乳腺癌前哨淋巴结活检术的发展历史及研究进展

Development history and research progress of sentinel lymph node biopsy in breast cancer

乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)是一项兼具诊断及治疗目的的外科技术,是近年来乳腺外科领域具有里程碑意义的重大进展之一。作为一种腋窝微创外科术式,在乳腺癌综合治疗效果不断提高的背景下,SLNB在近40年的发展呈现出降阶梯趋势,也从侧面反映出乳腺癌作为一种全身性疾病的生物学本质。首先,米兰SLNB185、NSABP-B32等一系列前瞻性随机对照临床试验证实,SLNB可以作为临床腋窝淋巴结阴性早期乳腺癌准确的腋窝分期手段。ACOSOG Z0011、IBCSG 23-01等临床试验结果则进一步丰富了腋窝外科手术降阶梯的概念,前哨淋巴结(sentinel lymph node,SLN)阳性的患者手术范围缩小,即SLN低肿瘤负荷患者中,SLNB可以安全替代腋窝淋巴结清扫(axillary lymph node dissection,ALND)。随后,SLNB以及由此衍生而来的标记淋巴结活检将腋窝微创手术的可行性人群范围进一步扩展到了新辅助治疗的患者。近年来,以EUBREAST-061为代表的回顾性研究及有限的前瞻性研究数据初步证实了腋窝降阶梯治疗在新辅助治疗患者中的肿瘤安全性。未来相关研究将聚焦在筛选寻找有望豁免SLNB的特定低危早期乳腺癌或者新辅助治疗后腋窝成功降期的超级反应者,有待于相关高质量临床研究如SOUND、BOOG 2013-08等临床试验长期随访数据的公布。本文就乳腺癌SLNB的发展历史、最新进展及未来展望进行综述,旨在为广大临床工作者提供参考。

Sentinel lymph node biopsy(SLNB)is a surgical technique for diagnosing and treating purposes in breast cancer,which is one of the major advances with milestone significance in the field of breast surgery.As a less-invasive axillary surgery,the development of SLNB has shown a de-escalating trend in the recent 40 years,depending on the greatly improved efficacy of multidiscipline treatment in breast cancer,which indirectly reflects the essence that breast cancer is a systemic disease.First,a series of clinical trials such as Milan SLNB185 and NSABP-B32 confirmed that SLNB is an accurate axillary staging procedure for patients with clinically node-negative early breast cancer.Next,results from ACOSOG Z0011 and IBCSG 23-01 trials further enriched the concept of de-escalating axillary surgery in the sentinel lymph node(SLN)-positive patients and showed that routine axillary lymph node dissection(ALND)can be safely replaced by SLNB in patients with limited tumor burden present with SLN.Furthermore,SLNB and deriving clipped lymph node biopsy extend the target population of minimally invasive axillary surgery to the patients undergoing neoadjuvant therapy.In the recent few years,numerous retrospective studies represented by EUBREAST-061 study and a limited number of prospective studies have preliminarily confirmed the oncological safety of de-escalating axillary surgery in the setting of neoadjuvant therapy.In the future,related research will focus on finding suitable candidates for omitting SLNB including a selected group of low-risk early breast cancer or exceptional responders in neoadjuvant therapy,and the long-term follow-up data of relevant high-quality clinical trials such as SOUND and BOOG 2013-08 are yet to be mature.This article summarized the development history,research progress and future outlook of SLNB,in order to provide a reference for clinicians.