Ahmed M, Douek M
Department of Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
Ecancermedicalscience. 2013 May 16;7:319. doi: 10.3332/ecancer.2013.319. Print 2013.
The Z11 trial demonstrated a subgroup of patients with low axillary burden who do not benefit from axillary lymph node dissection (ALND) at short-term follow-up when treated with adjuvant whole-breast radiotherapy and systemic therapy. We consider the role of sentinel lymph node biopsy (SLNB) and look at and beyond the Z11 trial to consider further imaging studies, which may offer truly minimally invasive management of the axilla and relegate SLNB to the realms of history. Regional lymph node status provides information regarding staging, local control, and prognostic outcomes in all cancers. This information was provided in breast cancer by axillary lymph node dissection (ALND). This changed with the development of sentinel lymph node biopsy (SLNB) [1, 2]. Sentinel lymph nodes (SLNs) are defined as the first lymph nodes receiving lymphatic drainage from the primary tumour and therefore the most likely to harbour metastatic cancer via lymphatic spread. SLNB is now the standard of care in patients with a clinically and radiologically clear axilla in early-stage breast cancer.
Z11试验表明，在接受辅助性全乳放疗和全身治疗的情况下，有一小部分腋窝负荷较低的患者在短期随访中未从腋窝淋巴结清扫（ALND）中获益。我们思考了前哨淋巴结活检（SLNB）的作用，并审视了Z11试验及其他相关情况，以考虑进一步的影像学研究，这些研究可能会提供真正微创的腋窝处理方法，从而使SLNB成为历史。区域淋巴结状态为所有癌症的分期、局部控制和预后结果提供信息。在乳腺癌中，这一信息过去是通过腋窝淋巴结清扫（ALND）来提供的。随着前哨淋巴结活检（SLNB）的发展，情况发生了变化[1,2]。前哨淋巴结（SLN）被定义为接受来自原发肿瘤淋巴引流的第一组淋巴结，因此最有可能通过淋巴转移而含有转移性癌。目前，SLNB是早期乳腺癌临床和影像学检查腋窝无异常患者的标准治疗方法。
