Chen Michael Y, Gillanders William E
Department of Surgery, Washington University, St Louis, MS, USA.
Siteman Cancer Center in St. Louis, St Louis, MS, USA.
Breast Cancer (Dove Med Press). 2021 May 17;13:311-323. doi: 10.2147/BCTT.S273039. eCollection 2021.
Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.
腋窝淋巴结长期以来一直被认为是乳腺癌发生全身转移的一条途径。因此，腋窝分期在乳腺癌治疗中一直起着核心作用。解剖学分期被认为很重要，原因有两个：1）它能预测预后并指导药物治疗；2）它是一种潜在的治疗方法，可用于清除腋窝病灶。然而，这种模式现在受到了质疑。预后信息越来越多地由肿瘤生物学决定，并且诸如美国外科医师学会肿瘤学组（ACOSOG）Z0011等试验表明，切除腋窝病灶并无治疗作用。腋窝分期已大幅简化；然而，前哨淋巴结活检（SLNB）仍然是一种侵入性手术，对医疗保健系统来说是一项巨大的经济负担。在这篇综述中，我们概述了乳腺癌腋窝分期从强调解剖学分期到肿瘤生物学的转变模式，以及腋窝超声不断演变的作用，从而为患者带来侵入性更小、更个性化的治疗。
