Meme Kanseri Evrelemesinde Oncotype ve Osna Kullanımı
Özet
Meme kanseri, kadınlarda en sık görülen malignite olup, mortalite oranı yüksek önemli bir halk sağlığı sorunudur. Hastalığın prognozu ve tedavi stratejisi, anatomik yayılımın yanı sıra biyolojik tümör özelliklerine dayanır. Sentinel lenf nodu biyopsisi, evreleme ve tedavi kararında kritik rol oynar. OSNA (One-Step Nucleic Acid Amplification) yöntemi, intraoperatif dönemde sentinel lenf nodu metastazlarını hızlı ve kantitatif şekilde saptayarak klasik histopatolojik yöntemlere güçlü bir alternatif sunar. OSNA’nın duyarlılığı %87–95, özgüllüğü %94–97 olup negatif prediktif değeri %97’nin üzerindedir. ACOSOG Z0011 ve AMAROS çalışmaları, uygun olgularda OSNA temelli yaklaşımın tamamlayıcı diseksiyona alternatif olabileceğini göstermektedir. Oncotype DX testi, özellikle hormon reseptörü pozitif, HER2 negatif erken evre meme kanserinde adjuvan kemoterapi gerekliliğini belirlemede kritik öneme sahiptir. 21 gen ekspresyon analiziyle hesaplanan rekürrens skoru, hem prognozu hem de tedavi yanıtını öngörür. TAILORx ve RxPONDER çalışmaları, RS skoruna göre kemoterapi kararının bireyselleştirilebileceğini göstermiştir. Bu test, gereksiz kemoterapiyi azaltırken yüksek riskli hastalarda uygun tedaviyi destekler. Güncel ASCO, ESMO ve NCCN kılavuzları, Oncotype DX kullanımını güçlü şekilde önermektedir. OSNA ve Oncotype DX, modern meme kanseri evrelemesinde kişiselleştirilmiş tedavi stratejilerinin temelini oluşturur.
Referanslar
Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993 Dec;2(6):335–40.
Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic Mapping and Sentinel Lymphadenectomy for Breast Cancer. Vol. 220, ANNALS OF SURGERY.
Zhang Y, Li J, Fan Y, Li X, Qiu J, Zhu M, et al. Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients. Medicine (United States). 2019 Oct 1;98(40).
Ravdin PM, De Laurentiis M, Vendely T, Clark GM. Prediction of Axillary Lymph Node Status in Breast Cancer Patients by Use of Prognostic Indicators. JNCI Journal of the National Cancer Institute. 1994 Dec 7;86(23):1771–5.
Cserni G. Intraoperative analysis of sentinel lymph nodes in breast cancer by one-step nucleic acid amplification. Vol. 65, Journal of Clinical Pathology. 2012. p. 193–9.
Tsujimoto M, Nakabayashi K, Yoshidome K, Kaneko T, Iwase T, Akiyama F, et al. One-step nucleic acid amplification for intraoperative detection of lymph node metastasis in breast cancer patients. Clinical Cancer Research. 2007 Aug 15;13(16):4807–16.
Osako T, Iwase T, Kimura K, Yamashita K, Horii R, Akiyama F. Accurate staging of axillary lymph nodes from breast cancer patients using a novel molecular method. Br J Cancer. 2011 Oct 11;105(8):1197–202.
Giuliano AE, Ballman K V., McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA - Journal of the American Medical Association. 2017 Sep 12;318(10):918–26.
Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014 Nov 1;15(12):1303–10.
Paik S, Shak S, Kim C, Baker J, Cronin M, Baehner FL, et al. Division of Pathology, NSABP, 4 Allegheny Center [Internet]. Vol. 27, n engl j med. 2004. Available from: www.nejm.org
Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. New England Journal of Medicine. 2018 Jul 12;379(2):111–21.
Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, et al. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy. JAMA Oncol. 2020 Mar 1;6(3):367.
Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2020 Apr;18(4):452–78.
Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, et al. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. New England Journal of Medicine. 2021 Dec 16;385(25):2336–47.
Andre F, Nofisat Ismaila ;, Allison KH, Barlow WE, Collyar DE, Damodaran S, et al. Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update [Internet]. 2022. Available from: www.asco.org/breast-cancer-guidelines.
Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up 5 behalf of the ESMO Guidelines Committee. Annals of Oncology [Internet]. 2024;35:159–82. Available from: https://doi.org/10.1016/j.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) Breast Cancer NCCN.org NCCN Guidelines for Patients ® available at www.nccn.org/patients NCCN recognizes the importance of clinical trials and encourages participation when applicable and available. Trials should be designed to maximize inclusiveness and broad representative enrollment [Internet]. 2025. Available from: www.nccn.org/patients
