前哨淋巴结时代乳腺癌的精准区域处理:演进与展望

Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect

区域淋巴结状况是乳腺癌重要的预后指标之一,可以指导分期和辅助治疗策略的制定。近30年来乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)研究发展迅速,循证医学Ⅰ类证据支持其为临床腋窝淋巴结阴性早期乳腺癌患者安全、有效的腋窝分期技术,前哨淋巴结阴性及低肿瘤负荷患者SLNB替代腋窝淋巴结清扫术后腋窝复发风险和并发症极低。乳腺癌局部区域控制新理念——应该综合考虑远处转移风险、全身治疗效果与不良反应以及局部区域治疗(手术/放疗)效果与不良反应——推动了SLNB适应人群不断扩展,新辅助治疗与SLNB、内乳SLNB将进一步促进区域淋巴结处理降阶梯,豁免腋窝手术临床研究值得期待。SLNB标志着乳腺癌区域淋巴结迈入微创化精准诊疗时代。本文就前哨淋巴结时代乳腺癌的精准区域处理的演进过程和最新进展进行总结,以期为广大临床工作者提供参考。

Regional lymph node status is one of the important prognostic indicators of breast cancer, which can guide the staging and adjuvant treatment strategy. Sentinel lymph node biopsy(SLNB) for breast cancer has developed rapidly over the past three decades, evidence-based medicine class Ⅰ evidence supports that SLNB is a safe and effective axillary staging technique for patients with clinically negative axillary lymph node in early breast cancer. The risk of axillary recurrence and complications in breast cancer patients with negative/few-positive sentinel lymph node omitting axillary lymph node dissection is very low. Locoregional management of breast cancer should consider the metastatic risk of the primary tumor, the efficacy and side effects of systemic therapy, and the efficacy and side effects of locoregional therapy(surgery/radiotherapy). This view has promoted the continuous expansion of the SLNB population. SLNB with neoadjuvant therapy and internal mammary SLNB will further promote the deescalation therapy, and the ongoing studies of omission of axillary surgery should be anticipated. The era of precision medicine for regional lymph node management of breast cancer has gradually arrived with the development of SLNB. This article evaluated the latest progress of precise regional processing of breast cancer in the sentinel lymph node era, in order to provide reference for clinical doctors.