Hirche C, Mohr Z, Kneif S, Hünerbein M
Helios Hospital Berlin-Buch, Department of General Surgery and Surgical Oncology, Berlin, Germany.
Minerva Chir. 2010 Oct;65(5):537-46.
The axillary nodal status is accepted as the most powerful prognostic tool available for early stage breast cancer. In the past radical removal of level I and level II lymph nodes at axillary node dissection (ALND) has been the most accurate method to assess nodal status, and it is the universal standard; however, it is associated with several adverse long-term sequelae. New diagnostic technologies have helped to individualize diagnostic evaluation and therapy of breast cancer thus improving efficacy and minimizing morbidity of treatment. Lymphatic mapping with sentinel lymph node biopsy has emerged as an effective and safe alternative to the ALND for detecting axillary metastases. Many issues such as indications or technique of performing sentinel node biopsy have been evaluated. Multiple studies now confirm that sentinel lymphadenectomy accurately stages the axilla and is associated with less morbidity than axillary dissection. Blue dye, radiocolloid, or both can be used to identify the sentinel node, and several injection techniques may be used successfully. Sentinel node biopsy is now minimally invasive, highly accurate method of axillary staging, and has replaced routine axillary lymph node dissection as the new standard of care in breast cancer. New technologies for axillary nodal staging include innovative imaging techniques such as single photon emission computerized tomography (SPECT) and modern histopathologic evaluation of sentinel nodes using molecular biologic approaches.
腋窝淋巴结状态被认为是早期乳腺癌最有效的预后评估工具。过去，在腋窝淋巴结清扫术（ALND）中彻底切除Ⅰ级和Ⅱ级淋巴结一直是评估淋巴结状态最准确的方法，也是通用标准；然而，它会带来一些不良的长期后遗症。新的诊断技术有助于乳腺癌诊断评估和治疗的个体化，从而提高疗效并将治疗的发病率降至最低。前哨淋巴结活检的淋巴绘图已成为一种有效且安全的替代ALND检测腋窝转移的方法。许多问题，如前哨淋巴结活检的适应证或技术，都已得到评估。多项研究现已证实，前哨淋巴结切除术能准确对腋窝进行分期，且与腋窝清扫术相比发病率更低。蓝色染料、放射性胶体或两者均可用于识别前哨淋巴结，并且几种注射技术均可成功使用。前哨淋巴结活检现在是一种微创、高度准确的腋窝分期方法，已取代常规腋窝淋巴结清扫术成为乳腺癌治疗的新标准。腋窝淋巴结分期的新技术包括创新的成像技术，如单光子发射计算机断层扫描（SPECT），以及使用分子生物学方法对前哨淋巴结进行现代组织病理学评估。
