不同分子分型早期乳腺癌1~2枚阳性前哨淋巴结避免腋清的研究进展

Research progress in avoiding axillary dissection of 1-2 positive sentinel lymph nodes in breast cancer of different molecular subtypes

腋窝淋巴结清扫(axillary lymph node dissection,ALND)既可评估乳腺癌患者分期及预后,也是腋窝淋巴结转移的标准治疗方法。随着乳腺外科保守治疗理念的流行,不仅乳房可保留,腋窝也可有条件的保留。前哨淋巴结(sentinel lymph node,SLN)是乳腺癌发生淋巴结转移的第一站,是浸润性乳腺癌腋窝分期、预后和治疗中不可或缺的组成部分。分子分型是根据雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)和细胞增殖标志物Ki-67表达水平将乳腺癌分为4类,是乳腺癌的又一大研究热点。本文将通过分析早期乳腺癌分子分型与1~2枚SLN阳性非前哨淋巴结(non-sentinel lymph node,NSLN)转移的关系,筛选出腋窝淋巴结(axillary lymph node,ALN)转移的低危患者为避免ALND做一综述。

Axillary lymph node dissection(ALND)can not only evaluate the stage and prognosis of breast cancer patients,but also is the standard treatment for axillary lymph node metastasis.With the increasing popularity of the concept of conservative treatment in breast surgery,not only the breast but also the fossa axillaris can be preserved conditionally.Sentinel lymph node(SLN)is the first stop of lymph node metastasis in breast cancer.It is an indispensable part of axillary staging,prognosis and the treatment of invasive breast cancer.Molecular typing,which divided breast cancer into four categories based on the expression level of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor-2(HER-2)and cell proliferation marker Ki-67,is another major research hotspot of breast cancer.This review analyzed the relationship between the molecular typing of early breast cancer and the metastasis of 1-2 SLN positive non sentinel lymph nodes(NSLN),in the hope to help screen out low-risk patients with axillary lymph node(ALN)metastasis to avoid ALND.