Ruers T J, Roumen R M
Academisch Ziekenhuis, afd. Heelkunde, Nijmegen.
Ned Tijdschr Geneeskd. 1998 Oct 10;142(41):2237-40.
Sentinel node biopsy may be useful in the staging of breast cancer. In experienced hands presence or absence of metastasis in the sentinel node accurately predicts the nodal status and in patients with a negative sentinel node biopsy axillary dissection may be avoided. The technique, however, shows a clear learning curve and hasty introduction may lead to an unacceptable rate of false negative biopsies. Moreover, the introduction of the technique in general practice should be well coordinated in order to prevent large differences between hospitals in the staging and treatment of breast cancer patients. On the initiative of NABON (Nationaal Borstkanker Overleg Nederland; 'national breast cancer consultation') and the Nederlandse Vereniging voor Chirurgische Oncologie (Netherlands Association for Surgical Oncology) a study group was formed to co-ordinate the introduction of the sentinel node biopsy in breast cancer patients in the Netherlands. Important topics are central registration of all procedures in order to evaluate its applicability and technical variations, the performance in each centre of at least 50 procedures together with axillary node dissection to evaluate the results before clinical application is considered, and nationwide co-ordination to find the best therapy for patients with positive sentinel nodes.
前哨淋巴结活检可能有助于乳腺癌的分期。在经验丰富的医生手中,前哨淋巴结有无转移能准确预测腋窝淋巴结状态,对于前哨淋巴结活检阴性的患者可避免腋窝淋巴结清扫。然而,该技术有明显的学习曲线,贸然采用可能导致不可接受的假阴性活检率。此外,在普通临床实践中引入该技术应进行良好协调,以防止不同医院在乳腺癌患者分期和治疗上出现较大差异。在荷兰国家乳腺癌咨询组织(NABON)和荷兰外科肿瘤学协会的倡议下,成立了一个研究小组,以协调在荷兰乳腺癌患者中引入前哨淋巴结活检。重要议题包括对所有操作进行集中登记,以评估其适用性和技术差异;每个中心至少进行50例操作并同时进行腋窝淋巴结清扫,以便在考虑临床应用前评估结果;以及全国范围内的协调,为前哨淋巴结阳性的患者找到最佳治疗方案。