早期乳腺癌腋窝处理研究热点

Research hotspots in axillary treatment for early-stage breast cancer

前哨淋巴结活检(SLNB)替代腋窝淋巴结清扫(ALND)已成为临床腋窝淋巴结阴性早期乳腺癌病人的标准处理方式。有限腋窝淋巴结转移的病人,接受保乳治疗满足美国外科医师协会肿瘤学组(ACOSOG)Z0011、IBCSG23-01入组条件,可豁免ALND;或参考AMAROS,考虑腋窝放疗替代ALND;接受乳房完全切除无放疗的病人,推荐ALND。区域淋巴结放疗能够降低乳腺癌局部区域复发,在早期乳腺癌病人的腋窝处理中应权衡临床病理指标进行个体化治疗。新辅助治疗初始临床腋窝淋巴结阴性的病人可在新辅助治疗后行SLNB。新辅助治疗前可疑腋窝淋巴结优选超声引导下穿刺明确状态并标记转移淋巴结。选择适宜病人,采用双示踪、活检超过2枚以上前哨淋巴结、评估标记的新辅助治疗前转移淋巴结,并考虑将淋巴结分期N0(i+)纳为进行ALND的标准,满足上述条件,则初始腋窝淋巴结有转移新辅助治疗后临床完全缓解的病人可谨慎考虑接受SLNB。实践中,除外参与相关临床试验,ALND仍是这部分病人的治疗推荐。

Sentinel lymph node biopsy（SLNB） has replaced axillary lymph node dissection（ALND） to stage clinically node-negative breast cancer patients. In the patients with low-volume nodal metastasis, ALND could be safely avoided when treated with breast-conserving therapy eligible for Z0011 or IBCSG 23-01, or radiation considered referring to AMAROS. ALND is still recommended for patients with involved axillary nodes received mastectomy and not planned for radiation. Addition of regional nodal irradiation in subgroups of patients reduces locoregional recurrence significantly and should be recommended taken all clinical and pathologic factors considered for individual patients. For patients with clinically node-negative disease, SLNB following neoadjuvant therapy is considered an acceptable approach.Ultrasound-guided biopsy and localization of suspicious axillary lymph nodes before neoadjuvant therapy are preferred. SLNB may be an option after neoadjuvant therapy in patients with proven positive axillary nodes who achieved clinical complete response, given that usage double tracers, biopsy more than 2 sentinel lymph nodes, evaluation the labelled lymph node before neoadjuvant therapy, and stage NO （i＋） may be regarded as the criteria for ALND. ALND remains the standard-of-care for the subset of patients in clinical practice, unless enrolled on some clinical trials. Staying the current of axillary treatments in early-stage breast cancer helps to make wiser clinical decision and organize further in-depth research, so that safe, effective and n^oderate axillary treatments can be performed.