精准医学时代乳腺癌腋窝淋巴结的管理

Management of axillary lymph nodes in breast cancer in the era of precision medicine

乳腺癌的全身系统化治疗策略正逐步发生改变,其中,内分泌治疗和靶向治疗等内科治疗方法不断被强化,而外科治疗领域步入了精准治疗时代,特别是在腋窝淋巴结管理方面。传统的腋窝淋巴结清扫逐渐被前哨淋巴结活组织检查(SLNB)所替代。SLNB通过精确检测腋窝淋巴结转移情况,减少了不必要的腋窝清扫,降低了术后并发症如淋巴水肿的风险,显著提高了患者术后的生活质量。本文总结了近年来腋窝淋巴结管理相关的高质量临床研究,证实了SLNB的安全性和有效性,并针对前哨淋巴结微转移和宏转移的患者,探讨了差异化的治疗策略。此外,本文分析了新辅助化疗后腋窝淋巴结管理的现状,并探讨了通过精准评估进一步豁免SLNB的潜力。腋窝淋巴结管理的精准化是乳腺癌外科治疗的重要进步,可以显著减少术后并发症,也为乳腺癌的个体化治疗提供了有力证据。

The systemic treatment strategy for breast cancer is gradually changing,among which medical treatments such as endocrine therapy and targeted therapy are being enhanced,and breast surgery has entered the era of precision medicine,especially for the management of axillary lymph nodes.Traditional axillary lymph node dissection is gradually replaced by sentinel lymph node biopsy(SLNB).SLNB can significantly reduce unnecessary axillary dissection and the risk of postoperative complications such as lymphedema by accurately detecting axillary lymph node metastases,thereby improving the quality of life of patients after surgery.This article summarized the high-quality clinical studies on axillary lymph node management in recent years,confirmed the safety and efficacy of SLNB,and discussed differentiated treatment strategies for patients with sentinel lymph node micrometastases and macrometastases.In addition,this article analyzed the current status of axillary lymph node management after neoadjuvant chemotherapy and explored the potential for further exemption from SLNB through accurate assessment.The precision management of axillary lymph nodes is a remarkable advancement in breast cancer surgery,which can significantly reduce postoperative complications,and also provide strong evidences for individualized treatment of breast cancer.