乳腺癌内乳淋巴结精准分期与个体化治疗

Accurate staging and individualized treatment of internal mammary lymph nodein breast cancer

内乳淋巴结(IMLN)和腋窝淋巴结(ALN)同是乳腺癌淋巴引流的“第1站”淋巴结,是淋巴分期、预后评估和治疗决策的重要依据。目前,ALN的处理已经接近个体化水平,但是,由于缺乏评估IMLN转移状况的微创技术,常导致分期不准确,治疗不足或过度。乳腺癌扩大根治术曾是获取IMLN转移数据的主要途径,但该术式在增加损伤的同时并未改善预后,导致外科医生对IMLN的关注度降低。近年来,多项研究显示出IMLN放疗的生存获益,但仅仅依靠转移风险(缺乏组织学诊断)来确定放疗指征很可能会导致治疗过度或不足。随着乳腺癌前哨淋巴结活检技术的发展,“新型示踪技术”引导内乳前哨淋巴结活检微创诊断技术可以准确、有效地评估IMLN转移状况,优化乳腺癌的区域淋巴分期,并指导精准的辅助治疗策略。

As a first-echelon nodal drainage site in breast cancer,the status of axillary lymph nodes(ALN)and internal mammary lymph nodes(IMLN)is valuable for nodal staging,prognosis evaluation and treatment choice.At present,our management of ALN is close to the individualized level,but a minimally invasive technique is still lacked to evaluate the status of IMLN,which might lead to understage and under/overtreatment.Interest in metastasis to IMLN culminated with the extended radical mastectomy,but this radical surgical procedure is abandoned because of its extra complications,longer operation time,and no survival benefit.In recent years,a number of studies have shown the survival benefits of IMLN radiotherapy,but relying solely on metastatic risk(lack of histological diagnosis)to determine radiotherapy indications is likely to lead to over/undertreatment.With the development of sentinel lymph node biopsy in breast cancer,internal mammary sentinel lymph node biopsy guided by“modified injection technique”could accurately and effectively evaluate the IMLN status,optimize the nodal staging and guide accurate treatment strategies.