BC Cancer, Victoria, Department of Radiation Oncology, University of British Columbia , Victoria , BC , Canada.
Expert Rev Anticancer Ther. 2019 Sep;19(9):803-810. doi: 10.1080/14737140.2019.1660165. Epub 2019 Sep 6.
: The pathologic status of the axillary lymph nodes is an important prognostic factor in patients with breast cancer. With the transition from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) for patients with clinically node negative breast cancer, there has been an increase in detection of pN0(i+) breast cancer with isolated tumor cells and pN1mi disease with micrometastatic nodal involvement. The prognostic impact of small volume nodal involvement and the role of locoregional radiotherapy, especially in the era of modern systemic therapy, are unclear. : This review examines contemporary data evaluating the prognostic impact of pN0(i+) and pN1mi breast cancer on locoregional recurrence and survival outcomes, then discusses controversies related to the use of adjuvant locoregional radiation therapy in the presence of low volume nodal disease. Relevant papers were identified by searching multiple engines for articles published since 2000. : Sentinel lymph node biopsy without completion ALND is a standard surgical option for patients with pN0(i+) and pN1mi disease. The available evidence does not support routine use of adjuvant locoregional radiation therapy in patients with pN0i+ or pN1mi disease, but locoregional radiotherapy should be considered in the presence of concomitant high-risk features and patient factors.
腋窝淋巴结的病理状态是乳腺癌患者的一个重要预后因素。随着临床淋巴结阴性乳腺癌患者从腋窝淋巴结清扫术（ALND）向前哨淋巴结活检术（SLNB）的转变，pN0(i+)乳腺癌伴孤立肿瘤细胞和 pN1mi 疾病伴微转移淋巴结受累的检出率有所增加。小体积淋巴结受累的预后影响以及局部区域放疗的作用，特别是在现代全身治疗时代，尚不清楚。
本文综述了评估 pN0(i+)和 pN1mi 乳腺癌对局部区域复发和生存结果的预后影响的当代数据，然后讨论了在存在低体积淋巴结疾病时使用辅助局部区域放疗的相关争议。通过搜索多个引擎，确定了自 2000 年以来发表的相关论文。
对于 pN0(i+)和 pN1mi 疾病患者，前哨淋巴结活检术而不进行完整 ALND 是一种标准的手术选择。现有证据不支持在 pN0i+或 pN1mi 疾病患者中常规使用辅助局部区域放疗，但在存在伴随高危特征和患者因素的情况下，应考虑局部区域放疗。
