Noguchi Masakuni, Inokuchi Masafumi, Noguchi Miki, Morioka Emi, Ohno Yukako, Kurita Tomoko
Breast Center, Kanazawa Medical University Hospital, Ishikawa, Japan.
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada, Ishikawa, 920-0293, Japan.
Breast Cancer. 2021 Jan;28(1):9-15. doi: 10.1007/s12282-020-01120-0. Epub 2020 Nov 9.
In breast cancer surgery, there has been a major shift toward less invasive local treatment. Although axillary lymph node dissection (ALND) was an integral part of surgical treatment for breast cancer, sentinel lymph node (SLN) biopsy was developed as an accurate method for axillary staging. ALND can be avoided not only in patients with negative SLNs but also in those with one or two positive SLNs receiving breast and/or axillary radiation. On the other hand, ALND has remained the standard treatment for patients with clinically positive nodes. However, axillary reverse mapping (ARM) was developed to map and preserve arm lymphatic drainage during ALND and/or SLN biopsy. This procedure allowed reduction of the rate of arm lymphedema without increasing axillary recurrence, although patients receive postoperative chemotherapy and high-risk patients undergo axillary radiation. Standard ALND may not be necessary even for patients with clinically positive nodes who receive axillary radiation and systemic therapy. Thus, the extent of axillary surgery in breast cancer has been decreased with increased use of systemic and radiation therapy.
在乳腺癌手术中，已出现向侵入性较小的局部治疗的重大转变。尽管腋窝淋巴结清扫术（ALND）曾是乳腺癌手术治疗的一个组成部分，但前哨淋巴结（SLN）活检已发展成为一种准确的腋窝分期方法。不仅SLN阴性的患者，而且接受乳房和/或腋窝放疗的一两个SLN阳性的患者都可以避免进行ALND。另一方面，对于临床淋巴结阳性的患者，ALND仍然是标准治疗方法。然而，腋窝反向映射（ARM）技术的发展是为了在ALND和/或SLN活检过程中对臂部淋巴引流进行映射和保留。尽管患者接受术后化疗且高危患者接受腋窝放疗，但该手术能够在不增加腋窝复发率的情况下降低臂部淋巴水肿的发生率。即使对于接受腋窝放疗和全身治疗的临床淋巴结阳性的患者，标准的ALND可能也没有必要。因此，随着全身治疗和放疗的使用增加，乳腺癌腋窝手术的范围已经缩小。
