Meme kanserli hastalarda preoperatif sentinel lenf nodu tutulumunu tahmin etmede kullanılan nomogramlar ile klinik, PET/BT bulguları ve laboratuvar parametrelerinin etkinliklerinin karşılaştırılması
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmada meme kanseri tanısı alan hastalarda preoperatif sentinel lenf nodu tutulumunu tahmin etmede kullanılan nomogramlar ile klinik bulgular, PET/BT görüntüleme ve laboratuvar parametrelerinin etkinliklerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Kliniği'ne 2015 - 2020 yılları arasında histopatolojik olarak meme kanseri tanısı almış kadın hastalar retrospektif olarak tarandı. Tanı anında uzak metastazı olmayan, ultrasonografik görüntüleme sonucuna sahip olup PET/BT çekimi yapılmış, sentinel lenf nodu biyopsisi uygulanmış ve bilgilerine hastane bilgisayar veri tabanından eksiksiz olarak ulaşılabilen hastalar çalışmaya dahil edildi. Neoadjuvan tedavi sonrası sentinel lenf nodu biyopsisi yapılan hastalar çalışma dışı bırakıldı. Laboratuvar parametreleri (PLR, NLR, LMR ve MPR) ameliyat öncesi 24 saat içinde alınan tam kan sayımından hesaplandı. Nomogramlardan MSKCC yöntemi kullanıldı. Hastalar sentinel lenf nodu pozitif ve negatif olmak üzere gruplandırıldı. Elde edilen tüm veriler istatistiksel testler ile karşılaştırıldı. Bulgular: Çalışmaya dünya genelinde etkili olan koronavirüs (COVİD-19) pandemisi nedeniyle toplam 48 hasta dahil edildi. Aksilla pozitifliği bakımından fizik muayene, USG ve PET/BT bulguları ile patoloji sonucu arasında istatistiksel olarak anlamlı ilişki bulundu (sırasıyla p<0.001, p=0.005 ve p=0.002). Aksillanın SUVmax değerinin SLNB sonucu pozitif hastalarda, negatif olanlara göre istatistiksel olarak anlamlı derecede daha yüksek olduğu görüldü (2.90±3.46 vs. 0.66±1.86, p=0.004). Laboratuvar parametrelerinden PLR, NLR, LMR ve MPR oranları SLNB pozitif grupta daha yüksek olsa da istatiksel olarak anlamlı bulunmadı (sırasıyla p=0,683, p=0,6, p=0,948 ve p=0,354). MSKCC nomogram değerleri SLNB pozitifliğini göstermede daha yüksek bulunsa da bu sonuçlar istatiksel olarak anlamlı değildi (p=0,243). Sonuç: Meme kanseri tanısı alan hastalarda aksiller tutulum durumu halen klinisyenlerin en çok ilgilendiği alanların başında gelmektedir. Günümüzde radikal cerrahilerin yerine minimal invaziv cerrahi stratejisinin yerleştiği meme kanserinde aksillanın daha kolay ve daha az invaziv yöntemlerle değerlendirilmesi önem arz etmektedir. Çalışmamızda da görülmüştür ki klinik, laboratuvar, PET/BT görüntüleme ve nomogramların tek başına aksiller tutulum hakkındaki öngörüsü sınırlıdır. Ancak bunların hepsinin birleştirildiği yeni bir algoritmanın bu konuda daha iyi sonuçlar vereceğini düşünmekteyiz. Anahtar Kelimeler: laboratuvar parametreleri, meme kanseri, nomogram, PET/BT, sentinel lenf nodu.
