Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect

doi:10.19401/j.cnki.1007-3639.2022.08.002

Abstract

Abstract:

Regional lymph node status is one of the important prognostic indicators of breast cancer, which can guide the staging and adjuvant treatment strategy. Sentinel lymph node biopsy (SLNB) for breast cancer has developed rapidly over the past three decades, evidence-based medicine class Ⅰ evidence supports that SLNB is a safe and effective axillary staging technique for patients with clinically negative axillary lymph node in early breast cancer. The risk of axillary recurrence and complications in breast cancer patients with negative/few-positive sentinel lymph node omitting axillary lymph node dissection is very low. Locoregional management of breast cancer should consider the metastatic risk of the primary tumor, the efficacy and side effects of systemic therapy, and the efficacy and side effects of locoregional therapy (surgery/radiotherapy). This view has promoted the continuous expansion of the SLNB population. SLNB with neoadjuvant therapy and internal mammary SLNB will further promote the de-escalation therapy, and the ongoing studies of omission of axillary surgery should be anticipated. The era of precision medicine for regional lymph node management of breast cancer has gradually arrived with the development of SLNB. This article evaluated the latest progress of precise regional processing of breast cancer in the sentinel lymph node era, in order to provide reference for clinical doctors.

Key words: Breast cancer, Sentinel lymph node biopsy, Axillary lymph node, Internal mammary lymph node

CLC Number:

R737.9

QIU Pengfei, WANG Yongsheng. Precise regional management of breast cancer in the sentinel lymph node era: evolution and prospect[J]. China Oncology, 2022, 32(8): 680-687.

Figures/Tables 1

References 42

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Item	French (n=1 334)	EORTC 22922/10925 (n=4 004)	MA.20 (n=1 832)	DBCG-IMN (n=3 089)
Recruitment years	1991-1997	1996-2004	2000-2007	2003-2007
Follow-up years (median)	11.3	15.7	9.5	14.8
Proportion of positive axillary node	75.2%	55.5%	90.3%	100.0%
Proportion of adjuvant systemic therapy	Chemotherapy 60.9% Endocrine therapy 52.3%	84.4%	100.0%	100.0%
Breast cancer recurrence	43.1% vs 50.3%	24.5% vs 27.1% ^Δ	NA	NA
Breast cancer mortality	NA	16.0% vs 19.8% ^Δ	10.3% vs 12.3%	31.7% vs 33.9%^Δ
Distant disease-free survival	NA	70.0% vs 68.2%	86.3% vs 82.4%^Δ	64.4% vs 61.4%^Δ
DFS	53.2% vs 49.9%	60.8% vs 59.9%	82.0% vs 77.0%^Δ	NA
OS	62.6% vs 59.3%	73.1% vs 70.9%	82.8% vs 81.8%	60.1% vs 55.4%^Δ