Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg Cedex, France; Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), UMR 7104 CNRS, U596 INSERM, ULP. BP 10142, Illkirch Cedex, France.
Chin Clin Oncol. 2021 Apr;10(2):20. doi: 10.21037/cco-20-207. Epub 2020 Dec 18.
The aim of this narrative review was to provide an update on the use of sentinel lymph node biopsy (SLNB) for breast carcinoma (BC). Relevant studies published between 01/01/1994 and 15/08/2020 assessing the accuracy and the usefulness of SLNB were reviewed. SLNB was first used in 1977 for penile cancers. However, it took 17 years to enter in clinical practice for BC. The first procedures were based on two methods of non-specific marking of LN vmacrophages using a radioisotope (99mTc) and a blue dye (BD, Isosulfan, Patent or Methylene). To overcome side effects of radioisotopes (radiation exposure) and BD (allergic reactions), innovative tracers such as indocyanine green (ICG), superparamagnetic iron oxide (SPIO), and microbubbles have been explored. The SLN intraoperative examination is no longer performed, due to its low impact on the rate of reoperation and high time and cost of surgery. Likewise, immunohistochemistry, which can lead to an unnecessary ALND in some cases of occult metastases, is no more recommended. Except cases with metastasized LN, all contraindications aim to avoid situations where the risk of false negative would be too high (notably T3-T4 or multicentric tumors). The current indications for invasive BC are T0-T1-T2 N0 or N1 (after an accurate LN evaluation with ultrasound and/or cytology or core biopsy) and for DCIS treated by mastectomy or presenting as a palpable mass. After SLNB, axillary recurrence rates are generally below 2% after a follow up of 8-10 years, comparable to those observed after ALN. Likewise, when the SLN contains less than 2 metastases, axillary recurrence rates remain low even when ALN is omitted. In case of more than 2 metastatic SLN or capsular effraction, ALND is still indicated. For most teams, SLNB can be performed in clinically node-negative patients receiving neoadjuvant systemic therapy. The results of the literature consistently show that SLNB is extremely reliable in selected BC, as long as it is performed with a rigorous technique by teams having undergone multidisciplinary training and having gained the necessary experience.
本文旨在对前哨淋巴结活检（SLNB）在乳腺癌（BC）中的应用进行综述更新。我们检索了 1994 年 1 月 1 日至 2020 年 8 月 15 日期间发表的评估 SLNB 准确性和实用性的相关研究。SLNB 于 1977 年首次应用于阴茎癌，但在 17 年后才应用于 BC。最早的操作是基于两种方法对淋巴结巨噬细胞进行非特异性标记：放射性同位素（99mTc）和蓝色染料（BD，异硫蓝、专利蓝或亚甲蓝）。为了克服放射性同位素（辐射暴露）和 BD（过敏反应）的副作用，已经探索了创新示踪剂，如吲哚菁绿（ICG）、超顺磁性氧化铁（SPIO）和微泡。由于 SLN 术中检查对再次手术率的影响较小，且手术时间和成本较高，因此不再进行。同样，免疫组织化学也不再推荐，因为在某些隐匿性转移的情况下，它可能导致不必要的腋窝淋巴结清扫（ALND）。除了淋巴结转移的病例外，所有的禁忌症都是为了避免假阴性风险过高的情况（特别是 T3-T4 或多中心肿瘤）。目前，浸润性 BC 的适应证为 T0-T1-T2 N0 或 N1（在超声和/或细胞学或核心活检准确评估淋巴结后）和接受乳房切除术治疗的 DCIS 或表现为可触及的肿块。在 SLNB 后，腋窝复发率通常在 8-10 年的随访中低于 2%，与 ALN 观察到的结果相当。同样，当 SLN 中含有少于 2 个转移灶时，即使省略 ALN，腋窝复发率仍然较低。如果 SLN 中有 2 个以上转移灶或包膜破裂，则仍需进行 ALND。对于大多数团队来说，SLNB 可以在接受新辅助全身治疗的临床淋巴结阴性患者中进行。文献结果一致表明，只要由经过多学科培训并获得必要经验的团队以严格的技术进行操作，SLNB 在选择的 BC 中非常可靠。