Background: The aim of the study was to compare the efficacy of nomograms used to predict preoperative sentinel lymph node involvement in patients diagnosed with breast cancer, and clinical findings, PET/CT imaging and laboratory parameters. Material and Methods: Female patients who were diagnosed with histopathological breast cancer in Bolu Abant İzzet Baysal University Medical Faculty Hospital General Surgery Clinic between 2015 and 2020 were retrospectively screened. Patients who did not have distant metastases at the time of diagnosis, had ultrasonographic imaging results, had PET/CT scans, had sentinel lymph node biopsy, and whose information could be fully accessed from the hospital computer database were included in the study. Patients who underwent sentinel lymph node biopsy after neoadjuvant therapy were excluded from the study. Laboratory parameters (PLR, NLR, LMR and MPR) were calculated from the complete blood count taken within 24 hours before surgery. MSKCC method was used from nomograms. The patients were grouped as sentinel lymph node positive and negative. All obtained data were compared with statistical tests. Results: A total of 48 patients were included in the study due to the coronavirus (COVID-19) pandemic, which is effective worldwide. A statistically significant correlation was found between physical examination, USG and PET/CT findings in terms of axilla positivity and pathology result (p<0.001, p=0.005 and p=0.002). The SUVmax value of the axilla was found to be statistically significantly higher in patients with positive SLNB results than in patients with negative results (2.90±3.46 vs. 0.66±1.86, p=0.004). Although the rates of PLR, NLR, LMR and MPR among the laboratory parameters were higher in the SLNB positive group, they were not statistically significant (p=0.683, p=0.6, p=0.948 and p=0.354). Although MSKCC nomogram values were higher in showing SLNB positivity, these results were not statistically significant (p=0.243). Conclusion: Axillary involvement in patients diagnosed with breast cancer is still one of the areas that clinicians are most interested in. Nowadays, it is important to evaluate the axilla with easier and less invasive methods in breast cancer, in which the minimally invasive surgical strategy is replaced by radical surgery. It was also seen in our study that clinical, laboratory, PET/CT imaging and nomograms alone have limited predictions about axillary involvement. However, we think that a new algorithm combining all of these will give better results in this regard. Keywords: laboratory parameters, breast cancer, nomogram, PET/CT, sentinel lymph node.
Background: The aim of the study was to compare the efficacy of nomograms used to predict preoperative sentinel lymph node involvement in patients diagnosed with breast cancer, and clinical findings, PET/CT imaging and laboratory parameters. Material and Methods: Female patients who were diagnosed with histopathological breast cancer in Bolu Abant İzzet Baysal University Medical Faculty Hospital General Surgery Clinic between 2015 and 2020 were retrospectively screened. Patients who did not have distant metastases at the time of diagnosis, had ultrasonographic imaging results, had PET/CT scans, had sentinel lymph node biopsy, and whose information could be fully accessed from the hospital computer database were included in the study. Patients who underwent sentinel lymph node biopsy after neoadjuvant therapy were excluded from the study. Laboratory parameters (PLR, NLR, LMR and MPR) were calculated from the complete blood count taken within 24 hours before surgery. MSKCC method was used from nomograms. The patients were grouped as sentinel lymph node positive and negative. All obtained data were compared with statistical tests. Results: A total of 48 patients were included in the study due to the coronavirus (COVID-19) pandemic, which is effective worldwide. A statistically significant correlation was found between physical examination, USG and PET/CT findings in terms of axilla positivity and pathology result (p<0.001, p=0.005 and p=0.002). The SUVmax value of the axilla was found to be statistically significantly higher in patients with positive SLNB results than in patients with negative results (2.90±3.46 vs. 0.66±1.86, p=0.004). Although the rates of PLR, NLR, LMR and MPR among the laboratory parameters were higher in the SLNB positive group, they were not statistically significant (p=0.683, p=0.6, p=0.948 and p=0.354). Although MSKCC nomogram values were higher in showing SLNB positivity, these results were not statistically significant (p=0.243). Conclusion: Axillary involvement in patients diagnosed with breast cancer is still one of the areas that clinicians are most interested in. Nowadays, it is important to evaluate the axilla with easier and less invasive methods in breast cancer, in which the minimally invasive surgical strategy is replaced by radical surgery. It was also seen in our study that clinical, laboratory, PET/CT imaging and nomograms alone have limited predictions about axillary involvement. However, we think that a new algorithm combining all of these will give better results in this regard. Keywords: laboratory parameters, breast cancer, nomogram, PET/CT, sentinel lymph node.
Açıklama
Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı
Anahtar Kelimeler
Genel Cerrahi, General Surgery
