Mamounas Eleftherios P, Kuehn Thorsten, Rutgers Emiel J T, von Minckwitz Gunter
University of Florida Health Cancer Center-Orlando Health, and University of Central Florida, Orlando, FL, USA.
Interdisciplinary Breast Cancer Center, Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany.
Lancet. 2017 Aug 14. doi: 10.1016/S0140-6736(17)31451-4.
The surgical approach of the axilla in patients with early-stage breast cancer has witnessed considerable evolution during the past 25 years. The previously undisputed gold standard of axillary-lymph-node dissection for staging has now been replaced by sentinel-lymph-node biopsy for patients with clinically negative axilla. For selected patients with limited sentinel-lymph-node involvement, completion axillary-lymph-node dissection can be omitted or replaced by axillary radiotherapy, reducing morbidity. The clinical interest of axillary staging after neoadjuvant chemotherapy is increasing and this approach might contribute to morbidity reduction, and to the further tailoring of future systemic and locoregional treatment decisions by response assessment. Refinement of the sentinel-lymph-node biopsy technique might overcome the slightly impaired success rates in this setting. New techniques for lymphatic mapping attempt to further simplify the procedure. In view of the declining influence of axillary nodal status on adjuvant therapy decision-making, ongoing clinical trials will evaluate whether sentinel-lymph-node biopsy can be avoided altogether in selected patients.
在过去25年中，早期乳腺癌患者腋窝的手术方式经历了相当大的演变。对于临床腋窝阴性的患者，先前无可争议的腋窝淋巴结清扫分期金标准现已被前哨淋巴结活检所取代。对于前哨淋巴结受累有限的特定患者，可以省略腋窝淋巴结清扫术或用腋窝放疗替代，以降低发病率。新辅助化疗后腋窝分期的临床关注度不断提高，这种方法可能有助于降低发病率，并通过反应评估进一步调整未来的全身和局部区域治疗决策。前哨淋巴结活检技术的改进可能会克服这种情况下成功率略有下降的问题。淋巴绘图新技术试图进一步简化该过程。鉴于腋窝淋巴结状态对辅助治疗决策的影响逐渐减小，正在进行的临床试验将评估在特定患者中是否可以完全避免前哨淋巴结活检。
