Ku saabsan-kansarka / baaritaanka-baaritaanka / abaabulka / sentinel-node-biopsy-fact-sheet

Sentinel Lymph Node Biopsy

Waa maxay qanjirada qanjirada?

Qanjirrada qanjirada waa xubno yaryar oo wareegsan oo qayb ka ah nidaamka lymfatikada jirka. Nidaamka lymfatiga waa qeyb ka mid ah habka difaaca jirka. Waxay ka kooban tahay shabakad ka kooban maraakiib iyo xubno ay ku jiraan lymf, dheecaan cad oo qaada unugyada dhiigga cad ee caabuqa la dagaallama iyo sidoo kale dheecaanka iyo walxaha qashinka ka yimaada unugyada jirka iyo unugyada. Qofka qaba kansarka, limfa sidoo kale wuxuu qaadi karaa unugyada kansarka ee ka go'ay buro weyn.

Anatomy ee nidaamka lymfatiga, oo muujinaya maraakiibta limfaha iyo xubnaha limfaha, oo ay ku jiraan qanjidhada qanjirada, qumanka, thymus, beeryarada, iyo dhuuxa lafta. Qaybta kore ee kore waxay muujineysaa qaab dhismeedka qanjidhada qanjidhada iyo maraakiibta qanjirada, oo leh fallaaro muujinaya sida qanjirada iyo unugyada difaaca jirka ee loo yaqaan 'lymphocytes' ay ugu soo baxaan oo uga baxaan qanjidhada. Gunta hoose ayaa muujineysa isku dhawaansho dhuuxa lafta.

Lymph waxaa lagu sifeeyaa qanjidhada qanjirada, kuwaas oo si ballaaran looga helo jirka oo dhan oo ay isugu xiran yihiin midba midka kale maraakiibta qanjirada. Kooxo qanjidhada qanjidhada waxay ku yaalliin qoorta, hoosta hoose, laabta, caloosha, iyo gumaarka. Qanjirrada qanjirada waxaa ku jira unugyo dhiig oo cad (B lymphocytes iyo T lymphocytes) iyo noocyo kale oo unugyada difaaca jirka ah. Qanjirada qanjirada 'Lymph node' waxay qabtaan bakteeriyada iyo fayrasyada, iyo sidoo kale qaar unugyada waxyeellada leh iyo kuwa aan caadiga ahayn, oo ka caawiya habka difaaca jirka inuu la dagaallamo cudurka.

Noocyo badan oo kansar ah ayaa ku faafay nidaamka dheecaanka jirka, mid ka mid ah goobaha ugu horreeya ee lagu faafiyo kansarradan ayaa ah burooyinka qanjidhka u dhow.

Waa maxay qanjidhka xididdada dhiigga?

Qanjirka 'sentinel lymph node' waxaa lagu qeexaa inuu yahay qanjidhkii ugu horreeyay ee unugyada kansarku ay ugu badan yihiin inay ku faafaan buro aasaasi ah. Mararka qaarkood, waxaa jiri kara wax ka badan hal xuub xinjiraha la diro.

Waa maxay biopsy qanjirka 'sentinel lymph node biopsy'?

Qalliinka unugyada qanjirka 'sentinel lymph node biopsy (SLNB) waa nidaam lagu ogaado unugyada qanjirka' sentinel lymph node ', lagana saaro, lana baaro si loo ogaado in unugyada kansarku ay jiraan iyo in kale. Waxaa loo isticmaalaa dadka horey looga helay kansarka.

Natiijada xun ee SLNB waxay soo jeedineysaa in kansarka uusan weli ku faafin qanjirada ku dhow ama xubnaha kale.

Natiijada wanaagsan ee SLNB waxay muujineysaa in kansarku ku jiro xuubka qanjirka 'sentinel lymph node' iyo in laga yaabo inuu ku faafay qanjidhada kale ee u dhow (oo loo yaqaan qanjidhada gobollada) iyo, laga yaabee, xubnaha kale. Macluumaadkani wuxuu ka caawin karaa dhakhtarka inuu go'aamiyo heerka kansarka (heerka cudurka ee jirka gudihiisa) iyo inuu sameeyo qorshe daaweyn habboon.

Maxaa dhacaya inta lagu jiro SLNB?

