Memede ele gelmeyen kuşkulu mikrokalsifikasyonların tanısında stereotaktik vakum biyopsinin yeri.
Küçük Resim Yok
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Meme kanseri kadın popülasyonu için en önemli mortalite ve morbidite nedenleri arasında yer almaktadır. Hastalığın tedavisi meme kanserinin mümkün olan en erken evrede tanınması ve uygun olan tedavinin uygulanması ile mümkün olabilmektedir. Bu konudaki önemli basamak olan biyopsi tekniklerinin çeşitleri ve buna bağlı olarak uygulama teknikleri farklılıklar göstermektedir. Stereotaktik vakum eşlikli biyopsi tekniği bu konuda atılmış önemli adımlardan biridir ve bu çalışmaya konu oluşturmaktadır.Mart 2008 ile Mayıs 2011 tarihleri arasında, memesinde saptanan mikrokalsifikasyonlar için sterotaktik vakum biyopsi uygulanan 57 kadın hasta çalışmaya dahil edildi. Bu olguların mamografik özellikleri, biyopsi öncesi tanımlanan BİRADS skorları ve biyopsi sonrası patoloji sonuçları retrospektif olarak değerlendirildi. Biyopsi uygulanan hastaların yaş aralığı 40-69, ortalama yaşları 50.8 idi.Biyopsiler öncesinde uygulanan tanısal işlemler ile lezyonlar BİRADS sınıflamasına göre gruplandı. İşlem öncesinde 44 lezyon (%77.2) kategori 4, 13 lezyon ise (%22.8) kategori 5 olarak sınıflandı.Vakum eşlikli biyopsi uygulanan hastalarda elde edilen histopatolojik sonuçların doğruluğunun değerlendirilmesi amacıyla bu bulgular eksizyonel biyopsi, mammografik takip ve klinik takip sonuçlarıyla değerlendirildi. Takip süresi 3-40 ay (ortalama 25.9 ay) olarak gerçekleşti.Biyopsi uygulanan 57 hastanın histopatolojik değerlendirmesinde 31 lezyon (%54.4) benign, 26 lezyon (%45.6) malign olarak değerlendirildi. Benign lezyonların 9 (%29) tanesi spesifik tanı alırken, 22 (%71) tanesi nonspesifik tanılar aldı. Malign lezyonların 22 (%84) tanesi DKİS olarak bildirildi.Vakum eşlikli biyopsi işlemi öncesinde kategori 4 olarak değerlendirilen 44 lezyondan 13 tanesi (%29.5) malign olarak rapor edilmiştir. Kategori 5 olarak değerlendirilen 13 lezyonun tamamı (%100) malign olarak rapor edilmiştir. Bu verilerden yola çıkarak stereotaktik vakum biyopsi yönteminin pozitif öngörü değeri (PÖD) %45.6 olarak hesaplanmıştır. PÖD değerlerinin arzu edilen sınırları %25-40 olarak kabul edilmektedir. Kullandığımız biyopsi yöntemi için değerlerimiz kabul edilebilir sınırlardadır. Çalışmamızda yanlış negatif sonuç %0 ve doğru pozitif sonuç %100 bulunmuş olup literatür değerleri ile uyumludur.Vakum eşlikli biyopsi diğer biyopsi yöntemlerine göre daha fazla doku örneklemesi yapabilmektedir. Bu özelliği sayesinde tanıda hata olma olasılığı azalmaktadır. Vakum eşlikli biyopsi tekniği sayesinde küçük meme lezyonlarının perkütan yolla tamamen çıkartılmaları mümkün olmakta ve bu sayede gereksiz cerrahi girişimler önlenebilmektedir. Radyolojik olarak BİRADS kategori 3 olarak sınıflanan mikrokalsifikasyonlara bazı özel durumlarda, gerekli ek incelemeler yapıldıktan sonra biyopsi uygulanabilir; ancak radyolojik olarak malign olma olasılıkları oldukça düşüktür. Vakum eşlikli biyopsi tekniği işlem sırasında ortaya çikabilecek kanama ve ağrı gibi komplikasyonlara lezyonun içerisinde müdahele şansı vermekte, bu sayede tedavi süresi ve boyutu büyümemektedir
Breast cancer has an important place among the most significant mortality and morbidity reasons for female population. The treatment of the disease is possible when the breast cancer is identified in the earliest period and relevant therapy applied afterwards. Because of the variety of biopsy techniques which are an important step in this subject the application techniques reveal differences. The technique of stereotactic vacuum assisted biopsy is one of the important steps which was made in this way and it adds subject to this study work.57 women patients, who underwent stereotactic vacuum assisted biopsy for microcalsifications determined in their breasts between the period March 2008 to May 2011, were added to the study work. The mammographic characteristics , BIRADS scores defined prior to biopsy and post-biopsy pathology results of these patients were retrospectively evaluated. Ages of patients who underwent biopsy ranged between 40 and 69, the average age was 50.8.Lesions were grouped with regards to BIRADS classification via pre-biopsy diagnostic procedures. 44 lesions (77.2%) were grouped under category 4, whereas 13 lesions (22.8%) under category 5 before the procedure.In order to justify the histopathological results obtained from patients who undergone stereotactic vacuum assisted biopsy these findings were evaluated with excisional biopsy, mammographic tracing and clinical follow-up. Follow up period was actualized to be 3-40 (25.9 on average) months.During the histopathological evaluation of 57 women patients who undergone biopsy31 lesions (54.4%) were evaluated as benign, whereas 26 lesions (45.6%) as malign. 