2009;53:165173)Öğe Fine needle aspiration cytology of glycogen-rich clear cell carcinoma of the breast(Karger, 2008) Akbulut, Metin; Zekioglu, Osman; Kapkac, Murat; Erhan, Vildiz; Ozdemir, NecmettinObjective To analyze fine-needle aspiration cytology (FNAC) material from 37 cases of breast glycogen-rich clear cell cancer (GRCC) and correlate cytomorphologic features with histologic appearance to determine characteristics of GRCC on FNAC. Study Design We reviewed cytologic features of 37 cases of breast GRCC fro m the archives of Ege University Hospital diagnosed between 1994 and 2006. Results Thirty-seven patients with available aspirate and confirmed GRCC were identified. The female patients ranged from 32 to 81 years (mean 52 years). The initial cytologic diagnoses were adenocarcinoma for 27 and atypical or suspicious for cancer for 10. The cytologic picture was characterized by hypercellular tumor cells in loosely cohesive syncytial groups and some single cells. Most tumor cells bad abundant, finely granular eosinophilic cytoplasm or foamy to clear cytoplasm with well-defined cytoplasmic membranes and moderate to marked nuclear pleomorphism with prominent nucleoli. Histologic examination confirmed all cases to be pure GRCC. Conclusion Breast GRCC is a rare, distinct categog with cytologic features that overlap considerably with those of other carcinomas. Awareness of variability in cytomorphologic appearance of GRCC and routine assessment for glycogen facilitate accurate diagnosis of these lesions by FNAC and enable prompt treatment of these poor-prognosis breast cancers.Öğe Fine needle aspiration cytology of mammary carcinoma with choriocarcinomatous features - A report of 2 cases(Karger, 2008) Akbulut, Metin; Zekioglu, Osinan; Ozdemir, Necmettin; Kapkac, MuratBackground Neoplasms of the breast containing multinucleated giant cells (MGCs) include both benign and malignant entities, such as benign soft tissue giant cell tumors, atypical fibrous histiocytoma, sarcomas, metaplastic carcinomas and the uncommon carcinomas containing osteoclast-like giant cells (OGC). Breast carcinoma with choriocarcinomatous features (BCCF) is a distinct variant of breast cancer. Cases We report the cytologic features, pathologic findings and immunohistochemical profile in 2 cases of this unusual variant of breast carcinoma. Two women aged 53 and 50 years women presented with a history of left and right breast lump hut no local lymphadenopathy, respectively. Fine needle aspiration cytology (FNAC) of both cases revealed abundant MGC with highly pleomorphic tumor cells in the hemorrhagic necrotic background. Both of the cases were histopathologically diagnosed as BCCF. Conclusion Choriocarcinomatous differentiation with multinucleated syncytiotrophoblast-like giant cells is extremely bare in breast tumors. Although rare, FNAC of breast cancer with pleomorphic MGC requires carefull search for differential diagnosis, breast carcinoma with giant cell features (choriocarcinomatous features, OGC features) must be differentiated from metastatic tumors and other breast lesions containing giant cells.Öğe High-Resolution Melting Analysis for Screening of Turkish Germline Mutations in BRCA1 and BRCA2(Akad Doktorlar Yayinevi, 2010) Purcu, Duygu U.; Karaca, Burcak; Kapkac, Murat; Ozdemir, Necmettin; Uzunoglu, Selim; Uslu, RuchanThe germline mutations of breast cancer susceptibility genes 1 (BRCA1) and 2 (BRCA2) are the two most frequently mutated genes in inherited breast and ovarian cancer. Among the most known mutations in these tumor suppressor genes are 5382insC and 185delAG in BRCA1 and 6174delT in BRCA2. The aim of the current study was to investigate the frequency of these BRCA1 and BRCA2 mutations in Western Turkish population. Twenty-five women with a history of self breast cancer and family history, 25 women with a familial history of breast cancer in their first degree-relatives and five healthy women formed the studied groups. DNA from peripheral blood was extracted and analyzed by high-resolution melting (HAM) analysis. None of the 50 patients and five healthy individuals was found to carry 185delAG mutation in BRCA1 and the 6174delT mutation in BRCA2. But, we found the 5382insC mutation in exon 20 of BRCA1 in five patients, having a strong family history. Four of these five patients were from the same family. Our preliminary results indicate that penetrance of 5382insC mutation in BRCA1 mutations is dominant in Turkish population; however, it seems there might be some other genes that contribute more significantly to familial breast carcinoma in Turkish population in BRCA.