Marka hore, qanjirka 'sentinel lymph node' (ama node) waa in la helaa. Si taas loo sameeyo, dhakhtar qalliin ayaa isku dura walax shucaac ah, midab buluug ah, ama labadaba meel u dhow buro. Dhakhtarka qalliinka ayaa markaa adeegsanaya qalab lagu ogaanayo qanjidhada qanjirada ee ay kujiraan walaxda shucaaca ama wuxuu raadiyaa qanjidhada qanjidhada ee lagu madoobey dheeha buluuga ah. Mar alla markii la helo unugyada qanjidhka 'sentinel lymph node', dhakhtarka qalliinka wuxuu ku sameeyaa jeexitaan yar (qiyaastii 1/2 inji) maqaarka dushiisa oo wuxuu ka saarayaa buudda.

Kadib xinjirta sentinel waxaa baaraya jiritaanka unugyada kansarka dhakhtarka cudurada cudurada. Haddii kansarka la helo, dhakhtarka qalliinka ayaa laga yaabaa inuu ka soo jaro qanjidhada dheeraadka ah, ha ahaato inta lagu guda jiro isla howsha ka-soo-qaadista qalliinka ama inta lagu guda jiro qalliinka la socoshada SLNB waxaa lagu samayn karaa bukaan socod eegto ama waxay u baahan kartaa in muddo gaaban cisbitaalka la joogo.

SLNB badanaa waxaa la sameeyaa isla waqtigaas oo burada aasaasiga ah laga saaro. Xaaladaha qaarkood qaliinka ayaa sidoo kale la samayn karaa ka hor ama xitaa kadib (iyadoo kuxiran inta ay le'eg tahay marinnada lymfatikada) saarista buro.

Waa maxay faa'iidooyinka SLNB?

SNLB waxay ka caawisaa dhakhaatiirta inay soo saaraan kansarka oo ay qiyaasaan halista unugyada burooyinka ay soo saareen awooda ay ugu fidayaan qaybaha kale ee jirka. Haddii qanjirka 'sentinel node' uu ku xun yahay kansarka, bukaanku wuxuu awoodi karaa inuu iska ilaaliyo qalliinka qanjidhada ballaadhan ee ballaadhan, taasoo yareyneysa dhibaatooyinka ka dhalan kara in la gooyo qanjiro fara badan.

Waa maxay waxyeelooyinka suurtagalka ah ee SLNB?

Dhamaan qalliinada looga saarayo qanjidhada qanjirada, oo ay ku jiraan SLNB, waxay yeelan karaan waxyeelo waxyeelo leh, in kasta oo ka saarida qanjirada yar yare ay badanaa la xiriirto waxyeelo yar, gaar ahaan kuwa halista ah sida lymphedema. Dhibaatooyinka ka imaan kara waxaa ka mid ah:

• Lymphedema, ama bararka unugyada. Inta lagu jiro qalliinka qanjirada 'limph node', maraakiibta qanjirada ee u socda kana imanaya nabarrada 'sentinel node' ama koox noodhadh ah ayaa la gooyaa. Tani waxay carqaladeyneysaa socodka limfaha ee caadiga ah ee loo maro aagga ay dhibaatadu saameysey, taas oo u horseedi karta dheecaan aan caadi ahayn oo ah dheecaanka qanjirada oo sababi kara barar. Lymphedema wuxuu sababi karaa xanuun ama raaxo la'aan aagga ay dhibaatadu saameysey, maqaarka dushana laga yaabo inuu adkaado ama adkaado.

Khatarta lymphedema waxay sii kordheysaa tirada qanjirada qanjidhada oo la saaro. Khatar yar ayaa ku jirta ka saarida kaliya qanjirka 'sentinel lymph node'. Marka laga hadlayo qanjirada qanjirada oo ballaaran ee kilkisha ama gumaarka, bararku wuxuu saameyn ku yeelan karaa gacanta ama lugta oo dhan. Intaas waxaa sii dheer, waxaa jira halista sii kordheysa ee infekshinka aagga ama addimada ay dhibaatadu saameysey. Marar aad u yar, lymphedema daba dheeraata oo ay sabab u tahay ka-goynta qanjidhada ballaadhan ayaa sababi kara kansar ku dhaca marinnada sanbabka ee loo yaqaan 'lymphangiosarcoma'.

• Seroma, ama cuf ama buro ay sababtay soo saarista dheecaanka qanjirada ee goobta qalliinka

• Kabuubyo, xoqid, barar, nabar, ama xanuun goobta qalliinka, iyo halista sii kordheysa ee infekshinka

• Dhibaato dhaqaajinta qaybta jirka ee ay dhibaatadu saameysey

• Maqaarka ama dareen-celinta xasaasiyadda ee midabka buluuga ah ee loo isticmaalo SNLB

• Natiijada biopsy ee beenta-diidmada ah - taasi waa, unugyada kansarka laguma arko xuubka qanjirka 'sentinel lymph node' in kasta oo ay horeyba ugu faafeen qanjidhada qanjidhada gobolka ama qaybaha kale ee jirka. Natiijada biopsy ee beenta-xun ayaa bukaanka iyo dhakhtarka u siinaysa dareen been ah oo ammaan ah oo ku saabsan xaddiga kansarka ku jira jidhka bukaanka.

