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Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] 17. Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH; Pathology Review Committee; Cooperative Clinical Investigators. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma:not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002; 26(3): 350-357. 18. Chapuis PH, Lin BP, Chan C, Dent OF, Bokey EL. Risk factors for tumour present in a circumferential line of resection after excision of rectal cancer. Br J Surg. 2006; 93(7): 860-865. 367
Articole originale Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] EVALUAREA LIMFOGANGLIONULUI SANTINELĂ ÎN CANCERUL MAMAR Victor-Gabriel Rugină 1,2 , Dan Mihalcea 2 1. Universitatea de Medicină şi Farmacie “Gr. T. Popa” Iaşi 2. Clinica a IV-a Obstetrică-Ginecologie, Spitalul Obstetrică Ginecologie Cuza Vodă Iaşi SENTINEL-LYMPH NODE ASSESSMENT IN BREAST CANCER (ABSTRACT): Introduction: Sentinel lymph node biopsy (SLNB) is an accurate and less invasive technique to assess the lymph node status when compared with axillaries lymph node dissection. Methods: The study was performed between 2000 – 2010 on 54 patients with palpable T1Nx or T2Nx invasive breast cancer, all with negative clinical axillaries physical examination diagnosed and treated in the 4 th Obstetrics and Gynecology Clinic. Only isosulphan blue (Lymphazurin) was used and all patients underwent axillary lymph node dissection (ALND) after SLNB. Results: The histopathological assessment of the sentinel lymph node was performed in 46 cases (89.13%). The presence of micrometastases was identified in 12 patients (26.08%), the ratio of false negative results being 18% (IC 95%: 8-33%). The sensitivity of the method was 82% (IC 95%: 67-92%). Conclusion: The assessment of the sentinel lymph node decreases the ratio of axillary dissection in patients with stage I and II breast tumors for which conservative surgery is as effective as mastectomy and preferable because it is less mutilated. KEYWORDS: SENTINEL LYMPH NODE, BREAST CANCER Corespondenţă: Dr. Victor-Gabriel Rugină, Universitatea de Medicină şi Farmacie „Gr.T. Popa” Iaşi, Clinica IV Obstetrică-Ginecologie, Obstetrică Ginecologie Cuza Vodă Iaşi, e-mail: dr.victorrugina @gmail.com * . INTRODUCERE Statusul histologic al limfoganglionilor axilari reprezintă factorul de prognostic major al supravieţuirii pacientelor diagnosticate cu cancer mamar, diagnosticarea corectă a invaziei tumorale fiind esenţială în vederea stabilirii indicaţiilor, etapizării şi prognosticului strategiilor terapeutice [1]. Actualmente, disecţia axilară, metoda standard de identificare a invaziei limfoganglionare se realizează sub anestezie generală şi poate fi invalidantă într-un număr mic, dar semnificativ, de cazuri, cu o rată maximă a complicaţiilor imediate de 20%, iar a complicaţiilor cronice, de tipul limfedemului braţului, de 20-30% [2,3]. Biopsia limfoganglionului santinelă s-a impus în ultimii ani drept o alternativă la disecţia axilară la pacientele cu cancer mamar invaziv. Conceptul de limfoganglion santinelă se bazează pe teoria diseminării limfatice a cancerului mamar, statusul primei staţii limfatice având valoare prognostică în progresia metastatică. Termenul de limfoganglion santinelă a fost introdus în 1977 de Ramón Cabañas care a demonstrat că analiza limfoganglionilor poate fi utilizată pentru decelarea primei staţii limfoganglionare invadate metastatic în cancerul penian [4]. * received date: 21.05.2011 accepted date: 22.07.2011 368
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