Sentinel lenf nodu pozitif hastalarda nonsentinel lenf nodu pozitifliğine etki eden faktörler
Yükleniyor...
Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç:Meme kanserinin cerrahi tedavisinde sentinel lenf nodu biyopsisi (SLNB) prosedürü,
aksiller lenf nodudiseksiyonuna (ALND) alternatif olarak geliştirilmiş ve düşük morbidite
ile güvenli bir evreleme yöntemidir.Bu çalışmada meme kanseri tanısı ile başvuran ve sentinel
lenf nodu pozitif olan hastalarda nonsentinel lenf nodu pozitifliğine etki eden faktörlerin neler
olduğu belirlenmesi amaçlanmıştır.
Yöntem: Bu çalışma Ege Üniversitesi Tıp Fakültesi Genel Cerrahi AnabilimDalı’nda Haziran
2003-Ocak 2016 yılları arasında erken evre aksalla negatif meme kanseri nedeniyle sentinel
lenf nodu biyopsisi uygulanan 17-87 yaş aralığındaki 2060 hasta retrospektif olarak tarandı.
54 hastanın patoloji sonuçlarında eksik veriler bulunmasından dolayı çalışmaya toplam 2006
hasta dahil edildi.Çalışmada yeralan 2006 hastanın sentinel lenf nodu sonucu 1474’ü benign,
submikrometastaz; 532’si mikrometastaz, makrometastaz olarak raporlandı. 403 hastaya
aksillerdiseksiyon uygulandı.23 hastanın SLN sonucu yalancı negatif olması üzerine 380
hasta nonsentinel lenf nodu pozitifliği açısından değerlendirildi. 219 hastanın nonsentinel
negatif, 161 hastanın nonsentinel pozitif olduğu görüldü. Hastalara çeşitli tümör bağımlı
parametreler çalışıldı. Hasta yaşı, tümör boyutu, tümör bölgesi, histolojik tipi, luminal
sınıflandırma, metastaz varlığı ve boyutu, östrojen-progesteron reseptör statüsü, P53, Ki-67,
Cerb-2, nükleer derece, modifiyeBloom-Richardson Skor (MBRS), metastatik odak yarıçapı,
AD sırasında disseke edilen lenf nodu sayısı bakıldı.Çalışmada toplanan verilerin analizi,
istatistiksel yazılım paketi SPSS 23 (Statistical PackagefortheSocialSciences – IBM®)
kullanılarak yapıldı. İstatistiksel anlamlılık düzeyini belirlemek için, %95 güven aralığında ve
p<0,05 anlamlı kabul edildi.
Bulgular: Çalışma kriterlerine uyan 2006 meme kanseri hastası çalışmaya dahil edilmiştir.
Benign+Submikrometastaz olan hastaların %48,6’sı 50 yaş ve üzeri, %51,4’u 50 yaş altı
hastalar olduğu saptanmıştır. Mikrometastaz+Makrometastaz olan hastaların %51,6’sı 50 yaş
ve üzeri, %48,4’u 50 yaş altı hastalar olduğu tespit edilmiştir. En küçük yaş 17 olurken en
büyük yaş 87 olarak bulunmuştur. Araştırmada yer alan hastaların yaş ortalaması 51,76’dır.
Çalışmada non SLN noddurumu ile yaş, tümör çapı, tümör tipi, Öströjen Reseptörü,
Progesteron Reseptörü, P53 Geni, Ki67 Reseptörü, MBRS Reseptörü veMultifokalite Durumu
arasında istatistiksel olarak anlamlı bir ilişki saptanmamıştır ( p>0,05). Fakat non SLN nod
durumu ileLenfovaskulerİnvazyon, ModifiyeBloom Richard Grupları,Cerb-2 reseptörü
veLuminal Gruplarıarasında istatistiksel olarak anlamlı bir ilişki saptanmıştır (p<0,05).
Sonuç: Sonuç olarak; çalışmanın tamamlandığı ve nonsentinel lenf nodu pozitifliğini, tümör
çapının artışı, lenfovaskülerinvazyon olması, yüksek nükleer grade ve progesteron reseptör
pozitifliği artırdığı sonucuna varılmıştır. Nonsentinel lenf nodu pozitif hastalar
aksillerdiseksiyondanterapötik fayda görürken, nonsentinel lenf nodu negatif hastalar net bir
fayda görememektedir.
