Dialani Vandana, Dogan Basak, Dodelzon Katerina, Dontchos Brian N, Modi Neha, Grimm Lars
Beth Israel Lahey Hospital, Department of Radiology, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Breast Imaging. 2021 Nov 16;3(6):645-658. doi: 10.1093/jbi/wbab082.
Traditionally, patients with newly diagnosed invasive breast cancer underwent axillary US to assess for suspicious axillary lymph nodes (LNs), which were then targeted for image-guided needle biopsy to determine the presence of metastasis. Over the past decade, there has been a shift towards axillary preservation. For patients with palpable lymphadenopathy, the decision to perform axillary imaging with documentation of the number and location of abnormal LNs in preparation for image-guided LN sampling is straightforward. Since LN involvement correlates with cancer size, it is reasonable to image the axilla in patients with tumors larger than 5 cm; however, for tumors smaller than 5 cm, axillary imaging is often deferred until after the tumor molecular subtype and treatment plan are established. Over the last decade, neoadjuvant chemotherapy (NACT) is increasingly used for smaller cancers with more aggressive molecular subtypes. In most cases, detecting axillary metastasis is critical when deciding whether the patient would benefit from NACT. There is increasing evidence that abnormal axillary US findings correlates with LN metastases and reliably establishes a baseline to monitor response to NACT. Depending on hormone receptor status, practices may choose to image the axilla in the setting of clinical stage T1 and T2 cancers to evaluate nodal status and help determine further steps in care. Radiologists should understand the nuances of axillary management and the scope and challenges of LN marking techniques that significantly increase the precision of limited axillary surgery.
传统上，新诊断为浸润性乳腺癌的患者会接受腋窝超声检查，以评估是否存在可疑腋窝淋巴结（LN），然后针对这些淋巴结进行影像引导下的穿刺活检，以确定是否存在转移。在过去十年中，出现了向腋窝保留的转变。对于可触及淋巴结肿大的患者，决定进行腋窝成像并记录异常淋巴结的数量和位置，为影像引导下的淋巴结采样做准备，这一过程很直接。由于淋巴结受累与癌症大小相关，对于肿瘤大于5 cm的患者，对腋窝进行成像检查是合理的；然而，对于小于5 cm的肿瘤，腋窝成像通常会推迟到确定肿瘤分子亚型和治疗方案之后进行。在过去十年中，新辅助化疗（NACT）越来越多地用于分子亚型更具侵袭性的较小癌症。在大多数情况下，在决定患者是否能从NACT中获益时，检测腋窝转移至关重要。越来越多的证据表明，腋窝超声检查的异常结果与淋巴结转移相关，并能可靠地建立一个基线来监测对NACT的反应。根据激素受体状态，临床医生可能会选择对临床分期为T1和T2期癌症的患者进行腋窝成像，以评估淋巴结状态并帮助确定进一步的治疗步骤。放射科医生应了解腋窝管理的细微差别以及淋巴结标记技术的范围和挑战，这些技术可显著提高有限腋窝手术的精确性。
