AI Summary & Key Takeaways
AI InsightConclusion: It was observed that during the four-year period of adaptation, the application rate of breast conserving surgery and SLNB reached accepted standards, and that both the technical problems encountered in SLNB and the requirement for re-excision after breast conserving surgery significantly decreased with increasing case volume and experience.
📌 3 Key Takeaways
Abstract
Objective: Minimally invasive surgery is increasingly gaining importance in breast surgery parallel to other surgical branches. Sentinel lymph node biopsy (SLNB) is a method that has radically changed the approach to breast surgery in the last decade of the 20th century. In this study, we aimed to evaluate the adaptation process to these alterations in breast surgery at our clinic. Material and Methods: Patients who underwent surgery with a diagnosis of breast cancer in our clinic between April 2010 and November 2013 were retrospectively evaluated in terms of demographic characteristics, the number of operations and type of surgical methods applied according to years, SLNB performance rate, and results of frozen section and histopathological analysis. The first year of SLNB practice was accepted as part of the learning curve, and 24 patients who were operated during that period underwent routine axillary dissection. Results: The median age of 198 patients who were included in the study was 55 years (25-89). It was detected that the number of cases who underwent surgery for breast cancer increased in years, that the SLNB application rate increased from 37% to 66% between 2010 and 2013 (p=0.01), and SLNB staining rates increased from 70% to 94% (p=0.03). When only results from the last four years were evaluated, the mean staining rate in patients with SLNB (n=105) was 88% (n=92), with positive histopathology in 32% of these cases (n=30). Despite a decreasing trend over the years, a metastatic axillary lymph node was detected in paraffin block evaluation in spite of negative frozen section examination of SLNB in five cases, and 5 patients (5%) out of 97 patients who underwent breast conserving surgery required re-excision. The histopathological diagnosis was invasive ductal carcinoma in 84% (n=167) of patients. Conclusion: It was observed that during the four-year period of adaptation, the application rate of breast conserving surgery and SLNB reached accepted standards, and that both the technical problems encountered in SLNB and the requirement for re-excision after breast conserving surgery significantly decreased with increasing case volume and experience.
Özet
Amaç: Minimal invaziv cerrahi tüm dallarda olduğu gibi meme cerrahisinde de giderek artan bir önem kazanmaktadır. Sentinel lenf nodu biyopsisi (SLNB) ise 20. yüzyılın son dekadında meme cerrahisine yaklaşımı kökten değiştirmiş bir yöntemdir. Bu çalışma ile kliniğimizin meme cerrahisindeki bu gelişimlere uyum sürecini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Nisan 2010-Kasım 2013 tarihleri arasında kliniğimizde meme kanseri tanısı ile ameliyat edilen hastalar; demografik özellikleri, yıllara göre ameliyat sayıları ve uygulanan yöntem, SLNB uygulanma oranı, frozen inceleme ve histopatolojik sonuçlar incelenerek retrospektif olarak değerlendirildi. SLNB uygulamasında ilk yıl ameliyat edilen 24 olgu öğrenim eğrisinde kabul edilip bu olgulara rutin olarak aksiller diseksiyon uygulandı.Bulgular: Çalışmaya dahil edilen 198 hastada ortanca yaş 55 idi. Çalışma süresince yıllara göre ameliyat edilen meme kanseri olgu sayısının arttığı, 2010'dan 2013'e SLNB uygulanma oranının %37'den %66'ya ulaştığı (p=0,01), SLNB boyanma oranlarının ise %70'ten %94'e ulaştığı görüldü (p=0,03). Son dört yıllık sürece bakıldığında ise SLNB uygulanan olgularda (n=105) ortalama boyanma oranı %88 (n=92) olup, bu olguların %32'sinde (n=30) pozitif histopatoloji saptandı. Yıllara göre azalmakla beraber toplam beş olguda SLNB frozen sonucu negatif olmasına rağmen parafin blok incelemede metastatik aksiller lenf nodu saptanırken, meme koruyucu cerrahi uygulanan 97 olgunun 5'inde (%5) yeniden eksizyon gerekti. Histopatolojik tanıda olguların %84'ü (n=167) invaziv duktal karsinom idi.Sonuç: Dört yıllık bu adaptasyon sürecinde meme koruyucu cerrahi ve SLNB uygulama oranının kabul edilen standartlara yaklaştığı, bununla beraber artan olgu hacmi ve tecrübe ile SLNB'de karşılaşılan teknik sorunların ve meme koruyucu cerrahi sonrası yeniden eksizyon gereksiniminin belirgin ölçüde azaldığı görüldü