Meme duktal karsinoma insitu hastalarında nüksle ilişkili klinik ve patolojik özelliklerin değerlendirilmesi
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Tarih
2023
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç : Tıbbi onkoloji kliniğimizde meme duktal karsinoma insitu tanısıyla takip edilmekte olan hastaların arşiv dosyalarında kayıtlı klinik ve patolojik özellikleri değerlendirmek ve bu özelliklerin nüks ile ilişkilerinin tespit edilmesi amaçlanmıştır.
Yöntem: Çalışmamıza yaklaşık 6000 meme kanseri tanılı hastanın sistem dosyası taranarak en az 2 sene takip edilmiş duktal karsinoma insitu (DCİS) hastaları dahil edilmiştir. Bu 6000 dosya sistemde 21 tane farklı tanı kodu ile taranmıştır. Nihai olarak 44 hasta DCİS olarak bulunmuştur. Bu hastaların patoloji raporlarından ve dosyalarından östrojen ve progesteron reseptör durumu, ki-67 yüzdesi , cerbb2 durumu, lezyon boyutu ve grade’i, nekroz varlığı, lezyonun patolojik varyantı, kalsifikasyon varlığı ve çeşidi, operasyon tipi, sentinel lenf nodu biyopsisi durumu, radyoterapi alıp almadığı, hormonoterapi alıp almadığı, takipte nüks zamanı ve nüks gelişen hastaların nüks ile ilişkili olabilecek klinik ve patolojik özelliklerine bakılmıştır.
Bulgular: Meme DCİS tanılı hastaların %56,8’ine (n=25) mastektomi operasyonu yapıldığı, %43,2’sine (n=19) meme koruyucu cerrahi (MKC) yapıldığı saptandı. Bu olguların %65,9’una (n=29) radyoterapi (RT) verilmediğini, %34,1’ine (n=15) RT verildiğini tespit ettik. Hastaların %38,6’sına (n=17) hiçbir hormon tedavisi verilmediği tespit edilirken, %40,9’u (n=18) tamoksifen almıştı, %9,1’i (n=4) aromataz inhibitörü almıştı, %11,4’ü ise (n=5) tamoksifen ve aromataz inhibitörünü sıralı olarak almıştı. Hormon tedavisi verilen 27 hastanın hormonoterapi süresi ortalama 3,65 ± 1,76 yıl olarak saptandı. Olguların %50,0’ında (n=22) sentinel lenf nodu biyopsisi yapılmamışken, %45,0’ında (n=20) sentinel lenf nodu biyopsisi yapılmıştı. Sentinel lenf nodu biyopsisi yapılan 20 hastanın da biyopsi sonucu negatifti. Hastaların %52,3’üne (n=23) aksiler lenf nodu diseksiyonu yapılmadığı, %38,6’sına (n=17) aksiler lenf nodu diseksiyonu yapıldığı saptandı. Aksiller diseksiyon yapılan hastaların lenf nodlarında pozitiflik saptanmadı. Hastaların %4,5’inde (n=2) nüks tespit edilirken bu hastaların birinde 2 yıl içinde, diğerinde 8 yılda nüks olduğu kaydedildi. Erken nüks olan hastada tümör boyutu 5,5 cm idi ve hastaya mastektomi yapılmıştı. Hasta bu operasyon sonrası RT ve hormonoterapi almamıştı, östrojen ve progesteron reseptörü negatifti, Cerbb2’si (+++) olarak raporlanmıştı. Hasta operasyondan 2 sene sonra nüks etmişti. 8 sene sonra nüks olan diğer hastamızda ise tümör boyutu 1 cm idi ve gradı 3 idi, MKC operasyonundan sonra hasta RT ve 5 sene tamoksifen almış daha sonra ilaçsız izleme alınmıştı ve bu süreçte nüks etmişti. Nüks olan iki hastanında nüks tipi invaziv kanserdi. Nüks yeri ikisinde de lokal olarak memedeydi.
Sonuç: Çalışmamızda DCİS tanısı ile takipli hastaların sadece ikisinde nüks saptandı. Nüks eden hasta sayımız az olduğu için nüks ile ilişkili olabilecek faktörler üzerine ek analiz yapamadık. Nüks ile ilişkili durumların analizi için daha geniş hasta sayısını içeren çalışmalara ihtiyaç vardır.
