乳腺癌患者保乳手术后再次前哨淋巴结活检的最新研究进展及展望

doi:10.19401/j.cnki.1007-3639.2023.06.003

摘要/Abstract

摘要：

由于传统腋窝淋巴结清扫易引起一系列并发症，目前前哨淋巴结活检已取代腋窝淋巴结清扫，成为临床腋窝淋巴结阴性患者的标准腋窝分期措施，在国内外临床广泛应用。随着保乳手术的增加，保乳术后同侧乳房内复发患者的例数也随之增加，如何对此类患者进行恰当的腋窝评估成为一个颇受临床关注的话题，再次前哨淋巴结活检的应用也成为其焦点之一。已有研究证实再次前哨淋巴结活检对于保乳手术后同侧乳房肿瘤复发的患者是一种可行且安全的腋窝评估方法，并且部分患者的治疗方式可根据腋窝淋巴结状态进行调整。但由于再次前哨淋巴结活检结果对预后影响的研究相对缺乏，并且随着非侵袭性检查技术的发展，此类患者是否必须进行再次前哨淋巴结活检仍存在争议，需要未来高质量的前瞻性临床试验进行探索。本文对以往关于再次前哨淋巴结活检相关的文献进行梳理和归纳，并就其可行性、安全性及临床应用价值进行综述，以供临床参考。

关键词: 乳腺癌, 前哨淋巴结活检, 再次前哨淋巴结活检

Abstract:

Due to a series of complications associated with traditional axillary lymph node dissection, sentinel lymph node biopsy has now replaced axillary lymph node dissection as the standard axillary staging procedure for patients with negative axillary lymph nodes in both domestic and international clinical practice. With the increased application of breast-conserving surgery and the subsequent increase in the number of patients with ipsilateral breast recurrence after breast-conserving surgery, the appropriate axillary evaluation of such patients has become a new topic of clinical concern, and the application of repeat sentinel lymph node biopsy has become one of the focal points of this topic. It has been shown that repeat sentinel lymph node biopsy is a feasible and safe method for axillary evaluation in patients with ipsilateral breast tumor recurrence after breast-conserving surgery, and that treatment can be adjusted for some patients depending on axillary lymph node status. However, due to the relative lack of studies on the prognostic impact of repeat sentinel lymph node biopsy results and with the development of non-invasive screening techniques, the necessity of repeat sentinel lymph node biopsy in this group of patients remains controversial and needs to be explored in future high-quality prospective trials. This article compiled and summarized the previous literature related to repeat sentinel lymph node biopsy, and focused on its feasibility, safety and clinical application value for clinical reference.

Key words: Breast cancer, Sentinel lymph node biopsy, Repeat sentinel lymph node biopsy

中图分类号:

R737.9

赵谦, 凌云霄, 柳光宇. 乳腺癌患者保乳手术后再次前哨淋巴结活检的最新研究进展及展望[J]. 中国癌症杂志, 2023, 33(6): 566-573.

ZHAO Qian, LING Yunxiao, LIU Guangyu. Recent advances and perspectives in the application of repeat sentinel lymph node biopsy in breast cancer patients underwent breast-conserving surgery[J]. China Oncology, 2023, 33(6): 566-573.

图/表 1

参考文献 57

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Study	Year	Patient number	Identification rate	Axillary recurrence rate	Median follow-up time t/month
Haarsma R, et al^[38]	2022	119	79/119 (66.4%)	-	58.8
Yoon C I, et al^[39]	2020	495	356/495 (71.9%)	-	-
Sávolt Á, et al^[32]	2019	160	106/160 (66.3%)	-	-
Poodt I G M, et al^[31]	2018	1 687	1 091/1 687 (64.7%)	-	-
Vugts G, et al^[30]	2015	536	333/536 (62.1%)	-	-
Intra M, et al^[36]	2015	212	207/212 (97.6%)	7/212 (3.3%)	48.0
Maaskant-Braat A J, et al^[37]	2013	692	452/692 (65.3%)	-	-
Cox C E, et al^[34]	2008	56	45/56 (80.4%)	0/56 (0.0%)	-
Intra M, et al^[35]	2007	65	63/65 (96.9%)	0/65 (0.0%)	45.9
Port E R, et al^[40]	2007	117	64/117 (54.7%)	0/117 (0.0%)	-
Intra M, et al^[27]	2005	18	18/18 (100.0%)	0/18 (0.0%)	12.7