Dudak yassı epitel hücreli kanserlerinde gama prob yardımlı sentinel lenf nodu örneklemesi ve lenf nodu haritalaması
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Dosyalar
Tarih
2013
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Olumsuz çevresel faktörler ve tütün mamullerinin kullanımındaki artış dudak tümörlerinin görülme sıklığını arttırmaktadır. Baş ve boyun kanserlerinin %90'ı YEHK'dir. İleri yaş, kronik cilt hastalıkları, cilt dışı kronik hastalıklar, dış etkenler predispozan faktörler arasında sayılmaktadır. Metastaz yapmamış tümörlerin cerrahi eksizyonu şifa ile sonuçlanırken, metastazın atlanması prognozu olumsuz yönde etkilemektedir. Her baş boyun tümöründe radikal boyun lenf nodu diseksiyonu yapmaksa yaratacağı morbidite ve ekonomik yük açısından çok uygun olmamaktadır. Lenf nodu metastazlarının atlanmaması için sentinel lenf nodu biopsisi gerekmektedir. Ancak sentinel lenf nodunun belirlenmesi için ileri seviye görüntüleme metodları kullanılmaktadır. Lenf nodu haritalaması ise bu tip kompleks işlemlerin mümkün olmadığı durumlarda hayat kurtarıcıdır. Dudak kanserlerine ait lenf nodu haritalamasına literatürde rastlanmamıştır. Çalışmamızda dudak YEHK tanısı ile olan; sintigrafik, cerrahi ve patolojik açıdan SLN değerlendirilen 30 erkek, 9 kadın hastanın muayene, tetkik, tedavi ve takip sonuçlarının değerlendirildi. 39 hastanın 9 (%23.1)'u kadın 30(76.9)'u erkek olarak saptandı. Kadın hastaların yaş ortalaması 67.44±8.918, erkek hastaların 59.97 ± 10.801 idi. Lezyon süresi kadınlarda 24 [6-72] ay, erkeklerde 18 [2-120] ay olarak saptandı. Lezyonların büyüklüğü kadınlarda 600 [50 - 4900] mm2, erkeklerde 200 [25 - 2000] mm2 olarak saptandı. Takip süreleri kadınlarda 356 [0 - 1279] gün, erkeklerde 225 [0 - 1568] olarak saptandı. Kadınların %44'ünün, erkeklerin %33'ünün 1 yıldan uzun takipleri yapılabilmişti. Kadın hastaların 7 (%77.8)'i, erkeklerin 15 (%50.0)'ı 60 yaş ve üzerindeydi. Sentinel lenf nodları boyun Ia, Ib ve V bölgelerinde yoğunluk görülmekle beraber; dudak sağ tarafında lezyonu olan bir hastada Ia bölgesiyle birlikte IV. bölgede de SLNna rastlanmıştır. Üst dudak sağ tarafta lezyonu olan bir hastada ise Ia ve Ib bölgelerine ilave olarak preauriküler bölgede de SLN işaretlenmiştir. Sentinel lenf nodlarının tamamı lezyonlarla aynı tarafta bulunmuştur. Dudak sağ tarafındaki lezyonlarda sentinel lenf nodları % 42 oranında Ia, % 58 oranında Ib ve % 33 oranında V. bölge boyun lenf nodunda tespit edildi. Dudak solundaki lezyonlarda ise % 50 Ia, % 50 Ib ve % 8 V bölgede tutulum görüldü. Dudak orta hattını tutan lezyonlarda bu oran sırası ile % 67, % 33 ve % 67 olarak gözlemlendi. Bu çalışma geniş tıbbi imkânları olmayan cerrahlara yol gösterici olacaktır. Daha geniş çalışmalara ışık tutacak niteliktedir.
