Buradasınız

LENFATİK HARİTALAMANIN SERVİKS KANSERİ YÖNETİMİNDEKİ ÖNEMİ

THE VALUE OF LYMPHATIC MAPPING IN THE MANAGEMENT OF CERVICAL CANCER

Journal Name:

Publication Year:

Keywords (Original Language):

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.
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.
130-135

REFERENCES

References: 

1. Ayhan A, Tuncer ZS, Yarali H. Complications of radical hysterectomy
in women with early stage cervical cancer: clinical analysis
of 270 cases. Eur J Surg Oncol. 1991; 17:492-494.
2. Bader AA, Winter R, Hass J, Tamussino KF. Where to look for
sentinel lymph node in cervical cancer. Am J Obstet Gynecol.
2007;197:1 -7.
3. Benedet J, Odicino F, Maisoneuve P, Beller U, Creasmen WT, Heinzt
AP, Ngan HY, Pecorelli S. Carcinoma of the cervix uteri. Int
J Gynaecol Obstet. 2003;1:41-78.
4. Burgharth E, Baltzer J, Tulusan AH, Haas J. Results of surgical
treatment of 1028 cervical cancers studied volumetry . Cancer
1992;70:648-655.
5. Coleman RL, Whitten CW, O’Boyle J, S›dhu B. Unexplained decrease
in measured oxygen saturation by pulse oximetry fallowing
injection of lymphazurin %1 (isosulfan blue) during a
lymphatic mapping procedure. J Surg Oncol 1999;70:126-129.
6. Dargent D, Martin X, Roy M, Mathevet P. Identification of sentinel
node with laparoscopy in cervical cancer 31. Meet Soc
Gynecol Oncol Abst. 2000;41:241-244.
7. Delgado G, Bundy BN, Fowler EC, et al. A prospective surgical
pathological study of stage 1 squamous carcinoma of cervix: A
Gynecologic Oncology Study Group. Gynecol Oncol
1989;36:314-320.
8. Di Stefano AB, Acquaviva G, Garozza G, Barbic M, Cvjeticanin
B, Meglic L, Kobal B, Rakar S. Lymph node mapping and sentinel
node detection in patients with cervical carcinoma: a 2-year
experience. Gynecol Oncol. 2005;99:671-679.
9. Finan M, DeCesera S, Fiorica J et al. Radical hysterectomy for stage
1B1 vs 1B2 carcinoma of the cervix: Does the new staging
system predict morbidity and survival? Gynecol Oncol
1996;62:139-147.
10. Frumowitz M, Coleman RL, Gayed IW, Ramirez PT, Wolf JK,
Gershenson DM, Levenback JF. Usefullnes of preoperative
lymphoscinticgraphy in patients who undergo radical hysterectomy
and pelvic lympadenectomy for cervical cancer. Am J Obstet
Gynecol , 2007;197:116.
11. Hacker NF, Wain GF, Niklin JF. Resection of bulky positive
lymph nodes in patients with cervical carcinoma. Int J Gynecol
Cancer 1995;5:250-256.
12. Hill AD, Mann GB, Borgen PI, Cody HS 3rd: Sentinel lymphatic
mapping in breast cancer. J AM Coll Surg 1999;188:545-549.
13. Inoue T, Morita K. The prognostic significance of number of positive
nodes in cervical carcinoma stages IB, IIA and IIB. Cancer
1990;65:1923-1927.
14. Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes T,
Ruers TJ. Intraoperative lymphatic mapping and the sentinel node
concept in colorectal carcinoma. Br J Surg 1999;86:482-486.
15. Kinney WK, Hodge DO, Egorshin EV, Ballard DJ, Podratz KC.
Surgical treatment of patients with stages IB and IIA carcinoma
of the cervix and palpably positive pelvic lymph nodes. Gynecol
Oncol. 1995;57:145-149.
16. Krag D, Weaver D, Ashikaga T, Moffat F, Kimberg VS, Shiriver
Management of Oncogenic Transformation
‹stanbul T›p Fakültesi Dergisi Cilt / Volume: 71 • Say› / Number: 4 • Y›l/Year: 2008
- 134 -
C, Feldman S, Kusmimsky R, Gadd M, Kuhn J, Harlow S, Beitsch
