Cipolla Calogero, Gebbia Vittorio, D'Agati Eleonora, Greco Martina, Mesi Chiara, Scandurra Giuseppa, Valerio Maria Rosaria
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90100 Palermo, Italy.
Breast Unit, AOUP Policlinico Paolo Giaccone, 90100 Palermo, Italy.
Cancers (Basel). 2024 Sep 30;16(19):3354. doi: 10.3390/cancers16193354.
In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing.
In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy.
At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended.
This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints.
在乳腺癌（BC）患者中，腋窝管理在过去几年有了重大改进，目前仍在努力确定腋窝手术管理的最佳策略。
在当前临床实践中，临床淋巴结阳性（cN+）的BC女性通常接受新辅助化疗（NACT），目的是缩小原发疾病范围，从而实现腋窝保守手术。值得注意的是，NACT后，高达三分之一的患者实现腋窝病理完全缓解，这反过来又与比腋窝残留疾病更有利的预后相关。然而，NACT并非没有缺点，因为NACT相关的炎症会损害淋巴管。此外，腋窝淋巴结可能出现不同程度的反应，增加前哨活检的假阴性率。
目前，对于接受NACT的cN+ BC患者的最佳治疗方法尚无共识，尽管多学科管理似乎是推荐的。
本叙述性综述全面概述了接受NACT的cN+ BC患者的腋窝管理。它采用了一种多学科方法，涵盖了肿瘤管理观点以及手术和化疗观点。
