Palpe edilemeyen meme lezyonlarında tel ve radyoaktif madde ile (ROLL: Radioguided occult lesion localization) işaretleme yöntemlerinin karşılaştırılması
Radioguided occult lesion localization versus wire-guided localization for nonpalpable breast lesions
Yazar: FIRAT MÜLKÜT
Danışman: DOÇ. DR. MEHMET ESER
Sağlık Bilimleri Üniversitesi / Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2017
Konu: Genel Cerrahi = General Surgery ; Radyoloji ve Nükleer Tıp = Radiology and Nuclear Medicine
Dizin: Cerrahi = Surgery ; Cerrahi aletler = Surgical instruments ; Meme = Breast ; Meme hastalıkları = Breast diseases ; Meme neoplazmları = Breast neoplasms ; Neoplazmlar = Neoplasms ; Palpasyon = Palpation ; Teşhis = Diagnosis ; Teşhis teknikleri ve prosedürleri = Diagnostic techniques and procedures

Özet:
Amaç: Memede malign şüpheli lezyonların eksizyonunda uygulanan işaretleme yöntemlerinden ROLL ve tel ile işaretlemenin karşılaştırılması.
Gereç ve Yöntem: 23 Eylül 2014 ile 02 Şubat 2017 tarihleri arasında Sağlık Bilimleri Üniversitesi Kartal Dr. Lütfi Kırdar Sağlık Uygulama ve Araştırma Merkezi'nde tarama amaçlı yapılan mammografi ve ultrasonografide tespit edilen ancak muayenede palpe edilemeyen malign şüpheli lezyonu olan 79 hasta çalışmaya dahil edildi. Bu hastaların 42 tanesine ROLL, 37 tanesine tel ile işaretleme uygulandı. Hastaların işaretlemeye bağlı komplikasyonları, piyes hacmi, operasyon süresi, son patoloji raporları ve rerezeksiyon ihtiyacı değerlendirildi. Veriler SPSS version 22 paket programına aktarılarak sonuçlar %, ortalama, ± standart sapma şeklinde ifade edildi.
Bulgular: Hastaların tümü kadındı. Hastaların yaş ortalaması 53,2 ve VKİ ortalaması 28,7 olarak bulundu. Olguların son patoloji raporlarında 43'ünün (%54,5) malign, 9'unun (%11,4) premalign, 27'sinin (%34,2) benign olduğu görüldü. Piyes hacmi ROLL hastalarında ortalama 36,2cc ±19,6, Tel hastalarında ise 40,8cc ±22,8 olarak bulundu (P=0,34). Ameliyat süresi ROLL hastalarında ortalama 13,2 dk ±4,2, Tel hastalarında ise 18,2 dk ±6,7 olarak bulundu (P= <0,001). ROLL hastalarında toplam 8 hastaya rerezeksiyon gerekliliği oldu. Tel hastalarında ise toplam 14 tanesinde rerezeksiyon yapıldı (P=0,07).
Sonuç: Nonpalpabl meme lezyonlarının tanısal amaçlı veya küratif eksizyonlarında, ROLL ile yapılan ameliyatın süresi tele göre anlamlı derecede kısa ve rerezeksiyon ihtiyacı daha azdır. ROLL yönteminde tele özgü komplikasyonlardan kaçınmak mümkündür.

Abstract:
Introduction: Breast cancer is the most common cancer seen in women. It is ranked second in cancer-related deaths in females. In developed countries, 1 in every 11 females, 1 in every 9 females in the United Kingdom, and 1 in every 8 females in the United States have breast cancer at some point in their lives. Early diagnosis of breast cancer reduces mortality and morbidity. The development and widespread use of imaging modalities now allows the tumor to be detected before it reaches the palpable magnitude. However, intraoperative localization of small, non-palpable malignant lesions and optimal surgical treatment are difficult conditions. Today, hook wire localization is most common technique used for resection of nonpalpable breast lesions. But, this technique has some disadvantages which migration and breaking off the wire, injury risk in patients and surgeons and making trouble in pathological examination. For this reason, additional marking methods need to be developed.
The ROLL (Radioguided Occult Lesion Localization) method, which was developed in the European Institute of Oncology in 1996, is becoming a more frequently used method in many countries according to hook wire localization complications. In ROLL method genarally used human albumin marked with Technesium-99. Human albumin marked with Technesium-99 injected into lesion by a radiologist under ultrasound or mammography imaging before operation, Surgeon extract lesion with help of gamma probe.
Objective: In our study, the ROLL method and hook wire localization compared with the volume of the piece, the weight of the piece, the duration of the operation, the necessity of the reresection, the complications that developed and evaluate the superiority of each other.
The method-Tool: 79 patients included in the study who had a malign suspicious lesion under mammography or ultrasound imaging but had nonpalpabl lesions. ROLL method applied in 42 patients and hook wire localization applied in 37 patients. Complications which developed during marking and operation, volume of pieces, weight of pieces, duration of operations, final pathological exam reports, needed for reresection is evaluated retrospectively. Outcomes transfered in SPSS version 22 programme and results reported as %, avarage value, ± standard deviation.
Findings: All of the patients were females. Average age of patients is 53,2. The average body mass index is 28,7. 43 excavated lesions are malign (%54,5), 9 lessions are pre-malign (%11,4). Average value for volume of pieces in ROLL group is 36,2cc ±19,6, in hook wire group is 40,8cc ±22,8 and p value is 0,34). Average value for duration of operation in ROLL patients is 13,2min ±4,2, in hook wire patients is 18,2min ±6,7 an p value is 0,001. 8 patients is needed reresection because of positive margins in ROLL group on the other hand 14 patients is needed reresection in hook wire group (p value is 0,007).
Results: Diagnostic or curative excision of nonpalpable breast lesions, the duration of surgery with ROLL is significantly shorter and the need for reresection is less the hook wire patients. In the ROLL method, it is possible to avoid complications specific to hook wire.