Duraes Martha, Guillot Eugénie, Seror Julien, Pouget Nicolas, Rouzier Roman
Institut Curie, hôpital René-Huguenin, service de chirurgie sénologique et gynécologique, site Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France.
Institut Curie, hôpital René-Huguenin, service de chirurgie sénologique et gynécologique, site Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France.
Bull Cancer. 2017 Oct;104(10):892-901. doi: 10.1016/j.bulcan.2017.08.003. Epub 2017 Sep 8.
Sentinel lymph node biopsy has replaced axillary lymph node dissection in those patients with clinically node-negative axilla without compromising their oncologic outcomes. Indication of neoadjuvant chemotherapy has been extended to patients to evaluate the pathologic response and to offer more conservative breast surgery. Sentinel lymph node dissection after neoadjuvant chemotherapy is feasible and accurate in patients with clinically node-negative patients. The timing of the sentinel lymph node biopsy, before or after medical treatment has been studied with benefits for each procedure. Sentinel lymph node dissection has been explored in different randomized prospective studies in clinically positive axilla with the aim of reduce axillary lymph node dissection. However, several studies are necessary to more accurately identify residual axillary disease and the sentinel lymph node after neoadjuvant chemotherapy, to adjust the adjuvant radiotherapy protocols and to evaluate the impact on oncologic outcomes.
对于临床腋窝淋巴结阴性的患者，前哨淋巴结活检已取代腋窝淋巴结清扫术，且不影响其肿瘤学预后。新辅助化疗的适应证已扩大到患者，以评估病理反应并提供更保守的乳房手术。新辅助化疗后对临床腋窝淋巴结阴性的患者进行前哨淋巴结清扫是可行且准确的。前哨淋巴结活检在治疗前或治疗后的时机已得到研究，每种方法都有其益处。在临床腋窝淋巴结阳性的患者中，已在不同的随机前瞻性研究中探索了前哨淋巴结清扫术，目的是减少腋窝淋巴结清扫术。然而，需要进行多项研究，以更准确地识别新辅助化疗后残留的腋窝疾病和前哨淋巴结，调整辅助放疗方案，并评估对肿瘤学预后的影响。
