Meme Kanserinin Tanısında Tru-Cut Biyopsinin Yeri
Özet
Meme kanseri tanısında tru-cut (kalın iğne) biyopsisi, ince iğne aspirasyon biyopsisine (İİAB) kıyasla daha fazla doku materyali sağlayarak patolojik ve histolojik tanıda doğruluk oranını artıran ve cerrahi eksizyona güvenilir bir alternatif olan altın standart bir yöntemdir. Görüntüleme yöntemlerinin gelişmesiyle lezyon tespit ve biyopsi oranları artmış; BI-RADS 3, 4, 5 mikrokalsifikasyonlar ile BI-RADS 4, 5 kitleler için biyopsi endikasyonu kesinleşmiştir. Yapılan çalışmalarda %95.4 sensitivite, %100 spesivite ve %98.9 diagnostik doğruluk oranlarına ulaşan bu yöntem, neoadjuvan kemoterapi öncesi ER, PR ve HER2 gibi prognostik faktörlerin belirlenmesine de olanak tanır. Ağrı, vazo-vagal reaksiyon, enfeksiyon ve en sık olarak da minimal hematom veya kanama gibi oldukça düşük (%0.2) komplikasyon riskine sahiptir. En büyük kısıtlılığı olan örneklem hatasını en aza indirmek için ultrasonografi eşliğinde yapılması önerilirken, son yıllarda B-mode ultrasonografiye eklenen elastografi tekniklerinin benign-malign ayrımını güçlendirerek gereksiz biyopsi sayılarını azalttığı gözlenmiştir. Klinik, radyolojik ve patolojik bulgular arasında uyumsuzluk olduğunda ise multidisipliner bir yaklaşımla cerrahi eksizyon veya yakın takip kararı verilmelidir.
Tru-cut (core needle) biopsy in the diagnosis of breast cancer is a gold standard method that provides more tissue material compared to fine needle aspiration biopsy (FNAB), increasing the accuracy rate in pathological and histological diagnosis and presenting a reliable alternative to surgical excision. With the advancement of imaging modalities, the rates of lesion detection and biopsy have increased, establishing definite biopsy indications for BI-RADS 3, 4, 5 microcalcifications and BI-RADS 4, 5 masses. Reaching a 95.4% sensitivity, 100% specificity, and 98.9% diagnostic accuracy in studies, this method also allows the determination of prognostic factors such as ER, PR, and HER2 before neoadjuvant chemotherapy. It carries a very low complication risk (0.2%) including pain, vaso-vagal reaction, infection, and most commonly minimal hematoma or bleeding. Performing the procedure under imaging guidance is recommended to minimize its greatest limitation, which is sampling error, while in recent years, elastography techniques added to B-mode ultrasonography have been observed to decrease unnecessary biopsies by strengthening benign-malignant differentiation. In case of discordance between clinical, radiological, and pathological findings, a surgical excision or close follow-up decision should be made through a multidisciplinary approach.
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