Spillane A J, Sacks N P
Breast Unit, Royal Marsden Hospital, London, UK.
Aust N Z J Surg. 2000 Jul;70(7):515-24. doi: 10.1046/j.1440-1622.2000.01838.x.
Controversy continues to surround the best practice for management of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women presenting with early stage disease, the more widespread utilization of adjuvant chemoendocrine therapy and, more recently, the advent of alternative staging procedures, principally sentinel node biopsy (SNB). The aim of the present review is to critically analyse the current literature concerning the preferred management of the axilla in early breast cancer and make evidence-based recommendations on current management.
A review was undertaken of the English language medical literature, using MEDLINE database software and cross-referencing major articles on the subject, focusing on the last 10 years. The following combinations of key words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy.
Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majority of women with EBC and a clinically negative axilla.
Sentinel node biopsy has no proven superiority over axillary dissection because no randomized controlled trials have been completed to date. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient demand. Therefore if patients are not being enrolled in clinical trials strict quality controls need to be established at a local level before SNB is allowed to replace standard treatment of the axilla. Unless this is strictly adhered to there is a significant risk of an increase in the frequency of axillary relapse and possible increased understaging and resultant inadequate treatment of patients.
早期乳腺癌（EBC）患者腋窝处理的最佳实践仍存在争议，尤其是临床腋窝阴性的情况。腋窝手术的治疗和分期作用之间的平衡（以及所采用手术的相应发病率）已经发生了改变。这是由于早期疾病女性患者的发病率增加、辅助性化学内分泌治疗的更广泛应用，以及最近替代分期程序的出现，主要是前哨淋巴结活检（SNB）。本综述的目的是批判性地分析当前关于早期乳腺癌腋窝首选处理的文献，并就当前管理提出基于证据的建议。
使用MEDLINE数据库软件对英文医学文献进行综述，并交叉引用关于该主题的主要文章，重点关注过去10年。搜索了以下关键词组合：乳腺肿瘤、腋窝、腋窝清扫、生存、预后和前哨淋巴结活检。
尽管有更频繁早期诊断的趋势，但对于大多数早期乳腺癌且临床腋窝阴性的女性，Ⅰ级和Ⅱ级腋窝清扫仍是首选治疗方法。
由于迄今为止尚未完成随机对照试验，前哨淋巴结活检相对于腋窝清扫尚无已证实的优势。尽管如此，由于负责其开发的主要中心取得了令人鼓舞的结果以及患者需求，前哨淋巴结活检将越来越多地被采用。因此，如果患者未纳入临床试验，在允许前哨淋巴结活检取代腋窝标准治疗之前，需要在地方层面建立严格的质量控制。除非严格遵守这一点，否则腋窝复发频率增加以及可能增加分期不足和患者治疗不充分的风险将显著增加。