Objective: It was aimed to evaluate the clinical and pathological features recorded in the archive files of patients who are being followed up with the diagnosis of breast ductal carcinoma in situ in our medical oncology clinic and to determine the relationship of these features with recurrence. Method: In our study, the system files of approximately 6000 patients diagnosed with breast cancer were scanned and ductal carcinoma insitu (DCIS) patients who were followed up for at least 2 years were included. These 6000 files were scanned in the system with 21 different diagnosis codes. Ultimately, 44 patients were found to have DCIS. From the pathology reports and files of these patients, estrogen and progesterone receptor status, Ki-67 percentage, CerBB2 status, lesion size and grade, presence of necrosis, pathological variant of the lesion, presence and type of calcification, operation type, sentinel lymph node biopsy status, whether they received radiotherapy or not. Whether the patient received hormonal therapy, time to recurrence during follow-up, and clinical and pathological characteristics of the patients who developed recurrence that may be related to recurrence were examined. Results: It was determined that 56.8% (n=25) of the patients diagnosed with breast ductal carcinoma in situ underwent mastectomy and 43.2% (n=19) underwent breast-conserving surgery. It was noted that 65.9% (n=29) of these cases were not given radiotherapy, and 34.1% (n=15) were given radiotherapy. It was determined that 38.6% (n=17) of the cases were not given any hormone therapy, 40.9% (n=18) were given tamoxifen, 9.1% (n=4) were given aromatase inhibitors, 11.4% were given no hormone therapy. It was determined that (n=5) tamoxifen and aromatase inhibitor were given sequentially. The average duration of hormonal therapy for 27 patients given hormone therapy was recorded as 3.65 ± 1.76 years. While sentinel lymph node biopsy could not be performed in 50.0% (n=22) of the cases, sentinel lymph node biopsy was performed in 45.0% (n=20). The biopsy results of 20 patients who underwent sentinel lymph node biopsy were interpreted as negative. It was determined that 52.3% (n=23) of the patients did not undergo axillary lymph node dissection, and 38.6% (n=17) underwent axillary lymph node dissection. No positivity was detected in the lymph nodes of patients who underwent axillary dissection. While recurrence was detected in 4.5% (n=2) of the patients, it was noted that one of these patients had a recurrence within 2 years and the other within 8 years. In the patient with early recurrence, the tumor size was 5.5 cm and mastectomy was performed. The patient did not receive RT or hormonotherapy after this operation. Estrogen and progesterone receptors were negative. Cerbb2 was reported as (+++). The patient relapsed 2 years after the operation. In our other patient, who had a recurrence in 8 years, the tumor size was 1 cm and the lesion was grade 3. After the BCS operation, the patient received RT and tamoxifen for 5 years, and then was monitored without medication, and he relapsed during this period. In 2 patients with recurrence, the type of recurrence was determined as invasive cancer. The site of recurrence was locally in the breast in both cases. Conclusion: In our study, we found that the number of recurrences was only 2 in patients diagnosed with ductal carcinoma in situ. Since our number of patients with relapse was low, we did not conduct additional analysis on factors that may be associated with relapse. Studies involving larger numbers of patients are needed to analyze relaps-related conditions.
Objective: It was aimed to evaluate the clinical and pathological features recorded in the archive files of patients who are being followed up with the diagnosis of breast ductal carcinoma in situ in our medical oncology clinic and to determine the relationship of these features with recurrence. Method: In our study, the system files of approximately 6000 patients diagnosed with breast cancer were scanned and ductal carcinoma insitu (DCIS) patients who were followed up for at least 2 years were included. These 6000 files were scanned in the system with 21 different diagnosis codes. Ultimately, 44 patients were found to have DCIS. From the pathology reports and files of these patients, estrogen and progesterone receptor status, Ki-67 percentage, CerBB2 status, lesion size and grade, presence of necrosis, pathological variant of the lesion, presence and type of calcification, operation type, sentinel lymph node biopsy status, whether they received radiotherapy or not. Whether the patient received hormonal therapy, time to recurrence during follow-up, and clinical and pathological characteristics of the patients who developed recurrence that may be related to recurrence were examined. Results: It was determined that 56.8% (n=25) of the patients diagnosed with breast ductal carcinoma in situ underwent mastectomy and 43.2% (n=19) underwent breast-conserving surgery. It was noted that 65.9% (n=29) of these cases were not given radiotherapy, and 34.1% (n=15) were given radiotherapy. It was determined that 38.6% (n=17) of the cases were not given any hormone therapy, 40.9% (n=18) were given tamoxifen, 9.1% (n=4) were given aromatase inhibitors, 11.4% were given no hormone therapy. It was determined that (n=5) tamoxifen and aromatase inhibitor were given sequentially. The average duration of hormonal therapy for 27 patients given hormone therapy was recorded as 3.65 ± 1.76 years. While sentinel lymph node biopsy could not be performed in 50.0% (n=22) of the cases, sentinel lymph node biopsy was performed in 45.0% (n=20). The biopsy results of 20 patients who underwent sentinel lymph node biopsy were interpreted as negative. It was determined that 52.3% (n=23) of the patients did not undergo axillary lymph node dissection, and 38.6% (n=17) underwent axillary lymph node dissection. No positivity was detected in the lymph nodes of patients who underwent axillary dissection. While recurrence was detected in 4.5% (n=2) of the patients, it was noted that one of these patients had a recurrence within 2 years and the other within 8 years. In the patient with early recurrence, the tumor size was 5.5 cm and mastectomy was performed. The patient did not receive RT or hormonotherapy after this operation. Estrogen and progesterone receptors were negative. Cerbb2 was reported as (+++). The patient relapsed 2 years after the operation. In our other patient, who had a recurrence in 8 years, the tumor size was 1 cm and the lesion was grade 3. After the BCS operation, the patient received RT and tamoxifen for 5 years, and then was monitored without medication, and he relapsed during this period. In 2 patients with recurrence, the type of recurrence was determined as invasive cancer. The site of recurrence was locally in the breast in both cases. Conclusion: In our study, we found that the number of recurrences was only 2 in patients diagnosed with ductal carcinoma in situ. Since our number of patients with relapse was low, we did not conduct additional analysis on factors that may be associated with relapse. Studies involving larger numbers of patients are needed to analyze relaps-related conditions.
Açıklama
Anahtar Kelimeler
Meme kanseri, duktal karsinoma insitu, radyoterapi, mastektomi, hormonoterapi
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yılmaz, M. Ş. (2023). Meme duktal karsinoma insitu hastalarında nüksle ilişkili klinik ve patolojik özelliklerin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
