Görüntüleme
9
İndirme
1
Amaç: Sentinel lenf nodu(SLN) biyopsisi prosedürü tümörün lenfatik sistem boyunca bir sıra içerisinde ilerlediği görüşünden gelişmiştir. SLN biyopsisinin uzun dönem terapötik kazancı henüz tam olarak aydınlanmamış olsa da bu prosedür lenfatik disseksiyon ve onun lenfödem gibi komplikasyonlarından korunulması gereken lenfatik metastazı olmayan hastaları, komple lenfadenektomi ve adjuvan kemoterapi gibi ek tedavilerden fayda görecek lenfatik metastazı olan hastalardan ayırmamızı sağlar. Bu çalışmada, lenfosintigrafi ile SLN biyopsisinin hasta yönetimindeki rolünü saptamayı amaçladık.Yöntemler: Çalışmamıza 25 cilt kanserli hasta (16 malign melanom, 9 epidermoid karsinom) dahil edildi. Operasyon günü tüm hastalara Tc-99m Nanokolloid intradermal enjeksiyon ile uygulandı. Preoperatif lenfosintigrafi sırasında sentinel lenf nodlarının derideki izdüşümleri işaretlendi. İşaretleme sonrası hastalar operasyona alındı. Cilt üzerinde izdüşümleri işaretlenmiş lenf nodları intraoperatif gama prob ile tespit edilip eksize edildi. Tüm sentinel nodlar histopatolojik inceleme için çıkartıldıktan sonra sentinel lenf nodlarının çıkartıldığı yataktaki rezidüel radyoaktivite sayımının rezeke edilen en yüksek aktiviteli nodun aktivitesinin %10’unun altına düşmesine dikkat edildi.Bulgular: Toplam 86 adet SLN, 54 adet non-SLN cerrahi olarak çıkartılıp, tüm nodlar histopatolojik inceleme için Patoloji Bölümüne gönderildi. Dört hastada sentinel lenf nodlarında metastaz tespit edildi. Bu hastalar geniş cerrahi için elektif şartlarda tekrar operasyona alındı.Sonuç:Lenfosintigrafi ve intraoperatif gamma prob ile lenfatik haritalama yöntemi yüksek bir spesifisite ve sensitivite oranına sahip olup morbiditeyi minimalize etmektedir. Bu yöntemin, mikrometastazları saptaması, olası metastaz yollarını ortadan kaldırması, evreleme ve adjuvan tedaviye yol göstermesi nedeniyle malign deri tümörlerinde rutin olarak uygulanması gereken bir yöntem olduğu düşünüldü.
Purpose: The procedure for the biopsy of the Sentinel lymphatic nodus (SLN) has been developed from the view that the tumor progresses in a row throughout the lymphatic system. Although the long-term therapeutic benefits of SLN biopsy are not yet fully illuminated, this procedure allows us to distinguish patients with lymphatic metastasis that must be protected from complications such as lymphatic dissection and its lymphodema from patients with lymphatic metastasis that will benefit from additional treatments such as complete lymphadenectomy and adjuvant chemotherapy. In this study, we aimed at determining the role of lymphosyntigraphy and SLN biopsy in patient management.Methods: Our study included 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma). On the day of operation, all patients were administered with Tc-99m Nanokolloid intradermal injection. During preoperative lymphosyntigraphy, the skin of the sentinel lymphatic nodes was marked. Patients were taken to surgery after the signing. The lymphatic nodes marked with scratches on the skin were detected and exhausted by the intraoperative gamma prob. After all the sentinel nodes were removed for histopathological examination, the number of residual radioactivity in the bed where the sentinel lymph nodes were removed was scratched, the activity of the high-activity nodes was observed to fall below 10% of the activity of the postpartum nodes.The results: A total of 86 SLNs, 54 non-SLNs were removed for surgery, and all nodes were sent to the Department of Pathology for histopathological examination. In four patients metastases were detected in the sentinel lymph nodes. These patients were re-operated in elective conditions for extensive surgery. The result:Lenfosyntigraphic and intraoperative gamma prob with the lymphatic maping method has a high specificity and sensitivity rate, minimizing morbidity. This method was thought to be a method that should be used routine in malignant skin tumors because it detects micrometastases, eliminates possible metastases, leads to evolution and adjuvant treatment.
Objective:Sentinel lymph node (SLN) biopsy procedure is developed from the view that the tumor progresses in a row through the lymphatic system. Although the long-term therapeutic benefit of SLN biopsy has not yet been fully elucidated, this procedure allows us to differentiate patients without lymphatic metastasis who need to be protected from complications such as lymphatic dissection and its lymphedema from patients with lymphatic metastasis who may benefit from additional therapies such as complete lymphadenectomy and adjuvant chemotherapy. In this study, we aimed to determine the role of lymphoscintigraphy in patient management of SLN biopsy. Methods: 25 skin cancer patients (16 malignant melanoma, 9 epidermoid carcinoma) were included in the study. Tc-99m Nanocolloid intradermal injection was applied to all patients on the day of operation. The projections of the sentinel lymph nodes on the skin were marked during preoperative lymphoscintigraphy. Patients were taken into operation after the marking. The lymph nodes with projections on the skin were detected by intraoperative gamma probe and excised. After removing all the sentinel nodes for histopathological examination, care was taken to reduce the residual radioactivity count in the bed, where sentinel lymph nodes were removed, to less than 10% of the activity of the most active activity of the resected node. Results: A total of 86 SLNs and 54 non-SLNs were surgically removed and all nodes were sent to the Department of Pathology for histopathological examination. Four patients had metastases in sentinel lymph nodes. These patients were reoperated under elective conditions for extensive surgery. Conclusion: Lymphatic mapping method with lymphoscintigraphy and intraoperative gamma probe have a high specificity and sensitivity ratio and minimize the morbidity. This method was thought to be a routine procedure in malignant skin tumors because of its determination of micrometastases, eliminating possible metastasis pathways, staging and guiding adjuvant therapy.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
Makale Detay 
Benzer Makaleler
PDF Görüntüle
Dergi Bilgisi
Eseri Dinleyin
Alıntı Yap
Bu Sayfayı Yazdırın
Paylaş
Mendeley