Öğe High-Resolution Melting Analysis for Screening of Turkish Germline Mutations in BRCA1 and BRCA2(Akad Doktorlar Yayinevi, 2010) Purcu, Duygu U.; Karaca, Burcak; Kapkac, Murat; Ozdemir, Necmettin; Uzunoglu, Selim; Uslu, RuchanThe germline mutations of breast cancer susceptibility genes 1 (BRCA1) and 2 (BRCA2) are the two most frequently mutated genes in inherited breast and ovarian cancer. Among the most known mutations in these tumor suppressor genes are 5382insC and 185delAG in BRCA1 and 6174delT in BRCA2. The aim of the current study was to investigate the frequency of these BRCA1 and BRCA2 mutations in Western Turkish population. Twenty-five women with a history of self breast cancer and family history, 25 women with a familial history of breast cancer in their first degree-relatives and five healthy women formed the studied groups. DNA from peripheral blood was extracted and analyzed by high-resolution melting (HAM) analysis. None of the 50 patients and five healthy individuals was found to carry 185delAG mutation in BRCA1 and the 6174delT mutation in BRCA2. But, we found the 5382insC mutation in exon 20 of BRCA1 in five patients, having a strong family history. Four of these five patients were from the same family. Our preliminary results indicate that penetrance of 5382insC mutation in BRCA1 mutations is dominant in Turkish population; however, it seems there might be some other genes that contribute more significantly to familial breast carcinoma in Turkish population in BRCA.Öğe A New and Simple Predictive Formula for Non-Sentinel Lymph Node Metastasis in Breast Cancer Patients with Positive Sentinel Lymph Nodes, and Validation of 3 Different Nomograms in Turkish Breast Cancer Patients(Karger, 2012) Yeniay, Levent; Carti, Erdem; Karaca, Can; Zekioglu, Osman; Yararbas, Ulkem; Yilmaz, Rasih; Kapkac, MuratBackground: Nomogram accuracies for predicting non-sentinel lymph node (SLN) involvement vary between different patient populations. Our aim is to put these nomograms to test on our patient population and determine our individual predictive parameters affecting SLN and non-SLN involvement. Patients and Methods: Data from 932 patients was analyzed. Nomogram values were calculated for each patient utilizing MSKCC, Tenon, and MHDF models. Moreover, using our own patient-and tumor-depended parameters, we established a unique predictivity formula for SLN and non-SLN involvement. Results: The calculated area under the curve (AUC) values for MSKCC, Tenon, and MHDF models were 0.727 (95% confidence interval (CI) 0.64-0.8), 0.665 (95% CI 0.59-0.73), and 0.696 (95% CI 0.59-0.79), respectively. Cerb-2 positivity (p = 0.004) and size of the metastasis in the lymph node (p = 0.006) were found to correlate with non-SLN involvement in our study group. The AUC value of the predictivity formula established using these parameters was 0.722 (95% CI 0.63-0.81). Conclusion: The most accurate nomogram for our patient group was the MSKCC nomogram. Our unique predictivity formula proved to be as equally effective and competent as the MSKCC nomogram. However, similar to other nomograms, our predictivity formula requires future validation studies.