Ferrari Alberta, Rovera Francesca, Dionigi Paolo, Limonta Giorgio, Marelli Marina, Besana Ciani Isabella, Bianchi Veronica, Vanoli Cristiana, Dionigi Renzo
University of Insubria, Department of Surgical Sciences, Viale Borri 57, 21100 Varese, Italy.
Expert Rev Anticancer Ther. 2006 Oct;6(10):1503-15. doi: 10.1586/14737140.6.10.1503.
During the recent years, based on the results of validation studies, the sentinel lymph node biopsy has replaced routine axillary dissection as the new standard of care in early breast cancer. The technique represents a minimally invasive, highly accurate method for axillary staging, which could spare approximately 65-70% of patients unnecessary axillary dissection and its related morbidity. Several technical and clinical controversies have been raised during the development of this new technique; the authors review the most important issues, some questions have already been answered and others are still under debate. As far as the technical aspects are concerned, mapping techniques, appropriate surgical training, options for pathological examination of sentinel lymph nodes and the issue of nonaxillary sentinel lymph nodes are discussed. An update on clinical controversies demonstrates that factors such as large tumor size, palpable axillary nodes, multifocality and multicentricity, previous breast and axillary surgery, and pregnancy are no longer regarded as absolute contraindications for sentinel lymph node biopsy. Feasibility, accuracy and timing of sentinel lymph node biopsy in patients undergoing neoadjuvant chemotherapy remain unsolved issues, as well as the indication of the technique for some subgroups of in situ lesions. Finally, one of the most attractive open forums for debate will be discussed: whether or not completion of axillary dissection in the case of positive SLN is always required.
近年来，基于验证性研究的结果，前哨淋巴结活检已取代常规腋窝清扫术，成为早期乳腺癌治疗的新标准。该技术是一种微创、高精度的腋窝分期方法，可使约65% - 70%的患者避免不必要的腋窝清扫及其相关并发症。在这项新技术的发展过程中引发了一些技术和临床方面的争议；作者回顾了最重要的问题，其中一些问题已经得到解答，而其他问题仍在争论中。就技术层面而言，讨论了示踪技术、适当的手术培训、前哨淋巴结病理检查的选择以及非腋窝前哨淋巴结的问题。临床争议的最新情况表明，肿瘤体积大、可触及腋窝淋巴结、多灶性和多中心性、既往乳腺和腋窝手术史以及妊娠等因素不再被视为前哨淋巴结活检的绝对禁忌证。新辅助化疗患者前哨淋巴结活检的可行性、准确性和时机，以及原位病变某些亚组应用该技术的指征仍是未解决的问题。最后，将讨论最具吸引力的公开辩论话题之一：前哨淋巴结阳性时是否总是需要完成腋窝清扫。
