乳腺癌术前腋窝评估与淋巴结清扫方式的选择

Preoperative estimate for axillary in breast cancer and different selection in axillary lymph node dissection

乳腺癌手术腋窝处理有不同方式。作者提出采用医生触诊+2种影像学检查作为评估腋窝的方法。根据评估结果采用相应的腋窝处理方式。(1)腋窝评估阴性,只做前哨淋巴结活检(SLNB),前哨淋巴结(SLN)无转移则不做腋窝淋巴结清扫(ALND)。(2)腋窝评估倾向阴性,如果SLN阴性,则不做腋窝清扫。如果SLN阳性,做功能性腋窝清扫。(3)腋窝评估可疑阳性,功能性腋窝淋巴结清扫。如果多个淋巴结转移,需要做level1或level2的淋巴结清扫。(4)术前评估腋窝阳性,在腋窝反向制图(ARM)基础上做腋窝level 1、level2甚至level3水平的腋窝淋巴结清扫。尽量保留被蓝染的引流上肢的淋巴通路。

There are several surgical treatments in axillary of breast cancer. Author suggests that axillary assessment should be depend upon the doctor＇s palpation and other two kinds of image inspection.On the base of the assessment, the different operative procedure should be selected.（1）Axillary estimate is negative, sentinel lymph node（SLN） biopsy（SLNB） is only done. If no metastasis is in SLN, don＇t do axillary lymph node dissection（ALND）.（2）Axillary estimate is apt to negative, firstly SLNB, if positive in SLN, functional axillary lymph node dissection（FALND） should be done.（3）Axillary estimate is inclined to positive, FALND should be selected. If multi-metastases would be found, the dissection to level 1 or level 2 needed.（4）Axillary estimate is positive, total ALND should be done at the basis of axillary reverse mapping. Blue-dyed lymphatic passageway draining the arm should be preserved as far as possible.