Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
Queen Margaret Hospital Dunfermline, Dunfermline, UK.
Breast J. 2020 Jan;26(1):22-26. doi: 10.1111/tbj.13720. Epub 2019 Dec 19.
Sentinel lymph node (SLN) biopsy is now used worldwide. It has led to many changes in how we manage the axilla in patients with breast cancer. This review covers four areas of management of the axilla in breast cancer: assessing the clinically node-negative axilla, managing the clinically negative axilla found to be involved at SLN biopsy, management of the clinically positive axilla in the context of neo-adjuvant chemotherapy, and treatment of the diseased axilla when radical therapy is required. We suggest that the evidence supports an optimum number of 3 nodes to be removed for accurate SLN biopsy. Breast cancer departments that have not adopted Z0011 patient management cannot continue to avoid change. The evidence is clear: Not all patients with limited axillary nodal disease on sentinel node biopsy need axillary lymph node dissection. For patients who do need axillary treatment, axillary radiotherapy continues to be under-used. Patients undergoing neo-adjuvant chemotherapy can be safely assessed by post-therapy SLN biopsy, with retrieval of any previously biopsied involved nodes by targeted axillary dissection. There is much to support the trend to doing less in the axilla. We are obliged to act based on the available robust clinical trial data in a way that limits morbidity while at the same time does not increase the risk of disease recurrence.
前哨淋巴结（SLN）活检现已在全球范围内应用。它导致我们对乳腺癌患者腋窝管理方式发生了许多变化。这篇综述涵盖了乳腺癌腋窝管理的四个方面：评估临床淋巴结阴性的腋窝，处理 SLN 活检中发现的临床阴性腋窝，在新辅助化疗背景下处理临床阳性腋窝，以及在需要根治性治疗时处理患病腋窝。我们建议，证据支持准确的 SLN 活检需要切除 3 个淋巴结的最佳数量。尚未采用 Z0011 患者管理的乳腺癌科室不能继续回避改变。证据很清楚：并非所有 SLN 活检显示腋窝淋巴结有限疾病的患者都需要腋窝淋巴结清扫术。对于确实需要腋窝治疗的患者，腋窝放疗的应用仍然不足。接受新辅助化疗的患者可以通过治疗后 SLN 活检进行安全评估，并通过靶向腋窝清扫术取回任何之前活检的受累淋巴结。有很多证据支持在腋窝中减少治疗的趋势。我们有责任根据现有可靠的临床试验数据采取行动，在限制发病率的同时，不会增加疾病复发的风险。