Öğe Precipitating Factors for Lymphedema Following Surgical Treatment of Breast Cancer: Implications for Patients Undergoing Axillary Lymph Node Dissection(Wiley-Blackwell Publishing, Inc, 2009) Dayangac, Murat; Makay, Oezer; Yeniay, Levent; Aynaci, Murat; Kapkac, Murat; Yilmaz, RasihÖğe Problematic Aspects of Sentinel Lymph Node Biopsy and Its Relation to Previous Excisional Biopsy in Breast Cancer(Lippincott Williams & Wilkins, 2009) Yararbas, Ulkem; Argon, A. Murat; Yeniay, Levent; Kapkac, MuratPurpose: The aim of the study is to review problematic aspects of sentinel lymph node biopsy (SLNB) and to evaluate the influence of a previous excisional biopsy on these problems. Materials and Methods: A total of 345 patients were evaluated retrospectively, 156 of them had a previous biopsy. Tc-99m tin colloid was injected the day before surgery at 4 quadrants around the areola intradermally. Problems complicating SLNB are reviewed in 3 topics: visualization or gamma probe detection problems, dilated lymphatic channels, and misleading activity accumulation. Results: SLN detection rate and mean sentinel lymph node numbers were as follows in patients with and without biopsy, respectively: 95.5% versus 99.4% and 1.71 +/- 0.97 versus 1.70 +/- 0.92. Problems complicating the procedure occurred in 20 patients (5.8%). Among these 20 patients, 15 had a prior excisional biopsy, and incisions were located in the upper, outer and periareolar zones. Visualization or gamma probe detection problems occurred in 8 patients. Except for one with faint uptake in a sentinel node, all had a prior biopsy. Lymphatic channel dilatation complicated the procedure in 7 patients. Of these 7 patients, 4 had a previous biopsy. Misleading activity accumulations compromised SLNB in 5 patients, 4 of whom had a prior biopsy. Conclusion: Although SLNB is still applicable with a high success rate in cases with excisional biopsy, a review of problematic aspects of SLNB demonstrated a relation with the presence of a previous biopsy and its localization. The demonstration of nonvisualization preoperatively and the precise localization of atypically located activity accumulation may be helpful in the prevention of potential complications.Öğe Problematic Aspects of Sentinel Lymph Node Biopsy and Its Relation to Previous Excisional Biopsy in Breast Cancer(Lippincott Williams & Wilkins, 2009) Yararbas, Ulkem; Argon, A. Murat; Yeniay, Levent; Kapkac, MuratPurpose: The aim of the study is to review problematic aspects of sentinel lymph node biopsy (SLNB) and to evaluate the influence of a previous excisional biopsy on these problems. Materials and Methods: A total of 345 patients were evaluated retrospectively, 156 of them had a previous biopsy. Tc-99m tin colloid was injected the day before surgery at 4 quadrants around the areola intradermally. Problems complicating SLNB are reviewed in 3 topics: visualization or gamma probe detection problems, dilated lymphatic channels, and misleading activity accumulation. Results: SLN detection rate and mean sentinel lymph node numbers were as follows in patients with and without biopsy, respectively: 95.5% versus 99.4% and 1.71 +/- 0.97 versus 1.70 +/- 0.92. Problems complicating the procedure occurred in 20 patients (5.8%). Among these 20 patients, 15 had a prior excisional biopsy, and incisions were located in the upper, outer and periareolar zones. Visualization or gamma probe detection problems occurred in 8 patients. Except for one with faint uptake in a sentinel node, all had a prior biopsy. Lymphatic channel dilatation complicated the procedure in 7 patients. Of these 7 patients, 4 had a previous biopsy. Misleading activity accumulations compromised SLNB in 5 patients, 4 of whom had a prior biopsy. Conclusion: Although SLNB is still applicable with a high success rate in cases with excisional biopsy, a review of problematic aspects of SLNB demonstrated a relation with the presence of a previous biopsy and its localization. The demonstration of nonvisualization preoperatively and the precise localization of atypically located activity accumulation may be helpful in the prevention of potential complications.