University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA.
Breast Cancer Res Treat. 2021 Jun;187(2):311-322. doi: 10.1007/s10549-021-06248-x. Epub 2021 May 12.
Axillary nodal status is one of the most important prognostic factors in breast cancer. While sentinel lymph node biopsy (SLNB) is a safe and validated procedure for clinically node-negative patients, axillary management of clinically node-positive patients has been more controversial. Patients with clinically detected axillary metastases often benefit from neoadjuvant chemotherapy (NAC). Those who convert to node-negative disease following NAC are important to identify, since they can often be spared significant morbidity from axillary dissection. SLNB has shown widely varying false-negative rates (FNR) but with the use of dual mapping and surgical biopsy of 3 or more nodes, it is considered an acceptable method to stage the axilla in clinically node-positive patients who receive NAC. Various methods including targeted axillary dissection (TAD) have been shown to decrease the FNR of SLNB. We will review appropriate methods to identify a metastatic node and subsequent ultrasound-guided biopsy with tissue marking techniques. We underscore key points in monitoring axillary response, techniques to accurately localize the biopsied and clipped known metastatic node for surgical excision and the effect of various methods in reducing the FNR of SLNB, including the emerging concept of TAD on patient care.
腋窝淋巴结状态是乳腺癌最重要的预后因素之一。虽然前哨淋巴结活检（SLNB）是临床淋巴结阴性患者的一种安全且经过验证的方法，但临床淋巴结阳性患者的腋窝处理一直存在更多争议。临床检测到腋窝转移的患者通常受益于新辅助化疗（NAC）。那些在 NAC 后转为淋巴结阴性疾病的患者非常重要，因为他们通常可以避免腋窝清扫术带来的显著发病率。SLNB 的假阴性率（FNR）差异很大，但通过使用双重绘图和对 3 个或更多淋巴结进行手术活检，它被认为是一种可接受的方法，可以对接受 NAC 的临床淋巴结阳性患者进行腋窝分期。已经证明了各种方法，包括靶向腋窝解剖（TAD），可以降低 SLNB 的 FNR。我们将回顾识别转移性淋巴结的适当方法，以及随后使用组织标记技术进行超声引导下的活检。我们强调了监测腋窝反应、准确定位活检和夹闭的已知转移性淋巴结以进行手术切除的关键点，以及各种方法在降低 SLNB 的 FNR 方面的效果，包括 TAD 在患者护理方面的新兴概念。
