THE VALUE OF LYMPHATIC MAPPING IN THE MANAGEMENT OF CERVICAL CANCER
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Key Words:
Keywords (Original Language):
| Author Name | University of Author | Faculty of Author |
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Abstract (2. Language):
Cervical cancer is second most common cancer among women under the age of forty years in the world. Radical
hysterectomy and pelvic lymphadenectomy are the mostly used procedures in early stages of cervical cancer. In
90% of the patients undergone radical hysterectomy pelvic lymph node metastasis were negative. Therefore pelvic
lymphadenectomy do not add any benefit to the survival of the patients, on the contrary the morbidity may increase
due to procedure. Currently no method is present to detect accurately preoperative lymph node metastasis. But
in the past years sentinel lymph node studies were performed, to perform lymphadenectomy in node positive patients
and to avoid lymphadenectomy due to complications in node negative patients. In this paper the value of
lymphatic mapping in the management of cervical carcinoma is reviewed. Various investigators studied patent blue,
lymphoscintigraphy and combine methods to evaluate the sentinel lymph node metastasis and best results were obtained
by combine methods.
Theoretically lymphadenectomy should be avoided and radical hysterectomy should be performed in sentinel node
negative patients and lymphadenectomy should be performed and radical hysterectomy should be avoided in
sentinel node positive patients. Lymphatic mapping and sentinel lymph identification seem feasible, well tolerated
and applicable procedure in early stages of cervical carcinoma. Patients in this group might benefit from lymphatic
mapping and sentinel lymph node identification due to low incidence of lymphatic metastasis.
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Abstract (Original Language):
Serviks kanseri tüm dünyada 40 yafl alt› kad›nlar aras›nda görülen ikinci en s›k kanserdir. Erken evre serviks kanserlerinde
en s›k uygulanan tedavi radikal histerektomi ve pelvik lenf adenektomidir. Radikal cerrahi uygulanan
hastalar›n %90’›nda lenf nodu (LN) metastaz› bulunmamaktad›r. Dolay›s›yla pek çok hastada yap›lan lenf adenektominin
hastan›n prognozuna olumlu katk›s› olmaz, di¤er yandan lenf adenektomiye ba¤l› morbiditenin artma riski
vard›r. Günümüzde preoperatif dönemde LN metastaz›n› kesin olarak belirleyecek bir yöntem bulunmamaktad›r.
Ancak son y›llarda serviks kanseri olgular›nda lenfatik haritalama yöntemi kullan›larak seçilmifl hastalarda cerrahiye
lenf adenektomi eklenip, di¤er hastalarda lenf adenektomi komplikasyonlar›ndan kaç›nmay› amaçlayan çal›flmalar
yap›lm›flt›r . Bu derlemede serviks kanseri yönetiminde lenfatik haritalaman›n önemi araflt›r›lm›flt›r. De¤iflik
araflt›rmac›lar lenfatik haritalama tekni¤inde mavi boya, sintigrafi ve kombine yöntemler kullan›larak sentinel lenf
nodu araflt›r›lmas› yapm›fl en baflar›l› sonuçlar kombine yöntemde elde edilmifltir.
Teorik olarak SLN biyopsisi negatif ise lenf adenektomi yap›lmamal›, radikal histerektomi yap›lmal›d›r. SLN biyopsisi
pozitif ise lenf adenektomi yap›lmal›, radikal histerektomi yap›lmamal›d›r.
Lenfatik haritalama ve SLN identifikasyonu uygulamas› kolay ve iyi tolere edilen, erken evre serviks kanserlerinde
uygulanabilir bir yöntem gibi gözükmektedir. Bu gruptaki hastalar LN metastaz oranlar› düflük oldu¤u için selektif
nodlar›n araflt›r›lmas›ndan yarar görebilirler.
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130-135