Meme karsinomlarında sentinel lenf nodülü biyopsilerinin histopatolojik ve immunohistokimyasal özellikleriyle değerlendirilmesi

Aim: Breast cancer is the most common malignity and cancer-related cause of death for women. Sentinel lymph node biopsy (SLNB) is a minimally invasive method for the evaluation of lymph node involvement. We aimed to determine the success of SLNB in predicting axillary lymph node (ALN) metastasis, the efficacy of intraoperative diagnosis of SLNB, and investigate a correlation with the characteristics of the primary tumour. Materials and Methods: Eighty-six patients with breast cancer who had undergone SLNB were included. Cases were re-evaluated with intraoperative histopathological diagnosis, axillary lymph node dissection (ALND), and primary tumour excision materials. The correlation between immunohistochemical characteristics (ER, PR, Her2, p53, and Ki67) of the primary tumour, and status of axillary metastasis were also investigated retrospectively. Results: Nine of 16 patients who had received ALND following the diagnosis of macrometastasis in SLNB intraoperatively, had ALN metastasis. Sixteen cases were diagnosed as micrometastasis or submicrometastasis in SLNB, and among them, only one out of 9 patients with completion of ALND, had metastasis in ALN. All 15 metastatic cases diagnosed intraoperatively had macrometastasis in paraffin sections. Cases within the good prognostic tumour group had low rates of metastasis in SLNB. Among the immunohistochemical markers performed for primary tumours, only Ki67 was found to be higher in cases with metastasis in SLNB. Conclusion: Our findings are in agreement with previous studies. If SLNB is negative for metastasis, SLNB is the reliable, appropriate and adequate way of axillary management with reduced arm-morbidity. Larger studies with long follow-up periods are needed to find out if completion of ALND is necessary for all patients with metastasis in SLNB.Amaç: Meme karsinomu kadınlarda en sık görülen malignite olup, günümüzde kadınlarda kansere bağlı ölüm nedenlerinin başında yer alır. Sentinel lenf nodülü biopsisi (SLNB), meme karsinomlu hastanın lenf nodülü tutulumunun değerlendirilmesinde minimal invaziv bir uygulamadır. Çalışmamızda SLNB’nin aksiller metastazı öngörme gücü, sentinel lenf nodu (SLN) incelemesinde intraoperatif histopatolojik değerlendirmenin etkinliği ve primer tümöre bağlı histopatolojik ve immunhistokimyasal (İHK) özelliklerin metastazla ilişkisini araştırmayı hedefledik. Gereç ve Yöntem: Çalışmaya, bölümümüzde SLNB değerlendirilen 86 olgu dahil edildi. Olgular intraoperatif histopatolojik değerlendirme sonuçları, SLNB sonrasında aksiller lenf nodülü diseksiyonu (ALND) uygulanmış olgularda aksillaya ait materyalleri yanısıra primer tümör eksizyon materyalleriyle birlikte incelendi, tümörde uygulanan İHK inceleme (östrojen reseptörü, progesteron reseptörü, Her2, p53, Ki67) sonuçlarının metastazla ilişkisi retrospektif olarak araştırıldı. Bulgular: SLN’de makrometastaz saptanması nedeniyle ALND uygulanan 16 olgunun 9’unda aksillada metastatik lenf nodülleri saptandı. Mikrometastaz ve izole tümör hücreleri saptanan 16 hastadan ALND uygulanan dokuz olgunun sadece birinde aksiller metastaz gözlendi. İntraoperatif değerlendirme sonucunda malignite saptanan 15 hastanın tümünde parafin kesitlerinde de makrometastaz gözlendi. Tümörü iyi prognostik grupta yer alan hastalarda SLN metastaz oranı daha düşük bulundu. SLNB’de metastaz saptanan hastaların primer tümörlerinde uygulanan İHK belirleyicilerden sadece Ki67 ortalaması metastatik grupta daha yüksek bulundu. Sonuç: SLNB uygulanan olgu grubunu değerlendirdiğimiz çalışmamızda literatürle uyumlu sonuçlar elde ettik. SLNB, negatif saptanması durumunda, tek başına uygun, güvenilir ve ALND’ye göre kol morbiditesinde azalma ve daha iyi yaşam kalitesi sağlayan etkin bir yöntemdir. SLNB’de metastaz saptanan hastaların tümünde ALND uygulaması yapılmalı mıdır sorusunun yanıtı için geniş serilerde uzun süre takipli çalışmalara ihtiyaç bulunmaktadır

Prediction of malignancy upgrade rate in high-risk breast lesions using an artificial intelligence model: a retrospective study

PURPOSE High-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy. METHODS A total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed. RESULTS Considering all cases, the malignancy upgrade rate was 24.5%. A significant association was ob-served between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P 0.001). With the SVM model, an 84% accuracy and 0.786 area-under-the-curve score were obtained in classifying the data as benign or malignant. CONCLUSION Our artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum exci-sions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology–pathology compatibility and by using an artificial intelligence model. © 2023, Turkish Society of Radiology. All rights reserved

Es zamanlı vulva ve kolon kanseri

Synchronous vulvar and colon cancer is rare. A 61-year-old woman presented with a lesion on her clitoris and fatigue, malaise and weight loss and underwent excisional biopsy over the lesion on the clitoris 2 cm in diameter. The vulvar biopsy showed squamous cell carcinoma and she had PET-CT scan at her own request demand. The PET-CT revealed invasive colon carcinoma and the colonoscopic examination and biopsy revealed adenocarcinoma. After work-up, she underwent radical anterior hemivulvectomy with superficial inguinal lymph node dissection and rigth hemicolectomy. The pathology of the vulva revealed squamous cell carsinoma with right inguinal lymph node metastasis and colon adenocarsinoma. This co-incidence is very uncommon and brings to mind of the possibility of multiple primary carsinomas.Vulva ve kolon kanserlerinin es zamanlılığı oldukça nadirdir. Altmıs bir yasında, halsizlik, istahsızlık, kilo kaybı ve klitoris üzerinde kitle yakınmaları olan bir hastaya klitoris üzerindeki 2 cm’lik lezyondan eksizyonel biyopsi yapılmıstır. Biopsi sonucunda skuamoz hücreli invasiv vulva karsinomu saptanan olgu, kendi isteği ile metastaz taraması için PET-BT tetkiki yaptırmıstır. PET-BT sonucu kolonda invasiv karsinom ile uyumlu radyolojik bulgular saptanan olgunun kolonoskopik inceleme ve kolon tümöral kitle biyopsi sonucu adenokarsinom saptanmıstır. Olguya vulva karsinomu için radikal anterior hemivulvektomi ve bilateral superfisyal inguinal lenf bezi diseksiyonu ile birlikte sağ hemikolektomi uygulanmıstır. Vulva patolojik inceleme sonucu skuamoz hücreli karsinom, sağ kasık lenf bezlerinde skuamoz hücreli karsinom metastazı ve kolonda adenokarsinom saptanmıstır. Bu birliktelik nadir olmakla birlikte multipl primer karsinom olasılığının her zaman göz önünde olması gerekliliğini bize hatırlatmaktadır