9 (29%) of benign lesions received specific diagnosis, while 22 (71%) non-specific diagnosis. 22 (84%) of malign lesions were reported as DCİS.13 (29.5%) out of 44 lesions which were defined as category 4 prior to vacuum assisted biopsy process were reported as malign. All 13 (100%) lesions previously evaluated as category 5 were reported as malign. Based on these data, positive predictive value (PPV) for stereotactic vacuum assisted biopsy method was calculated to be 45.6%. The desirable margins for PPV are acceptable between 25-40%. Our results for applied biopsy method is within borderlines. We had 0% wrong negative results and 100% right positive results in our study work which are compatible with literature results.Vacuum assisted biopsy gives more tissue sampling compared to other biopsy methods. Due to such features diagnosis error probability decreases. Due to vacuum assisted biopsy method it?s possible to completely remove small breast lesions percutaneously and this helps to avoid unnecessary surgical procedures. Microcalsifications radiologically grouped as BIRADS category 3, can undergo biopsy in some special cases after necessary additional inspections, but radiologically the probability of being malignant is very low. Vacuum assisted biopsy gives opportunity of intervention inside lesion in case of possible complications like bleeding or pain which can occure while processing. The period and size of treatment is not growing then.
Breast cancer has an important place among the most significant mortality and morbidity reasons for female population. The treatment of the disease is possible when the breast cancer is identified in the earliest period and relevant therapy applied afterwards. Because of the variety of biopsy techniques which are an important step in this subject the application techniques reveal differences. The technique of stereotactic vacuum assisted biopsy is one of the important steps which was made in this way and it adds subject to this study work.57 women patients, who underwent stereotactic vacuum assisted biopsy for microcalsifications determined in their breasts between the period March 2008 to May 2011, were added to the study work. The mammographic characteristics , BIRADS scores defined prior to biopsy and post-biopsy pathology results of these patients were retrospectively evaluated. Ages of patients who underwent biopsy ranged between 40 and 69, the average age was 50.8.Lesions were grouped with regards to BIRADS classification via pre-biopsy diagnostic procedures. 44 lesions (77.2%) were grouped under category 4, whereas 13 lesions (22.8%) under category 5 before the procedure.In order to justify the histopathological results obtained from patients who undergone stereotactic vacuum assisted biopsy these findings were evaluated with excisional biopsy, mammographic tracing and clinical follow-up. Follow up period was actualized to be 3-40 (25.9 on average) months.During the histopathological evaluation of 57 women patients who undergone biopsy31 lesions (54.4%) were evaluated as benign, whereas 26 lesions (45.6%) as malign. 9 (29%) of benign lesions received specific diagnosis, while 22 (71%) non-specific diagnosis. 22 (84%) of malign lesions were reported as DCİS.13 (29.5%) out of 44 lesions which were defined as category 4 prior to vacuum assisted biopsy process were reported as malign. All 13 (100%) lesions previously evaluated as category 5 were reported as malign. Based on these data, positive predictive value (PPV) for stereotactic vacuum assisted biopsy method was calculated to be 45.6%. The desirable margins for PPV are acceptable between 25-40%. Our results for applied biopsy method is within borderlines. We had 0% wrong negative results and 100% right positive results in our study work which are compatible with literature results.Vacuum assisted biopsy gives more tissue sampling compared to other biopsy methods. Due to such features diagnosis error probability decreases. Due to vacuum assisted biopsy method it?s possible to completely remove small breast lesions percutaneously and this helps to avoid unnecessary surgical procedures. Microcalsifications radiologically grouped as BIRADS category 3, can undergo biopsy in some special cases after necessary additional inspections, but radiologically the probability of being malignant is very low. Vacuum assisted biopsy gives opportunity of intervention inside lesion in case of possible complications like bleeding or pain which can occure while processing. The period and size of treatment is not growing then.
Açıklama
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine, Biyopsi, Biopsy, Biyopsi-iğne, Biopsy-needle, Kalsifikasyon-fizyolojik, Calcification-physiologic, Meme, Breast, Meme muayenesi-kendi kendine, Breast self-examination, Meme neoplazmları, Breast neoplasms