SLNB miyaa loo isticmaalay in lagu caawiyo marxalada dhamaan noocyada kansarka?

Maya. SLNB waxaa badanaa loo isticmaalaa in lagu caawiyo marxaladda kansarka naasaha iyo melanoma. Waxaa mararka qaarkood loo isticmaalaa in lagu jiido kansarka xubinta taranka (1) iyo kansarka endometrial (2). Si kastaba ha noqotee, waxaa lagu baranayaa noocyada kale ee kansarka, oo ay ku jiraan kansarka xubinta taranka iyo xubinta taranka dumarka (3), iyo malawadka, caloosha, hunguriga, madaxa iyo qoorta, qanjirka 'thyroid', iyo kansarka unugyada aan yareyn (4).

Maxay cilmi baaris ka muujisay isticmaalka SLNB ee kansarka naasaha?

Unugyada kansarka naasuhu waxay u badan tahay inay marka hore ku faafaan qanjidhada qanjirada ee ku yaal axilla, ama aagga kilkisha, oo ku xigta naaska ay dhibaatadu saameysey. Si kastaba ha noqotee, kansarka naasaha ee ku dhow bartamaha laabta (agagaarka lafta naaska), unugyada kansarku waxay marka hore ku faafi karaan qanjidhada qanjidhada ee gudaha xabadka (hoosta lafaha naaska, oo loo yaqaan noodhadhka naasaha gudaha) ka hor inta aan lagu ogaan axilla.

Tirada qanjidhada qanjidhada 'axilla' way ku kala duwan yihiin qofba qof ka kale; heerka caadiga ah waa inta udhaxeysa 20 iyo 40. Taariikh ahaan, dhamaan burooyinkaan axillary limph node waa laga saaray (qaliin la yiraahdo axillary lymph node dissection, ama ALND) dumarka laga helay kansarka naasaha. Tan waxaa loo sameeyay laba sababood: si looga caawiyo marxaladda kansarka naasaha iyo in laga caawiyo kahortagga soo noqoshada gobolka ee cudurka. (Soo noqoshada gobolka ee kansarka naasaha wuxuu dhacaa marka unugyada kansarka naasaha ee u hayaamay qanjidhada u dhow ay keenaan buro cusub.)

Qalliinka naasaha ee 'biopsy node biopsy' oo loo yaqaan 'Sentinel lymph node'. Walax shucaac leh iyo / ama dheeh buluug ah ayaa lagu durayaa meel u dhow buro (gudiga koowaad). Qalabka la isku duray waxay ku yaalliin muuqaal ahaan iyo / ama qalab aaladda ogaanaya shucaaca (qeybta dhexe). Salka nalka (s) (lymph node (yada) ugu horeeya ee qaata maaddada) waa laga saarayaa oo laga baarayaa unugyada kansarka (gudiga ugu dambeeya).

Si kastaba ha noqotee, sababtoo ah ka saarista qanjidhada qanjirada badan isla mar ahaantaana waxay kordhisaa halista waxyeellooyinka waxyeellada leh, tijaabooyin caafimaad ayaa la bilaabay si loo baaro in kaliya unugyada qanjirada 'sentinel lymph node' laga saari karo iyo in kale. Laba tijaabo oo kala-sooc ah oo loo yaqaan 'NCI-sponsored randomized 3' oo tijaabin caafimaad ah ayaa muujiyey in SLNB oo aan lahayn ALND ay ku filan tahay qabashada kansarka naasaha iyo ka hortagga soo noqoshada gobolka ee haweenka aan lahayn astaamo caafimaad oo ku saabsan qanjirka 'axillary lymph node metastasis', sida buro ama barar kilkilaha ah oo laga yaabo waxay keenaan raaxo la'aan, iyo kuwa lagu daweeyo qalliin, daaweynta nidaamsan ee daaweynta, iyo daaweynta shucaaca.

