Meme Kanserli Hastalarda Radyoterapi Sonrası Görüntülemede Yaşanan Zorluklar
Özet
Meme kanseri, dünya genelinde 40-55 yaş aralığındaki kadınlarda en sık rastlanan ve multidisipliner tedavi gerektiren bir malignitedir. Erken evre tanı alan hastalar meme koruyucu cerrahi (MKC) için uygun adaylar olup, radyoterapi (RT) bu tedavi protokolünün temel taşlarından biridir. Ancak RT sonrasında memede meydana gelen patolojik ve sekonder değişiklikler, takip süreçlerindeki radyolojik değerlendirmeleri önemli ölçüde zorlaştırmaktadır. Bu süreçte mamografi (MG) ve ultrasonografi (US), postoperatif sıvı koleksiyonlarını (seroma, hematom), doku ödemini, cilt kalınlaşmasını ve distrofik kalsifikasyonları saptamada yaygın olarak birlikte kullanılır. Skar dokusu, fibrozis ve yapısal distorsiyonların nüks tümörlerden ayırt edilmesi cerrahi lojda kritik bir eşiktir; zira kalsifikasyon içermeyen nüks kitleler ile karmaşık yağ nekrozları maligniteyi taklit edebilir. Konvansiyonel yöntemlerin yetersiz kaldığı yoğun meme parankimine sahip seçilmiş olgularda, yüksek duyarlılığa sahip dinamik kontrastlı manyetik rezonans görüntüleme (MRG), dijital tomosentez (DT) ve kontrastlı dijital mamografi (KDM) nüks ve rezidü lezyonların ayrımında problem çözücü olarak devreye girer. Nadiren gelişen Paget hastalığı, apse formasyonu ve RT'ye sekonder sarkomlar gibi malignitelerin erken teşhisi için de uzun süreli ve multimodalite radyolojik takip hayati önem taşımaktadır.
Breast cancer is the most common malignancy among women aged 40–55 years worldwide, necessitating a multidisciplinary therapeutic approach. Patients diagnosed at an early stage are eligible candidates for breast-conserving surgery (BCS), with radiotherapy (RT) being a cornerstone of the primary treatment protocol. However, post-RT pathological and secondary changes in breast tissue introduce significant challenges during radiological follow-up examinations. In this context, mammography (MG) and ultrasonography (US) are extensively utilized in tandem to detect postoperative fluid collections (seroma, hematoma), tissue edema, skin thickening, and dystrophic calcifications. Differentiating scar tissue, fibrosis, and structural distortion from tumor recurrence is critical within the surgical bed, as complex fat necrosis and non-calcified recurrent masses frequently mimic malignancy. In selected cases with dense breast parenchyma where conventional methods are limited, dynamic contrast-enhanced magnetic resonance imaging (MRI), digital tomosynthesis (DT), and contrast-enhanced digital mammography (CEDM) serve as high-sensitivity problem-solving tools to differentiate recurrence from benign sequelae. Long-term multimodal radiological surveillance remains vital for the early detection of rare complications such as Paget’s disease, abscess formation, and radiation-induced secondary sarcomas.
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