master's thesis
Pitanje indikacije aksilarne disekcije u bolesnica sa invazivnim karcinomom dojke i pozitivnim sentinel limfnim čvorom

Matija Mavrić (2015)
Sveučilište u Rijeci
Medicinski fakultet
Katedra za kirurgiju
Metadata
TitlePitanje indikacije aksilarne disekcije u bolesnica sa invazivnim karcinomom dojke i pozitivnim sentinel limfnim čvorom
AuthorMatija Mavrić
Mentor(s)Harry Grbas (thesis advisor)
Abstract
Rak dojke je jedan od najčešćih malignih tumora u svijetu. Od ranih početaka kirurškog liječenja (Halstedova radikalna mastektomija) kirurgija raka dojke je napredovala do sve poštednijh zahvata (segmentektomija, tumorektomija). Opseg kirurškog zahvata se donosi na temelju biopsije sentinel limfnog čvora. Ukoliko je sentinel limfni čvor pozitivan, prema ranijim smjernicama liječenja zahvat se proširuje na aksilarnu disekciju. Novost koja se uvodi u terapiju je izbacivanje aksilarne disekcije ukoliko su pozitivni do dva sentinela uz uvjet da je bolesnica operirana poštednom operacijom dojke u kombinaciji s postoperativnom radioterapijom. Cilj ovog rada bio je prikazati u kolikoj mjeri su zahvaćeni ostali limfni čvorovi aksile u slučaju pozitivnog sentinel čvora te kako navedeno ovisi o infiltraciji kapsule sentinela, gradusu i T stadiju bolesti. U ovom je istraživanju analizirano 77 pacijentica sa pozitivnim sentinelom u razdoblju od pet godina. Bolesnice su kategorizirane prema nekoliko kriterija: pozitivnost ostalih limfnih čvorova aksile, zahvaćenost kapsule sentinela, gradus tumora, T stadij tumora, dob te molekularni podtip raka. Uočeno je da preko 65% pacijentica unatoč pozitivnom sentinel limfnom čvoru ima negativne ostale limfne čvorove aksile. Dokazana je statistički značajna razlika u ovisnosti o zahvaćenosti kapsule sentinela i pozitivnih ostalih limfnih čvorova aksile (p=0,001). Također je potvrđena činjenica da bolesnice s većim gradusom i T stadijem imaju i češće zahvaćenu aksilu. Prema našim rezultatima, a u skladu s novim smjernicama još je uvijek velik broj bolesnica kojima se nepotrebno radi aksilarna disekcija. Smanjivanje navedenog broja bolesnika i usmjeravanje prema što poštednijoj kirurgiji aksile cilj je kojem moramo težiti u budućnosti.
Keywordsaxillary dissection breast cancer positive sentinel lymph node
GranterSveučilište u Rijeci
Medicinski fakultet
Lower level organizational unitsKatedra za kirurgiju
PlaceRijeka
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Surgery
Study programme typeuniversity
Study levelintegrated undergraduate and graduate
Study programmeMedicine
Academic title abbreviationdr. med.
Genremaster's thesis
Language Croatian
Defense date2015
Parallel abstract (English)
Breast cancer is one of the most common malignant tumors in the world. The surgery of breast cancer has progressed a lot since the early beginnings (Halsted’s radical mastectomy) to more conserving procedures (segmentectomy, tumorectomy). The extent of the surgical treatment is based on the result of the biopsy of the sentinel lymph node. According to earlier guidelines, if the lymph node is positive, the procedure will be expanded to axillary dissection. A novelty in the treatment is to avoid axillary dissection if the patient has up to two positive sentinel lymph nodes and has priorly been subjected to a conserving procedure and postoperative chemotherapy. The purpose of this paper was to show how many of the axillary lymph nodes have been affected if there is a positive sentinel node and how it correlates with the infiltration of sentinel’s capsule, grade and the T stadium of illness. This research has analyzed 77 patients with a positive lymph node in the period of five years and they have been categorized according to several criteria: positivity of the other axillary lymph nodes, affection of the capsule, the grade of the tumor and its T stadium,age and the molecular type of the tumor. In over 65% of the patients the rest of the axillary lymph nodes are negative even though the sentinel lymph node was positive. There was a noticeable connection between the affection of the capsule of the sentinel lymph node and the rest of the axillary lymph nodes that were proven positive (p=0,001). It has also been confirmed that the axillary region is more often affected in the patients with a higher tumor grade and T stadium. According to our results, there is still a large number of unnecessary axillar dissections which supports the new guidelines. A goal that we must aim to in the future is to decrease the number of patients with axillar dissection and to direct the treatment to more conserving procedures.
Parallel keywords (Croatian)aksilarna disekcija pozitivan sentinel limfni čvor rak dojke
Resource typetext
Access conditionAccess restricted to students and staff of home institution
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:887465
CommitterBosa Licul