精准治疗理念下乳腺癌患者腋窝淋巴结的评估与处理

Assessment and Management of Axillary Lymph Nodes for Breast Cancer Under Concept of Precision Therapy

腋窝淋巴结状态是乳腺癌分期、治疗决策以及预后判断的重要依据。精准医疗时代的到来更突显了腋窝淋巴结状态评估的重要性。除查体、超声等常规检查外,乳腺核磁、PET/CT以及近红外荧光、超顺磁性氧化铁、光声造影剂等新方法也可提供指导,其中前哨淋巴结活检是最重要的检查方法。新的临床证据表明前哨淋巴结阴性和前哨淋巴结1~2枚阳性的患者可以免除腋窝淋巴结清扫。炎性反应指标的比值可能是预测淋巴结转移的有用指标。部分高龄患者可以免除腋窝手术并获得良好预后。本文将围绕腋窝淋巴结的评估方法和处理争议进行梳理和总结,以期为精准治疗理念下乳腺癌患者腋窝淋巴结的处理提供新的指导。

The status of axillary lymph nodes is important for the staging,treatment,and prognosis of breast cancer.The arrival of the era of precision medicine highlights the importance of axillary lymph nodes status assessment.Magnetic resonance imaging,positron emission tomography/computed tomography,and new imaging examinations can be used in the assessment of axillary lymph nodes,in addition to routine examinations,such as physical examination and breast ultrasound.Sentinel lymph node biopsy is the most significant method for the assessment of axillary lymph nodes.Emerging evidence suggests that axillary lymph node dissection can be avoided in patients with negative or 1-2 positive sentinel lymph nodes.The ratio of inflammatory indicators may be a reliable predictor of lymph node metastases.Specific elder patients can have a good prognosis without axillary procedure.In this paper,we review and summarize the controversies surrounding the assessment methods and management of axillary lymph nodes.We hope to provide new perspectives for the axillary lymph node diagnosis and management of breast cancer patients under the concept of precision therapy.