Gynecological Oncology, Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCS), Candiolo, Italy.
University of Turin, Medical School, Turin, Italy.
Cancer Treat Rev. 2016 Jul;48:1-7. doi: 10.1016/j.ctrv.2016.05.005. Epub 2016 May 24.
Omission of axillary dissection in women with breast cancer and one or two positive sentinel-node biopsy is a major advancement in the management of this disease. Supported by a sound rationale and confirmed by prospective, randomized trials, omission of axillary dissection is now recommended in women who have undergone breast conserving surgery and who are candidate to adjuvant radiotherapy. Because breast cancer is best managed in the context of a multidisciplinary team, this surgical shift in the paradigm is expected to have implications that extend also to the other specialties involved in the team. In fact, the full evaluation of the axillary tumor burden has been historically considered an essential part of tumor staging and the absolute number of involved node critical information to tailor post-surgical treatments. Lack of this information in a patient with axillary involvement documented by a positive sentinel lymph-node biopsy may represent a challenge when deciding on further, post-surgical treatments. This review will address the critical aspects and the potential implications of omission of axillary dissection in the context of the multidisciplinary breast team.
在患有乳腺癌且前哨淋巴结活检有 1 或 2 个阳性的女性中，省略腋窝清扫术是该疾病治疗的重大进展。这一策略得到了合理依据的支持，并通过前瞻性随机试验得到了证实，目前推荐对接受保乳手术且有辅助放疗适应证的女性省略腋窝清扫术。由于乳腺癌最好在多学科团队的背景下进行管理，这种手术模式的转变预计会对涉及该团队的其他专业产生影响。事实上，对腋窝肿瘤负荷的全面评估历来被认为是肿瘤分期的重要组成部分，而阳性前哨淋巴结活检所记录的腋窝淋巴结受累的绝对数量是制定术后治疗方案的关键信息。在前哨淋巴结活检阳性的腋窝受累患者中缺乏这些信息，可能会在决定进一步的术后治疗方案时带来挑战。这篇综述将在多学科乳腺癌团队的背景下讨论省略腋窝清扫术的关键方面和潜在影响。
