Meme Kanserinde Lokal Tedavi Seçiminde Nükleer Tıp’ın Yeri
Özet
Meme kanseri, kadınlarda en sık görülen kanser türü olup, lokal tedavisinde nükleer tıp yöntemleri kritik bir rol oynamaktadır. Erken evre hastalarda aksiller lenf nodu durumunun belirlenmesi amacıyla uygulanan sentinel lenf nodu biyopsisi (SLNB), aksiller lenf nodu diseksiyonuna (ALND) göre morbiditeyi belirgin şekilde azaltan standart bir yöntem haline gelmiştir. SLNB uygulamasında, Technetium-99m (99mTc) işaretli radyokolloidler lenfatik akımı izlemek ve gama prob eşliğinde "bekçi" lenf nodunu saptamak için güvenle kullanılmaktadır. Palpe edilemeyen (okült) meme lezyonlarının preoperatif lokalizasyonunda ise cerrahi sınırların net belirlenmesi, operasyon süresinin kısaltılması ve sağlıklı dokunun korunması amacıyla Radyonüklid Rehberliğinde Okült Lezyon Lokalizasyonu (ROLL) tekniği yaygınlaşmıştır. Bu iki yöntemin birleşimi olan SNOLL tekniği, tek bir operasyonda hem palpe edilemeyen lezyonun hem de sentinel lenf nodunun radyonüklid madde ile işaretlenip çıkarılmasına olanak tanır. Radyasyon güvenliği açısından, hastaların, cerrahların ve patoloji personelinin maruz kaldığı dozlar uluslararası limitlerin oldukça altında olup ek koruyucu önlem gerektirmemektedir. Sonuç olarak, nükleer tıp yöntemleri meme kanserinin lokal yönetiminde multidisipliner yaklaşıma katkı sunan, kozmetik sonuçları optimize eden ve hastanın yaşam kalitesini artıran güvenilir cerrahi kılavuzluk araçlarıdır.
Breast cancer is the most prevalent malignancy among women, and nuclear medicine techniques play a critical role in its local management. In early-stage patients, sentinel lymph node biopsy (SLNB) has become the standard approach for evaluating axillary nodal status, significantly reducing morbidity compared to axillary lymph node dissection (ALND). During SLNB, Technetium-99m (99mTc)-labeled radiocolloids are safely utilized to track lymphatic drainage and identify the "sentinel" node with a gamma probe. For preoperative localization of non-palpable (occult) breast lesions, Radioguided Occult Lesion Localization (ROLL) has expanded widely, ensuring clear surgical margins, short operative times, and preservation of healthy tissue. Combining these two methods, the SNOLL technique enables simultaneous marking and excision of both the occult lesion and the sentinel lymph node in a single surgical session. Regarding radiation safety, the doses received by patients, surgeons, and pathology personnel remain well below international exposure limits, requiring no additional protective measures. Consequently, nuclear medicine modalities serve as reliable surgical guidance tools that contribute to the multidisciplinary management of breast cancer, optimize cosmetic outcomes, and enhance the overall quality of patient care.
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