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

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (6): 566-573.doi: 10.19401/j.cnki.1007-3639.2023.06.003

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

赵谦(), 凌云霄, 柳光宇()

复旦大学附属肿瘤医院乳腺外科，复旦大学上海医学院肿瘤学系，上海 200032

收稿日期:2022-12-12 修回日期:2023-05-15 出版日期:2023-06-30 发布日期:2023-07-26
通信作者: 柳光宇（ORCID：0000-0001-5464-4395），主任医师，复旦大学附属肿瘤医院乳腺外科副主任。
作者简介:赵谦（ORCID：0009-0003-7306-7847），硕士研究生。
柳光宇，主任医师，教授，博士研究生导师，复旦大学附属肿瘤医院乳腺外科行政副主任、乳腺外科党支部书记。现任上海市抗癌协会乳腺癌专业委员会主任委员、中国抗癌协会乳腺癌专业第九届委员会常委。担任《中国癌症杂志》《中华转移性肿瘤》《中华内分泌外科杂志》等杂志编委。2000年毕业于复旦大学上海医学院七年制临床医学专业，获临床医学硕士学位；2002—2003年以访问学者身份赴加拿大Manitoma大学病理科进行学术交流；2006年以访问学者身份赴美国得克萨斯大学MD安德森癌症中心（University of Texas MD Anderson Cancer Center）进行学术交流。在腋窝淋巴结外科处理方面具有丰富经验，本人及团队基于乳腺癌新辅助治疗平台，创新性地提出腋窝淋巴结疗效早期预测的多维度分析理念，鉴定一系列疗效标志物，建立了“基于分子分型的乳腺癌新辅助治疗精准评估体系”，个体化指导新辅助治疗决策，相关前瞻性临床试验初步证实了新辅助治疗后腋窝降阶梯外科手术的安全性。相关研究成果发表在International Journal of Surgery、British Journal of Surgery、Journal of Nuclear Medicine、Cell Death and Differentiation、Clinical and Translational Medicine等国际主流期刊，相关研究项目获得上海市科学技术奖一等奖、上海市抗癌科技奖二等奖。

Recent advances and perspectives in the application of repeat sentinel lymph node biopsy in breast cancer patients underwent breast-conserving surgery

ZHAO Qian(), LING Yunxiao, LIU Guangyu()

Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University Shanghai 200032, China

Received:2022-12-12 Revised:2023-05-15 Published:2023-06-30 Online:2023-07-26

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

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

Recent advances and perspectives in the application of repeat sentinel lymph node biopsy in breast cancer patients underwent breast-conserving surgery

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