Öğe Tuberculous mastitis: A masquerading face of granulomatous mastitis(Turkish Assoc Tuberculosis & Thorax, 2022) Ucan, Eyup Sabri; Alpaydin, Aylin Ozgen; Karayazi, Damla Gunduz; Kapkac, Murat; Takar, Burca; Zekioglu, Osman; Balci, PinarIntroduction: Tuberculosis (TB) mastitis is a rare form of granulomatous mas-titis. We aimed to evaluate the clinical characteristics and prognosis of patients diagnosed with TB mastitis.Materials and Methods: A descriptive study was carried out on patients who were reported to national tuberculosis control authorities as having TB masti-tis between 2003 and 2021. Demographic, histopathological, and radiological data including mammography, ultrasonography (US), and magnetic resonan-ce imaging (MRI) were reviewed. All were followed up to 24 months and prognosis was also evaluated.Results: This study identified 29 TB mastitis patients who had been diagnosed using excisional biopsies. The mean age was 33.5 +/- 10.1, all were premeno-pausal women. The most common symptom was breast mass (n= 24, %82.8), nearly half of the patients also had ipsilateral axillary lymphadenopathy (n= 14, 48.3). One-fourth of the patients had bilateral involvement (n= 7, 24.1%), and half of the patients (n= 16, 55.2%) presented with multiple masses. One patient had co-existing pulmonary TB. Predisposing factors for TB were not identified in any of the patients. Nearly half of the patients rece-ived prior mastitis treatment. The most common radiological finding was mass in both mammography and US. All patients received anti-tuberculosis treat-ment of a standard regimen for six to 21 months, three patients had a relapse but were finally cured.Conclusion: TB mastitis should be suspected in young and premenopausal women presenting with a breast mass and axillary lympha-denopathy in an endemic region. Radiological findings could not identify the diagnosis. A multidisciplinary approach including bacteriology and histopathology should be performed. Anti-tuberculosis treatment can be implemented successfully.Öğe The use of periareolar intradermal Tc-99m tin colloid and peritumoral intraparenchymal isosulfan blue dye injections for determination of the sentinel lymph node(Lippincott Williams & Wilkins, 2006) Argon, Aziz Murat; Duygun, Ulkem; Acar, Ebru; Daglioz, Gozde; Yenjay, Levent; Zekioglu, Ozman; Kapkac, MuratPurpose: The purpose of the present study was to evaluate the use of lymphoscintigraphy, blue dye, and gamma probe detection methods for determination of the sentinel lymph node (SLN) using both periareolar intradermal injection of Tc-99m tin colloid and peritumoral intraparenchymal injection of isosulfan blue dye. Methods: One hundred patients with T1-2 breast cancer and clinically negative nodes were enrolled in the present study. The study was composed of 2 groups. Backup axillary lymph node dissection (ALND) was mandatory in group 1 (20 patients) regardless of their lymph node status. In group 2 (80 patients), complete ALND was performed when intraoperative frozen section analysis of SLN revealed metastases. Otherwise, only SLN biopsy was performed without ALND. One day before surgery, Tc-99m tin colloid was injected at 4 periareolar sites intradermally. Lymphoscintigraphy was performed 1 to 2 hours after injection of the radiocolloid. Twenty minutes before surgery, isosulfan blue dye was injected into parenchyma surrounding the tumor or the biopsy cavity. Results: The detection rates of SLN and false-negative rate of lymphoscintigraphy, blue dye, and gamma probe detection were 85%, 95% 100%, and 0% in group 1, 91%, 87%, and 95% in group 2, respectively. Detection rate by the combination of blue dye and radio tracer was 98%. Conclusions: According to the results of our study, we conclude that perioareolar intradermal injection of Tc-99m tin colloid combined with peritumoral intraparenchymal injection of blue dye is an accurate and easy method of locating the sentinel node with very high detection rates. It is recommended that the combination of all methods such as lymphoscintigraphy, blue dye, and gamma probe application will increase the success rate of SLN detection in patients with breast cancer.