Hal tijaabo, oo ku lug leh haweenka 5,611, cilmi baarayaashu waxay si aan kala sooc lahayn ugu qoondeeyeen kaqeybgalayaasha inay helaan kaliya SLNB, ama SLNB oo lagu daray ALND, qalliinka kadib (5). Haweenkaas labada koox ah ee unugyadooda qanjirka 'sentinel lymph node' (yada) ay u liitaan kansarka (wadar ahaan 3,989 haween ah) ayaa la raacay celcelis ahaan 8 sano. Baarayaasha ma helin kala duwanaansho guud oo badbaado ama jirro la'aan cudurka u dhexeeya labada koox ee haweenka ah.

Tijaabada kale waxaa ka mid ahaa 891 haween ah oo leh burooyin ilaa 5 cm naaska ku jira iyo hal ama labo xuub xinjiraha dareemayaasha ah. Bukaannada ayaa si aan kala sooc lahayn loogu qoondeeyey inay helaan SLNB oo keliya ama inay helaan ALND kadib SLNB (6). Dumarka oo dhan waxaa lagu daaweeyay lumpectomy, badankooduna waxay heleen daaweyn nidaamsan iyo daaweynta shucaaca banaanka ee naaska ay saameysay. Dabagal dheer kadib, labada koox ee haweenku waxay wadaageen 10 sano guud ahaan badbaadin, badbaadin cudur la'aan, iyo heerarka soo noqoshada gobolka (7).

Maxay cilmi baaris ka muujisay isticmaalka SLNB ee melanoma?

Cilmi-baaristu waxay tilmaamaysaa in bukaanada qaba melanoma ee soo maray SLNB isla markaana qanjidhada xinjirowga sentinel loo arko inay ku xun yihiin kansarka isla markaana aan lahayn calaamado caafimaad oo muujinaya in kansarku ku faafay qanjidhada kale ee lymph node waxaa laga badbaadi karaa qalliinka qanjirada ee ballaaran ee burooyinka aasaasiga ah waqtiga burooyinka koowaad ka saarid Falanqayn meta ah oo ka kooban 71 daraasadood oo xog laga helay 25,240 bukaan ah ayaa lagu ogaaday in halista lymph node gobolku ku soo noqnoqonayo bukaanada qaba SLNB taban ay tahay 5% ama ka yar (8).

Qalliinka qalliinka 'Sentinel lymph node biopsy' ee bukaanka qaba melanoma. Walax shucaac leh iyo / ama dheeh buluug ah ayaa lagu durayaa meel u dhow buro (gudiga koowaad). Qalabka la isku duray waxay ku yaalliin muuqaal ahaan iyo / ama qalab aaladda ogaanaya shucaaca (qeybta dhexe). Salka nalka (s) (lymph node (yada) ugu horeeya ee qaata maaddada) waa laga saarayaa oo laga baarayaa unugyada kansarka (gudiga ugu dambeeya). Cad ka-qaadista unugyada 'Sentinel lymph node biopsy' ayaa la samayn karaa ka hor ama ka dib marka la soo saaro burada.

Natiijooyinka ka soo baxa Multicenter Selective Lymphadenectomy Trial II (MSLT-II) ayaa sidoo kale xaqiijiyey badbaadada SLNB ee dadka qaba melanoma oo leh qanjidhada qanjirka 'Sentinel Lymph node' oo aan lahayn caddayn caafimaad oo ku saabsan ka qayb qaadashada qanjirada kale. Wejigan ballaadhan ee la kala soocay ee 3, oo ay ku jiraan in ka badan 1,900 oo bukaan ah, ayaa la barbardhigay faa'iidada daaweynta ee SLNB oo lagu daray isla markaaba ka saarista qanjidhada qanjidhada ee haray (oo loo yaqaan dhammaystirka qanjidhada dhammaystirka, ama CLND) oo leh SNLB oo lagu daray ilaalin firfircoon, oo ay ku jiraan baaritaanka joogtada ah ee ultrasound-ka ee hadhaaga qanjidhada gobolka iyo daaweynta CLND haddii la ogaado calaamadaha lymph node metastasis dheeraad ah.

Ka dib dabagal dhexdhexaad ah oo ah bilooyin 43, bukaanada soo maray CLND isla markiiba ma aysan helin badbaado melanoma-gaar ah oo ka wanaagsan kuwa soo maray SLNB ee leh CLND kaliya haddii calaamadaha lymph node metastasis dheeraad ah ay muuqdaan (86% kaqeybgalayaasha labada kooxba waxay leeyihiin uma dhiman melanoma 3 sano) (9).

Tixraacyo Xullan

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7. Giuliano AE, Ballman KV, McCall L, 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 2017; 318(10):918-926. [PubMed Abstract]
8. Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. Journal of Clinical Oncology 2011; 29(11):1479–1487. [PubMed Abstract]
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