前哨淋巴结活检在早期乳腺癌患者腋窝管理中的研究进展

Research progress of sentinel lymph node biopsy in axillary management for early breast cancer patients

传统的观点认为腋窝淋巴结清扫(axillary lymph node dissection,ALND)是前哨淋巴结(sentinel lymph node,SLN)阳性乳腺癌患者的标准治疗方法,而ALND容易引起上肢水肿、功能障碍等术后并发症,影响患者生活质量。近几年研究显示,对于SLN阳性的早期乳腺癌,并非所有患者都需行ALND。对于微转移及1~2枚SLN阳性的早期乳腺癌患者,免除ALND并不影响总体生存。此外,对于临床腋窝淋巴结阳性的乳腺癌患者,经新辅助化疗临床腋窝淋巴结转阴后,行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)能否准确评估腋窝淋巴结状况仍有较多争议。本文将结合乳腺癌腋窝淋巴结管理的相关文献,针对前哨淋巴结阳性的早期乳腺癌腋窝处理策略,以及临床淋巴结阳性的乳腺癌新辅助化疗后行SLNB的可行性进行综述。

Traditionally,axillary lymph node dissection(ALND)is the standard treatment for patients with sentinel lymph node-positive breast cancer,while ALND tends to cause upper limb edema,dysfunction and other postoperative complications,which affect the quality of life of patients.Studies in recent years have shown that not all patients need ALND for SLN-positive early breast cancer.For early breast cancers patients who with micrometastasis and 1-2 SLN-positive,omitting ALND dose not affect overall survival.For breast cancer patients with positive clinical axillary lymph nodes,after the clinical axillary lymph nodes turn to the negative through neoadjuvant chemotherapy,whether SLNB can accurately assess the status of axillary lymph nodes is still controversial.This article will summarize the latest literature on breast cancer axillary treatment,and the therapeutic strategies for early breast cancer patients with positive sentinel lymph nodes and the clinical feasibility of SLNB after neoadjuvant chemotherapy for clinical lymph node positive breast cancer are reviewed.