South Clin Ist Euras. Ahead of Print: SCIE-57625 | DOI: 10.14744/scie.2021.57625

Our Axilla Approach Following Neoadjuvant Chemotherapy In Breast Cancer Patients With Axillary Involvement

Muhammet Fikri Kündeþ
Kartal Dr Lütfi Kýrdar City Hospital Generaly Surgery Clinic Ýstanbul

INTRODUCTION: The aim of this article is to determine the condition of the breast cancer patient’s axilla after neoadjuvant chemotherapy (NACT) with PET/CT and to evaluate our approach to the axilla after sentinel lymp node biopsy (SLNB) and to examine the axillary lymph node dissection and its results in the light of the literatüre.
METHODS: : Between 2016 and 2019 in Dr Lütfi Kýrdar Kartal City Hospital, 100 women patients who were diagnosed with breast cancer and operated after NACT were evaluated retrospectively. Patients were evaluated in terms of tumor size,stage, presence or absence of axillary involvement before and after NACT; age,operation performed, follow-up time, recurrence and pathological status of the axilla and mass.
RESULTS: In this study, our mean age was 53.4 ± 11(26/75). The mean tumor diameter before NAC T was 29.06 ± 13mm (10-80mm), after NACT it was 13.42 ± 17mm (0-80mm)(P<0001). The mean tumor diameter in the pathogen specimen was 14.91 ± 19mm (0-80mm). Before NACT 36 of our patients were Stage III, 64 were Stage II. After NACT; 79 of our patients were downstage (p<0.001), 18 patients did not change in stage and 3 patients progressed from stage II to III. Pathological complete response (pCR) was obtained in a total of 34 patients (38%). Before NACT, all patients had axillary lymph node (LN) positivity clinically and imaging. SLNB was negative in 51 of 100 patients who underwent SLNB and positive in 49 patients. After axillary lymph node dissection of positive patients, it was seen that positive lymph nodes of 25 patients were removed by SLNB. Metastasis to other lymph nodes was also detected in 24 patients

DISCUSSION AND CONCLUSION: We evaluated that it would be appropriate to consider NACT in breast cancer and it would be appropriate to make a surgical decision for axilla after SLNB.

Keywords: Breast cancer, Neoadjuvant chemotherapy, Sentinel Lenf Nodu, Aksiller Dissection

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AksillaTutulumu Olan Meme Kanseri Hastalarýnda Neoadjuvant Kemoterapi Sonrasý Aksillaya Yaklaþýmýmýz

Muhammet Fikri Kündeþ
Kartal Dr Lütfi Kýrdar Þehir Hastanesi Genel Cerrahi Kliniði Ýstanbul

GÝRÝÞ ve AMAÇ: : Bu yazýnýn amacý meme kanseri nedeni ile neoadjuvant kemoterapi( NAKT) gören hastalarýn aksillalarýnýn durumunu PET/BT ile deðerlendirmek ve sentinel lenf nodu biopsisi (SLNB) ile aksillaya yaklaþýmýmýzý ve aksiler lenf nodu diseksiyonunu ve sonuçlarýný literatür eþliðinde irdelemek.
YÖNTEM ve GEREÇLER: : 2016-2019 yýllarý arasýnda Kartal Dr Lütfi Kýrdar Þehir Hastanesinde meme kanseri tanýsý alýp NAKT sonrasý opere edilen 100 kadýn hasta retrospektif olarak deðerlendirildi. Hastalar yaþ; NAKT öncesi tümör çapý, evre, aksiler tutulum olup olmamasý,;NAKT sonrasý tümör çapý,evresi,aksilla durumu, yapýlan operasyon ve operasyon sonucu patolojik olarak aksilla ve kitle durumu,takip süresi, nüks, açýsýndan deðerlendirildi.
BULGULAR: Bu çalýþmamýzda, yaþ ortalamamýz 53.4±11 idi(26/75). Hastalarýmýzýn neoadjuvant kemoterapi (NAKT) öncesi tümör çapý ortalamasý 29.06±13mm (10-80mm), NAKT sonrasý tümör çapý 13,42±17mm(0-80mm)(P<0.001). Patojoli spesmeninde ise tümör çapý ortalamsý 14,91±19mm(0-80mm)idi. NAKT öncesi hastalarýmýzýn 36 si Evre III, 64 ü Evre II idi.NAKT sonrasý;79 hastamýzýn evresi geriledi(P<0.001),18 hastamýzda evre gerilemesi olmadý,3 hastamýzýn ise evresi II den III e ilerledi. Toplam 34 hastamýzda(38%) patolojik tam yanýt (pCR) elde edildi. NAKT öncesi bütün hastalarda klinik ve görüntüsel olarak aksillar lenf nodu(LN) pozitifliði vardý. NAKT sonrasý SLNB yapýlan 100 hastanýn 51 inde SLNB negatif,49 hastada pozitif idi. Pozitif gelen hastalarýn aksiler diseksiyonundan sonra 25 hastanýn pozitif lenf nodunun SLNB ile çýkarýlmýþ olduðu görüldü. 24 hastada ise diðer lenf nodlarýnda da yayýlým vardý.
TARTIÞMA ve SONUÇ: Meme kanserinde NAKT in dikkate alýnmasý ve aksilla için SLNB sonrasý cerrahi karar vermenin uygun olacaðýný deðerlendirdik.

Anahtar Kelimeler: Meme kanseri, Neoadjuvant kemoterapi, Sentinel Lenf Nodu, Aksiller Diseksiyon

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