Objective: Sentinellymph node biopsy (SLNB) procedure has been developed as an alternative to axillarylymphnodedissection (ALND) in the surgical treatment of breast cancer and is a safe method of staging with low morbidity. In this study, it was aimed to determine the factors affecting the positivity of the nonsentinellymph node in patients with breast cancer diagnosis and sentinellymph node positive. METHODS: This study was retrospectively performed on 2060 patients between the ages of 17- 87 years who under went sentinellymph node biopsy due to early stage axal negative breast cancer between June 2003 and January 2016 in Ege University Medical Faculty General Surgery Department. A total of 2006 patients were enrolled in the study because of the missing data in the pathology results of 54 patients. In the study, 2006 patient sentinellymph node resultant 1474 was diagnosed as benign, submicrometastasis; 532 were reported as micrometastases, macrometastases. 403 patients were treated with axillary dissection. 38 patients were assessed for non sentinellymph node positivity when the SLN result was false negative in 23 patients. 219 patients were negative for nonsentineland 161 patients were positive for nonsentinel. Varioustumor-dependent parameters were studied in the disease. P53, Ki-67, Cerb-2, nuclear grade, modified Bloom-Richard son Score (MBRS), metastatic focus, tumor size, tumor size, histologic type, luminal classification, metastasis presence and size, estrogen-progesterone receptor statusThe radius, and the number of nodes dissected during AD were measured. Analysis of the data collected in the study was made using statistical software package SPSS 23 (Statistical Package for theSocial Sciences - IBM®). To determine the statistical significance level, 95% confidence intervaland p <0.05 were considered significant. Results: 2006 breast cancer patients meeting the study criteria were included in the study. 48.6% of the patients with benign + submychrometastas is were found to be over 50 years old and 51.4% were under 50 years old. 51.6% of patients with micrometastasis + macrometastasis were found to be over 50 years old and 48.4% were under 50 years old. The younge stage was 17 years and the large stage was 87 years. The average age of the patients in the study is 51.76. There was no statistically significant relationship between non SLN node status and age, tumor diameter, tumor type, estrogenreceptor, progesterone receptor, p53 genotype, Ki67 receptor, MBRS receptor and multifocal status in the study (p> 0,05). However, there was a statistically significant relationship between non-SLN node status and Lymphovascular Invasion, Modified Bloom Richard Group, Cerb-2 receptor and Luminal Group (p <0.05). Conclusion: As a result; The result of the study was complete and resulted in a positive nonsentinellymph node, increased tumor diameter, lymphovascular invasion, increased high nuclear grade and progester one receptor positivity. Nonsentinellymph node positive patients have the rapeutic benefit fromaxillary dissection, where as negative patients with non-nonsentinellymph node have no clear benefit.
Objective: Sentinellymph node biopsy (SLNB) procedure has been developed as an alternative to axillarylymphnodedissection (ALND) in the surgical treatment of breast cancer and is a safe method of staging with low morbidity. In this study, it was aimed to determine the factors affecting the positivity of the nonsentinellymph node in patients with breast cancer diagnosis and sentinellymph node positive. METHODS: This study was retrospectively performed on 2060 patients between the ages of 17- 87 years who under went sentinellymph node biopsy due to early stage axal negative breast cancer between June 2003 and January 2016 in Ege University Medical Faculty General Surgery Department. A total of 2006 patients were enrolled in the study because of the missing data in the pathology results of 54 patients. In the study, 2006 patient sentinellymph node resultant 1474 was diagnosed as benign, submicrometastasis; 532 were reported as micrometastases, macrometastases. 403 patients were treated with axillary dissection. 38 patients were assessed for non sentinellymph node positivity when the SLN result was false negative in 23 patients. 219 patients were negative for nonsentineland 161 patients were positive for nonsentinel. Varioustumor-dependent parameters were studied in the disease. P53, Ki-67, Cerb-2, nuclear grade, modified Bloom-Richard son Score (MBRS), metastatic focus, tumor size, tumor size, histologic type, luminal classification, metastasis presence and size, estrogen-progesterone receptor statusThe radius, and the number of nodes dissected during AD were measured. Analysis of the data collected in the study was made using statistical software package SPSS 23 (Statistical Package for theSocial Sciences - IBM®). To determine the statistical significance level, 95% confidence intervaland p <0.05 were considered significant. Results: 2006 breast cancer patients meeting the study criteria were included in the study. 48.6% of the patients with benign + submychrometastas is were found to be over 50 years old and 51.4% were under 50 years old. 51.6% of patients with micrometastasis + macrometastasis were found to be over 50 years old and 48.4% were under 50 years old. The younge stage was 17 years and the large stage was 87 years. The average age of the patients in the study is 51.76. There was no statistically significant relationship between non SLN node status and age, tumor diameter, tumor type, estrogenreceptor, progesterone receptor, p53 genotype, Ki67 receptor, MBRS receptor and multifocal status in the study (p> 0,05). However, there was a statistically significant relationship between non-SLN node status and Lymphovascular Invasion, Modified Bloom Richard Group, Cerb-2 receptor and Luminal Group (p <0.05). Conclusion: As a result; The result of the study was complete and resulted in a positive nonsentinellymph node, increased tumor diameter, lymphovascular invasion, increased high nuclear grade and progester one receptor positivity. Nonsentinellymph node positive patients have the rapeutic benefit fromaxillary dissection, where as negative patients with non-nonsentinellymph node have no clear benefit.
