乳腺癌前哨淋巴结的研究现状与评价

Current studies and evaluations of sentinel lymph node biopsy for breast cancer

前哨淋巴结活检为乳腺癌患者提供了精确的分期,并且减少了手术并发症,因此日益为临床所接受。但是在临床研究中,前哨淋巴结活检的方法、适应证尚有一些争议。本文就前哨淋巴结活检技术、前哨淋巴结病理学评估、前哨淋巴结活检的适应证和前哨淋巴结活检取代腋淋巴结清扫等几方面进行讨论,明确了同位素和染料示踪剂可以互补,淋巴核素显像对于内乳前哨淋巴结活检的价值,内乳前哨淋巴结活检目前仍处于临床研究阶段;术中前哨淋巴结的病理学评估方法中,细胞学印片显示了快速、廉价、节省组织材料等优点,但对微转移灶的识别仍有不足;前哨淋巴结有微转移的患者目前仍应进行腋淋巴结清扫。导管内癌、预防性乳房切除、乳房缩小成型术及隆乳手术后患乳腺癌的患者,有必要进行前哨淋巴结活检;虽然NSABPB32、Z0010、Z0011等大样本前瞻性随机临床试验结果要等待许多时间,但是乳腺癌前哨淋巴结活检已在临床上广泛开展,我们必须重视技术的规范和病例的选择。

As a result of accuracy of staging and decreased patient morbidity, sentinel lymph node biopsy for breast cancer was quickly accepted into clinical practice. Many controversies remain in the methods and indications of sentinel lymph node biopsy. In this article, we attempt to highlight the clinical studies regarding the biopsy techniques, pathologic evaluation, indication for lymphatic mapping and eliminating axillary lymph dissection by sentinel lymph node biopsy. It is demonstrated that radioisotope and blue dye techniques are complementary. Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN, but the practicability of internal mammary SLN biopsy is still in the investigative stage. As for intraoperative diagnosis of sentinel lymph node, imprint cytology is a quick, economic and tissue-preserving method, but not very effective in the identification of micrometastasis; axillary lymph node dissection is preferable for patients with micrometastasis. Sentinel lymph node biopsy is indicated for ductal carcinoma in situ, with prophylactic mastec- tomy, breast cancer patients with previous reduction mammoplasty and breast implants. Currently, NSABP B32, Z0010 and Z0011, large, prospective randomized trials are in progress to evaluate unresolved issues of SLN biopsy. Although data from these trials is not available, SLN biopsy has been widely adopted in the clinic. Consistency of technique as well as case selection has attained great significance.