Lowes S, Leaver A, Cox K, Satchithananda K, Cosgrove D, Lim A
Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead, UK.
Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Kent, UK.
Clin Radiol. 2018 Apr;73(4):396-409. doi: 10.1016/j.crad.2018.01.003. Epub 2018 Feb 10.
The presence and extent of axillary nodal metastases at the time of breast cancer diagnosis is a critical factor in disease prognosis and plays a central role in deciding the best treatment for patients. Accurate assessment of the axilla is therefore an essential component in staging breast cancer. Over the years, axillary staging has evolved from surgical axillary lymph node dissection (ALND), with its numerous associated long-term complications, to the much less-radical surgical sentinel lymph node excision biopsy (SLNB), the current reference standard. In parallel, radiological staging of the axilla has become increasingly more useful as our knowledge and techniques have improved. Preoperative axillary ultrasound is used widely to stage patients with breast cancer, providing an evaluation of node morphology and allowing targeted biopsy of abnormal nodes. This is important in helping stratify which patients should proceed directly to ALND and which should undergo SLNB first. Grey-scale ultrasound on its own is not perfect and can over- and underestimate axillary disease. Newer ultrasound techniques such as elastography may help to improve diagnostic confidence when visually assessing axillary nodes; for example, in more accurately assessing the extent of axillary disease burden or in differentiating benign reactive nodes from malignant nodes in equivocal cases. The use of intradermal "microbubbles" has shown great promise in being able to locate and biopsy the sentinel lymph node under ultrasound guidance, and raises the possibility that in the future such techniques may obviate the need for surgical SLNB in select patient populations.
乳腺癌诊断时腋窝淋巴结转移的存在及范围是疾病预后的关键因素，在决定患者的最佳治疗方案中起着核心作用。因此，准确评估腋窝是乳腺癌分期的重要组成部分。多年来，腋窝分期已从伴有众多相关长期并发症的手术腋窝淋巴结清扫术（ALND），演变为创伤小得多的手术前哨淋巴结切除活检术（SLNB），即目前的参考标准。与此同时，随着我们知识和技术的进步，腋窝的放射学分期变得越来越有用。术前腋窝超声被广泛用于乳腺癌患者的分期，可评估淋巴结形态并对异常淋巴结进行靶向活检。这对于帮助区分哪些患者应直接进行ALND以及哪些患者应首先接受SLNB非常重要。单纯的灰阶超声并不完美，可能会高估或低估腋窝疾病。弹性成像等更新的超声技术在视觉评估腋窝淋巴结时可能有助于提高诊断信心；例如，在更准确地评估腋窝疾病负担程度或在可疑病例中区分良性反应性淋巴结与恶性淋巴结方面。皮内“微泡”的使用在超声引导下定位和活检前哨淋巴结方面显示出巨大潜力，并增加了未来此类技术可能使部分患者群体无需进行手术SLNB的可能性。