P. The sentinel node in breast cancer. Amulticenter validation
study. N Engl J Med 1998;339:941-946.
17. Kushner DM, Connor JP, Wilson MA, Hafez GR, Chappell RJ,
Sarah L. Stewart and Ellen M. Hartenbach. Laparoscopic sentinel
lymph node mapping for cervix cancer-A detailed evaluation
and time analysis. Gynecologic Oncology 2007;106:507–512
18. Lambaudie E, Collinet P, Narducci F, Sonoda Y, Papageorgiou
T, Carpentier P, Leblanc E, Querleu D. Laparoscopic identification
of sentinel lymph nodes in early stage cervical cancer: Prospective
study using a combination of patent blue dye injection
and technetium radiocolloid injection. Gynecologic Oncology,
2003;89: 84-87
19. Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W,
Deavers M, Delpassand ES. Lymphatic mapping and sentinel
node identification in patients with cervix cancer undergoing radical
hysterectomy and pelvic lymphadenectomy. J Clin Oncol
2002;15:20-26.
20. Little AG, DeHoyos A, Kirgan DM, Arcomano TR, Murray K.
Intraoperative lymphatic mapping for non-small cell cancer: The
sentinel node technique. J Thorac Cardiovasc Surg
1999;117:220-234.
21. Malur S, Krause N, Köhler C, Schneider A. Sentinel lymph node
detection in patients with cervical cancer. Gynecol Oncol
2001;80:254-257.
22. Morton DL, Wen DR, Foshag IJ, Essner R, Cochran A. Intraoperative
lymphatic mapping and selective cervical lympadenectomy
for early stage melanoma of the head and neck. J Clin Oncol
1993;11:1751-1756.
23. Noguchi H, Shiozawa I, Sakai Y Yamazaki T, Fukuta T. Pelvic
lymph node metastasis of uterine cervical cancer. Gynecol Oncol
1987; 27:150-158.
24. O’Boyle JD, Coleman RL, Bernstein SG, Lifthitz S, Muller CY,
Miller DS. Intraoperative Lymphatic Mapping in Cervix Cancer
Patients Undergoing Radical Hysterectomy: A Pilot Study.
Gynecol Oncol 2000; 79:238-243.
25. Parker SL, Tong T, Bolder S, Wingo PA. Cancer statistics, 1997.
CA Cancer J Clin 1997; 47:810.
26. Pitman KT, Jonhson JT, Edington H, Barnes EL, Day R, Wagner
RL, Myers EN. Lymphatic mapping with isosulfan blue dye in
squamous cell carcinoma of the head and neck. Arc Otolaryngol
Head Neck Surg 1998;124:790-793.
27. Samlal RA, Van Der Velden J, Van Eerden T, Schilthius MS,
Gonzales Gonzales D, Lammes FB. Recurrent cervical carcinoma
after radical hysterectomy: an analysis of clinical aspects and
prognosis.Int J Gynecol Cancer 1998;8:78-84.
28. Trappen POV, Gyselman VG, Lowe DG, Ryan A, Oram DH,
Bosze P, Weekes AR, Shepherd JH, Dorudi S, Bustin SA, Jacops
IJ. Molecular quantification and mapping of lymph node micrometastases
in cervical cancer. The Lancet 2001;357:15-20.
29. Van Dam PA, Hauspy J, Vanderheyden T, Sonnemans H, Spaepen
A, Eggenstein G, Dirix L, Verkinderen L. Intraoperative
sentinel node identification with Technetium-99m-nanocolloid
labeled in patients with cancer of the uterine cervix: a feasibility
study. Int J Gynecol Cancer 2003;13:182-186.
30. Verheijen RH, Pijpers R, van Diest PJ, Burger CW, Buist MR,
Kenemans P. Sentinel node detection in cervical cancer. Obstet
Gynecol 2000;96:135-137.
31. Veronesi U, Paganelli G, Galimberti V, Viale G. Sentinel-node
biopsy to avoid axillary disection in breast cancer with clinically
negative lymph-nodes. Lancet 1997;349:1684-1687.

Thank you for copying data from http://www.arastirmax.com