Leiden University Medical Center, Department of Surgery, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
Eur J Surg Oncol. 2013 May;39(5):417-24. doi: 10.1016/j.ejso.2013.02.011. Epub 2013 Mar 6.
Neoadjuvant chemotherapy (NAC) is an increasingly important component in the treatment of both locally advanced and early-stage breast cancer. With this, a debate on the timing of the sentinel lymph node biopsy (SLNB) has emerged. At the end of the last century, the SLNB was introduced as an axillary staging modality, and this paper aims to further elucidate this issue in the context of NAC. We compiled available data on the SLNB after NAC and provide clinical guidance for timing the SLNB in this context. On the basis of our findings, we recommend that the SLNB can be performed after NAC in all cases. In patients with a clinically node-negative (cN0) status prior to NAC, the SLNB should be performed after NAC, and in case of a histologically confirmed negative SLNB, a completion axillary lymph node dissection (ALND) has no added value and can be omitted. In patients with clinically positive nodal involvement (cN+) prior to NAC, all axillary surgery can also be performed after NAC.
新辅助化疗（NAC）在局部晚期和早期乳腺癌的治疗中越来越重要。随着这一治疗方法的出现，人们对前哨淋巴结活检（SLNB）的时机产生了争议。在本世纪末，SLNB 被引入作为一种腋窝分期方法，本文旨在结合 NAC 进一步阐明这一问题。我们收集了 NAC 后 SLNB 的可用数据，并为这一背景下的 SLNB 时机提供了临床指导。基于我们的研究结果，我们建议在所有情况下都可以在 NAC 后进行 SLNB。在 NAC 前临床淋巴结阴性（cN0）的患者中，应在 NAC 后进行 SLNB；如果 SLNB 组织学检查证实为阴性，则进行补充腋窝淋巴结清扫术（ALND）并无额外价值，可以省略。在 NAC 前临床淋巴结阳性（cN+）的患者中，所有腋窝手术也可以在 NAC 后进行。
