中国实用外科杂志

中国实用外科杂志

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美国临床肿瘤学会《早期乳腺癌病人前哨淋巴结活检指南》更新介绍与解读

吴克瑾   

  1. 上海交通大学医学院附属新华医院普外科，上海 200092
  • 出版日期:2015-01-01 发布日期:2014-12-31

  • Online:2015-01-01 Published:2014-12-31

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摘要：

2014年4月，临床肿瘤学杂志（Journal of Clinical Oncology，JCO）上发表了美国临床肿瘤学会（American Society of Clinical Oncology，ASCO）关于早期乳腺癌病人应用前哨淋巴结活检（sentinel node biopsy，SNB）的若干新推荐。这是继2005年该学会首次推荐《早期乳腺癌病人前哨淋巴结活检指南》后的第一次更新。基于随机临床试验（RCT）证据，该项指南提出3条推荐：（1）无前哨淋巴结（sentinel lymph node，SLN）转移的女性病人不必接受腋窝淋巴结清扫术（axillary lymph node dissection, ALND）；（2）大多数伴有1~2个SLN转移，且计划接受保乳术及术后全乳放疗者无需行ALND；（3）有SLN转移并行全乳切除术者应接受ALND。基于队列研究和（或）非正式共识，更新两组推荐：（1）可手术的多中心肿瘤的乳腺癌病人、将行乳房切除术的导管原位癌（ductal carcinoma in situ，DCIS）病人、之前接受过乳腺和（或）腋窝手术的以及接受术前或新辅助系统治疗的病人，可以行SNB；（2）对瘤体较大或局部晚期浸润性乳腺癌（肿瘤大小T3/T4）、炎性乳腺癌、拟接受保乳治疗的DCIS以及孕期妇女，不适于行SNB。

关键词: 早期乳腺癌, 前哨淋巴结活检

Abstract:

Express and interpretation on American society of clinical oncology guideline update for Sentinel lymph node biopsy in early-stage breast cancer        WU Ke-jin.
Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Abstract    2014 April, American Society of Clinical Oncology (ASCO) issued new clinical practice guideline on sentinel lymph node biopsy for patients with early-stage breast cancer in Journal of Clinical Oncology (JCO). This guideline update reflects some changes since the 2005 guideline. Based on randomized clinical trials (RCTs), there are three recommendations: (1) Women without sentinel lymph node (SLN) metastases should not accept axillary lymph node dissection (ALND). (2) In most cases, Women with 1-2 metastatic SLNs going to undergo breast-conserving surgery (BCS) with whole-breast radiotherapy should not adopt ALND. (3) Women with SLN metastases planning to receive mastectomy should be provided ALND. Based on cohort studies and/or informal consensus, there are two prime recommendations. (1) Sentinel node biopsy (SNB) may be offered to those women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ (DCIS) planning to undergo mastectomy, who previously got breast and/or axillary surgery or who accepted preoperative/neoadjuvant systemic therapy. (2) SNB should not be offered to those women with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or DCIS will undergo BCS, or are pregnant.

Key words: early-stage breast cancer, sentinel node biopsy