乳腺癌外科治疗领域新技术的进展和争议

doi:10.19401/j.cnki.1007-3639.2025.04.001

摘要/Abstract

摘要：

乳腺癌是女性最常见的恶性肿瘤之一，严重威胁女性的生命健康。精准治疗理念的深化，使乳腺癌外科治疗取得了长足的进展，但新技术、新观点的产生同时带来了诸多争议。随着降阶梯理念的普及，对特定患者人群行前哨淋巴结活组织检查（sentinel lymph node biopsy，SLNB）替代腋窝淋巴结清扫术（axillary lymph node dissection，ALND）成为治疗趋势。前哨淋巴结（sentinel lymph node，SLN）1~2枚阳性且临床淋巴结阴性的早期乳腺癌患者接受术后放疗可安全豁免ALND。初始腋窝淋巴结阳性的患者接受新辅助治疗（neoadjuvant treatment，NAT）后经SLNB证实SLN转阴可安全免除ALND。双示踪法和靶向腋窝淋巴结切除术（targeted axillary dissection，TAD）作为目前NAT后患者接受SLNB常用的腋窝手术分期技术被认为肿瘤安全性一致。预防性乳房切除术是高危女性降低乳腺癌发病风险的重要干预手段，单侧原发性乳腺癌患者接受对侧预防性乳房切除术（contralateral prophylactic mastectomy，CPM）能够降低对侧乳腺癌（contralateral breast cancer，CBC）发生率但未显著改善患者的生存结局，提升评估手段的可及性和建立精准有效的风险预测模型成为临床医师亟需解决的问题。当前乳腺外科技术的发展总体呈现精细化的风险管理和损伤控制的特征，力求在个体化治疗的基础上实现外科手术的安全降阶梯。本文对近期乳腺外科技术进展与相关争议进行汇总和探讨，以期为优化乳腺癌外科诊疗提供新的思路。

关键词: 乳腺癌, 腋窝淋巴结, 预防性乳房切除术, 新技术

Abstract:

Breast cancer is one of the most common malignant tumors in women, which posing a serious threat to women's health. With the deepening of the concept of precision treatment, the surgical treatment of breast cancer has made great progress. However, new techniques and ideas have also brought about many controversies. With the popularization of the “de-escalation” concept, performing sentinel lymph node biopsy (SLNB) as an alternative to axillary lymph node dissection (ALND) in specific patients has emerged as a trend. For clinically node-negative early-stage breast cancer with 1-2 positive sentinel lymph nodes (SLN), ALND can be safely omitted with effective axillary radiotherapy. Patients with clinically node-positive early-stage breast cancer can forgo ALND if SLNB proves that they have been downstaged to cN0 by neoadjuvant treatment (NAT). As the two most commonly used axillary surgical staging techniques in SLNB for post-NAT patients, dual-tracer of lymph nodes and targeted axillary dissection (TAD) are considered consistent in oncologic safety. Prophylactic mastectomy is a significant intervention to reduce breast cancer incidence among women at high risk. It has been confirmed that contralateral prophylactic mastectomy (CPM) can reduce the incidence of contralateral breast cancer (CBC) but does not significantly improve the survival outcomes. Enhancing the accessibility of risk assessment methods and establishing precise and effective risk prediction models have emerged as important issues. Above all, the development of breast surgery shows a refinement of risk management and damage control, striving to achieve a safe “de-escalation” in surgical modalities based on individualized treatment. This article summarized and analyzed relevant studies on the aspect of the surgery techniques for breast cancer, aiming to provide new insights into optimizing the clinical diagnosis and treatment of breast cancer.

Key words: Breast cancer, Axillary lymph node, Prophylactic mastectomy, Emorging techniques

张钰佳, 马力. 乳腺癌外科治疗领域新技术的进展和争议[J]. 中国癌症杂志, 2025, 35(4): 339-345.

ZHANG Yujia, MA Li. Advances and controversies in emerging techniques of surgery on breast cancer[J]. China Oncology, 2025, 35(4): 339-345.

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