Park Ko Un, Somerfield Mark R, Anne Nirupama, Brackstone Muriel, Conlin Alison K, Couto Henrique Lima, Dengel Lynn T, Eisen Andrea, Harvey Brittany E, Hawley Jeffrey, Kim Janice N, Lasebikan Nwamaka, McDonald Elizabeth S, Pradhan Deepti, Shams Samantha, Vega Raymond Mailhot, Thompson Alastair M, Torres Mylin A
Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2025 May 10;43(14):1720-1741. doi: 10.1200/JCO-25-00099. Epub 2025 Apr 10.
To update the ASCO evidence-based recommendations on the use of sentinel lymph node biopsy (SLNB) in patients with early-stage breast cancer treated with initial surgery.
ASCO convened an Expert Panel to develop updated recommendations based on a systematic literature review (January 2016-May 2024).
Eleven randomized clinical trials (14 publications), eight meta-analyses and/or systematic reviews, and one prospective cohort study met the inclusion criteria for this systematic review. Expert Panel members used available evidence and informal consensus to develop practice recommendations.
Clinicians should not recommend routine SLNB in select patients who are postmenopausal and ≥50 years of age and with negative findings on preoperative axillary ultrasound for grade 1-2, small (≤2 cm), hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer and who undergo breast-conserving therapy. Clinicians may offer postmastectomy radiation (RT) with regional nodal irradiation (RNI) and omit axillary lymph node dissection (ALND) in patients with clinically node-negative invasive breast cancer ≤5 cm who receive mastectomy and have one to two positive sentinel nodes. Clinicians may offer SLNB in patients who have cT3-T4c or multicentric tumors (clinically node-negative) or ductal carcinoma in situ treated with mastectomy, and in patients who are obese, male, or pregnant, or who have had prior breast or axillary surgery. Clinicians should not recommend ALND for patients with early-stage breast cancer who do not have nodal metastases, and clinicians should not recommend ALND for patients with early-stage breast cancer who have one or two sentinel lymph node metastases and will receive breast-conserving surgery and whole-breast RT with or without RNI.Additional information is available at www.asco.org/breast-cancer-guidelines.This guideline has been endorsed by the American Society for Radiation Oncology (ASTRO).
更新美国临床肿瘤学会（ASCO）关于在接受初次手术治疗的早期乳腺癌患者中使用前哨淋巴结活检（SLNB）的循证推荐。
ASCO召集了一个专家小组，基于系统文献综述（2016年1月至2024年5月）制定更新后的推荐。
11项随机临床试验（14篇出版物）、8项荟萃分析和/或系统评价以及1项前瞻性队列研究符合本系统综述的纳入标准。专家小组成员利用现有证据和非正式共识制定实践推荐。
对于绝经后年龄≥50岁、术前腋窝超声检查结果为阴性、组织学1 - 2级、肿瘤较小（≤2 cm）、激素受体阳性、人表皮生长因子受体2阴性且接受保乳治疗的乳腺癌患者，临床医生不应推荐常规进行前哨淋巴结活检。对于接受乳房切除术且前哨淋巴结有1 - 2枚阳性、临床腋窝淋巴结阴性、侵袭性乳腺癌≤5 cm的患者，临床医生可提供乳房切除术后放疗（RT）联合区域淋巴结照射（RNI），并省略腋窝淋巴结清扫（ALND）。对于接受乳房切除术治疗的cT3 - T4c或多中心肿瘤（临床腋窝淋巴结阴性）或导管原位癌患者，以及肥胖、男性或怀孕患者，或既往有乳房或腋窝手术史的患者，临床医生可提供前哨淋巴结活检。对于没有淋巴结转移的早期乳腺癌患者，临床医生不应推荐腋窝淋巴结清扫；对于有1或2枚前哨淋巴结转移且将接受保乳手术和全乳放疗（无论是否联合RNI）的早期乳腺癌患者，临床医生也不应推荐腋窝淋巴结清扫。更多信息可在www.asco.org/breast - cancer - guidelines查询。本指南已得到美国放射肿瘤学会（ASTRO）的认可。
