School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney 2006, Australia.
Anticancer Res. 2014 Mar;34(3):1087-97.
Sentinel node biopsy (SNB) has largely replaced axillary lymph node dissection (ALND) as the standard-of-care for nodal staging in invasive breast cancer. Preoperative imaging-based staging of the axilla using ultrasound with selective ultrasound-guided needle biopsy (UNB) is moderately-sensitive and identifies approximately 50% of patients (pooled estimate from meta-analysis 50%; 95% confidence interval=43%-57%) with axillary nodal metastases prior to surgical intervention. It is also a highly specific staging strategy that allows patients to be triaged to ALND based on a positive result (positive predictive value approximates 100%), thus avoiding two-stage axillary surgery and unnecessary SNB. Axillary UNB has a good clinical utility: based on an updated meta-analysis, we found that a median proportion of 18.4% (inter-quartile range=13.3%-27.4%) from 7,097 patients can be effectively triaged to axillary treatment and can avoid SNB. However, the changing algorithm of axillary surgical treatment means that UNB will have relatively less utility where surgeons omit ALND for minimal nodal metastatic disease. Research that allows enhanced application of ultrasound and UNB to specifically identify and biopsy sentinel nodes and to discriminate between patients with minimal versus advanced nodal metastatic involvement is likely to have the most impact on future management of the axilla in breast cancer.
前哨淋巴结活检（SNB）在很大程度上已经取代了腋窝淋巴结清扫术（ALND），成为浸润性乳腺癌淋巴结分期的标准治疗方法。术前使用超声引导选择性超声引导下针吸活检（UNB）对腋窝进行基于影像学的分期，其敏感性中等，可在手术干预前识别出约 50%的腋窝淋巴结转移患者（荟萃分析的汇总估计值为 50%；95%置信区间=43%-57%）。它也是一种高度特异的分期策略，可根据阳性结果将患者分诊至 ALND（阳性预测值接近 100%），从而避免两阶段腋窝手术和不必要的 SNB。腋窝 UNB 具有良好的临床应用价值：基于更新的荟萃分析，我们发现 7097 名患者中有中位数比例为 18.4%（四分位间距=13.3%-27.4%）可以有效地分诊至腋窝治疗，并可以避免 SNB。然而，腋窝外科治疗方法的变化意味着，在外科医生因最小的淋巴结转移疾病而省略 ALND 时，UNB 的应用相对较少。研究允许增强超声和 UNB 的应用，以专门识别和活检前哨淋巴结，并区分具有最小和晚期淋巴结转移受累的患者，这可能对未来乳腺癌腋窝的管理产生最大影响。