Abstract
Adverse environmental factors and increased use of tobacco products have increased the incidence of tumors of the lips. 90% of head and neck cancers are squamous cell carcinoma. Advanced age, chronic skin diseases, other chronic diseases are considered among predisposing factors. While surgical excision of the tumors without metastases resulted in healing, the skipping metastases effected the prognosis negatively. It is not very convenient to make radical neck lymph node dissection in each of the head and neck tumors in terms of morbidity and economic burden. Biopsy of sentinel lymph node is needed so that lymph node metastases couldnt spread. However, advanced imaging methods are used to identify the sentinel lymph node. Lymph node mapping is life-saving in such situations where such complex transactions are impossible. The lymph nodes mapping was not found in the literature for lip cancers. In our study, 30 male and 9 female patients, diagnosed with squamous cell carsinoma evaluated in terms of scintigraphic, surgical and pathological SLN were studied. Of 39 patients, 9 (23.1%) were female, 30 (76.9) were male. The average age of female patients was 67.44±89.18, of male patients was 59.97±10.801. The lenght of lesion in females was [6-72] months, in males it was 18 [2-120] months. The size of lesions in females was 600 [50-4900] mm2, and in males it was 200[25-2000] mm2 respectively. The follow-up periods for females was 356 days [0-1279] and for males was 225 [0-1568] days. 44% of female and 33% of male patients could be followed-up for longer than one year. 7 female patients (77.8%) and 15 male patients were at the age of 60 and above. While SLN was seen mostly around the neck level Ia, Ib and V, it was also found in the level IV in a patient with right lip lesion. In a patient with lesions on the right side of the upper lip SLN was marked in preauricular area in addition to level Ia and Ib. Sentinel lymph nodes were all on the same side with lesions. In the right side of the lip lesions, the sentinel lymph nodes were detected in 40% level Ia, 58% level Ib and 33% level V neck lymph node. 50% Ia, 8% Ib and 50% V were affected in the region of lesions on the left lip. In the lesion on the left lift involvement was seen in 50% level Ia, 50% level Ib and 8% level V. This study will contribute to the wide range of surgeons who do not have enough medical facilities. It will be enlightening the more large-scale study.
Abstract
Adverse environmental factors and increased use of tobacco products have increased the incidence of tumors of the lips. 90% of head and neck cancers are squamous cell carcinoma. Advanced age, chronic skin diseases, other chronic diseases are considered among predisposing factors. While surgical excision of the tumors without metastases resulted in healing, the skipping metastases effected the prognosis negatively. It is not very convenient to make radical neck lymph node dissection in each of the head and neck tumors in terms of morbidity and economic burden. Biopsy of sentinel lymph node is needed so that lymph node metastases couldnt spread. However, advanced imaging methods are used to identify the sentinel lymph node. Lymph node mapping is life-saving in such situations where such complex transactions are impossible. The lymph nodes mapping was not found in the literature for lip cancers. In our study, 30 male and 9 female patients, diagnosed with squamous cell carsinoma evaluated in terms of scintigraphic, surgical and pathological SLN were studied. Of 39 patients, 9 (23.1%) were female, 30 (76.9) were male. The average age of female patients was 67.44±89.18, of male patients was 59.97±10.801. The lenght of lesion in females was [6-72] months, in males it was 18 [2-120] months. The size of lesions in females was 600 [50-4900] mm2, and in males it was 200[25-2000] mm2 respectively. The follow-up periods for females was 356 days [0-1279] and for males was 225 [0-1568] days. 44% of female and 33% of male patients could be followed-up for longer than one year. 7 female patients (77.8%) and 15 male patients were at the age of 60 and above. While SLN was seen mostly around the neck level Ia, Ib and V, it was also found in the level IV in a patient with right lip lesion. In a patient with lesions on the right side of the upper lip SLN was marked in preauricular area in addition to level Ia and Ib. Sentinel lymph nodes were all on the same side with lesions. In the right side of the lip lesions, the sentinel lymph nodes were detected in 40% level Ia, 58% level Ib and 33% level V neck lymph node. 50% Ia, 8% Ib and 50% V were affected in the region of lesions on the left lip. In the lesion on the left lift involvement was seen in 50% level Ia, 50% level Ib and 8% level V. This study will contribute to the wide range of surgeons who do not have enough medical facilities. It will be enlightening the more large-scale study.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Yassı Epitelyum Hücreli Kanser, Alt Dudak, Lenf Nodu Sintigrafisi, Squamous Cell Carcinoma, Lower Lip, Lymph Node Scintigraphy
