Stańczyk Marek, Dziekiewicz Mirosław, Maruszyński Marek, Olszewski Waldemar L
Wojskowy Instytut Medyczny, Klinika Chirurgii Ogólnej, Onkologicznej i Naczyniowej CSK MON, Warszawie.
Pol Merkur Lekarski. 2005 Aug;19(110):245-8.
Mastectomy with axillary lymph node dissection remains the routine surgical treatment of breast cancer in Poland. Lymph edema of the upper extremity is one of the major long-term complications of axillary dissection. Axillary lymph node status is the most valuable prognostic indicator and decision factor on adjuvant chemotherapy or radiotherapy for breast cancer patients. Level I and II axillary lymph node dissection provides prognostic information, maintains local control in the axilla and determines the need for adjuvant systemic treatment, but it is also associated with 30% rate of lymph edema. Multiple studies confirm that sentinel lymphadenectomy accurately stages cancer advancement and is associated with less morbidity than axillary dissection. Over 40% of breast cancer patients in Japan are submitted to breast conserving therapy with sentinel node biopsy. In our opinion sentinel node biopsy may be accepted as an alternative staging procedure for the axilla in breast cancer. Sentinel node biopsy is especially valuable tool for breast cancer patients undergoing breast sparing surgery (IIA), due to excellent cosmetic outcome, minimal morbidity and high degree of histological accuracy associated with the procedure. This article reviews current literature in breast conserving therapy and sentinel node biopsy. Author would like to thank to Professor Kenji Ogawa, Chairman of Surgical Department of Tokyo Women's Medical University Daini Hospital, Professor Fujio Kasumi Chief of Breast Surgical Department of Cancer Institute Hospital and the Japan Society for the Promotion of Science for the scientific support during research visit in Tokyo.
在波兰,乳房切除术加腋窝淋巴结清扫术仍是乳腺癌的常规外科治疗方法。上肢淋巴水肿是腋窝清扫术的主要长期并发症之一。腋窝淋巴结状况是乳腺癌患者辅助化疗或放疗最有价值的预后指标和决策因素。Ⅰ级和Ⅱ级腋窝淋巴结清扫可提供预后信息,维持腋窝局部控制并确定辅助全身治疗的必要性,但它也伴有30%的淋巴水肿发生率。多项研究证实,前哨淋巴结活检能准确分期癌症进展情况,且与腋窝清扫术相比,发病率更低。在日本,超过40%的乳腺癌患者接受保乳治疗并进行前哨淋巴结活检。我们认为,前哨淋巴结活检可被视为乳腺癌腋窝分期的替代方法。前哨淋巴结活检对于接受保乳手术(ⅡA期)的乳腺癌患者来说是一种特别有价值的工具,因为该手术具有出色的美容效果、最低的发病率以及与之相关的高度组织学准确性。本文综述了保乳治疗和前哨淋巴结活检的当前文献。作者感谢东京女子医科大学第二医院外科主任小川健二教授、癌症研究所医院乳腺外科主任春日藤夫教授以及日本学术振兴会在东京研究访问期间提供的科学支持。