Kaidar-Person Orit, Pfob André, Gentilini Oreste Davide, Borisch Bettina, Bosch Ana, Cardoso Maria João, Curigliano Giuseppe, De Boniface Jana, Denkert Carsten, Hauser Nik, Heil Jörg, Knauer Michael, Kühn Thorsten, Lee Han-Byoel, Loibl Sibylle, Mannhart Meinrad, Meattini Icro, Montagna Giacomo, Pinker Katja, Poulakaki Fiorita, Rubio Isabel T, Sager Patrizia, Steyerova Petra, Tausch Christoph, Tramm Trine, Vrancken Peeters Marie-Jeanne, Wyld Lynda, Yu Jong Han, Weber Walter Paul, Poortmans Philip, Dubsky Peter
Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel.
Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
EClinicalMedicine. 2023 Jul 14;61:102085. doi: 10.1016/j.eclinm.2023.102085. eCollection 2023 Jul.
Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy ( ± targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.
早期乳腺癌的临床腋窝淋巴结管理已从仅仅是外科管理的一个方面发展而来，现在涉及整个多学科团队。由欧洲癌症协会和患者代表组成的多学科联盟“卢塞恩工具箱”第二版探讨了临床腋窝淋巴结管理面临的挑战，从腋窝的诊断到局部治疗。按照患者的就医流程并针对特定临床情况制定了五个工作包。小组成员对72项声明进行了投票，其中52.8%达成共识（75%或以上同意），43.1%为多数意见（51%-74%同意），4.2%未做出决定。根据投票结果，淋巴结的靶向成像和标准化病理检查应作为规划局部和全身治疗的先决条件；在大多数情况下，腋窝淋巴结清扫术可被前哨淋巴结活检（±靶向方法）取代；患者的良好预后应由低复发风险和低淋巴水肿发生率共同推动。
