Axillary management after neoadjuvant therapy for breast cancer and optimization of sentinel lymph node diagnosis and treatment

Jiaqian ZHONG; Jiaping LI; Xiaoyan XIE; Yanling ZHENG

doi:10.19401/j.cnki.1007-3639.2025.09.009

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Axillary management after neoadjuvant therapy for breast cancer and optimization of sentinel lymph node diagnosis and treatment

Review | 更新时间：2025-12-31

- Axillary management after neoadjuvant therapy for breast cancer and optimization of sentinel lymph node diagnosis and treatment
- China Oncology Vol. 35, Issue 9, Pages: 884-892(2025)
- 作者机构：
  
  中山大学附属第一医院超声医学科，广东广州 510080
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2025.09.009
  CLC： R737.9
- Received：14 February 2025，
  
  Revised：2025-06-12，
  
  Published：30 September 2025
- 稿件说明：
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Jiaqian ZHONG, Jiaping LI, Xiaoyan XIE, et al. Axillary management after neoadjuvant therapy for breast cancer and optimization of sentinel lymph node diagnosis and treatment[J]. China Oncology, 2025, 35(9): 884-892.
DOI：

Jiaqian ZHONG, Jiaping LI, Xiaoyan XIE, et al. Axillary management after neoadjuvant therapy for breast cancer and optimization of sentinel lymph node diagnosis and treatment[J]. China Oncology, 2025, 35(9): 884-892. DOI： 10.19401/j.cnki.1007-3639.2025.09.009.

摘要

乳腺癌患者新辅助治疗（neoadjuvant therapy，NAT）后的腋窝管理正在优化，目前针对腋窝淋巴结（axillary lymph node，ALN）状态的评估，前哨淋巴结活检（sentinel lymph node biopsy，SLNB）已经成为重要手段，尤其是在初始临床ALN阴性（clinically negative ALN，cN0）的早期乳腺癌患者中，可以替代传统的ALN清扫（ALN dissection，ALND），减少不必要的手术风险和并发症，但是SLNB在初始临床ALN阳性（clinically positive ALN，cN

）的乳腺癌患者NAT后的应用上存在着一些假阴性率（false negative rate，FNR）及差异。通过切除≥3个SLN、使用双重示踪剂（如放射性核素联合蓝染料）或结合免疫组织化学（immuno

histochemistry，IHC）进行病理学评估，可将其FNR显著降低至可接受范围（4.9%~9.1%），并且发展出多种优化方案如放射性碘粒子标记ALN（marking ALN with radioactive iodine，MARI）、靶向腋窝清扫（targeted axillary dissection，TAD）、放射性碘粒子标记联合SLNB（radioactive iodine seed placement in the axilla with SLNB，RISAS），均表现出低FNR。不仅如此，非侵入性影像技术如正电子发射计算机体层成像（positron emission tomography and computed tomography，PET/CT）、磁共振成像（magnetic resonance imaging，MRI）、常规超声及超声造影（contrast-enhanced ultrasound，CEUS）都可以用于评估NAT后的腋窝反应，其诊断效能各异。本文对近年来cN

的乳腺癌患者NAT后的腋窝管理及SLNB诊治优化的相关研究进行总结。

Abstract

The axillary management of breast cancer patients after neoadjuvant therapy (NAT) is undergoing optimization. Sentinel lymph node biopsy (SLNB) has become an important means for evaluating the status of axillary lymph node (ALN)

especially in early-stage breast cancer patients with initially clinically negative ALN (cN0)

where it can replace traditional ALN dissection (ALND) to reduce unnecessary surgical risks and complications. However

SLNB has some limitations in terms of false negative rate (FNR) and variability when applied to breast cancer patients with initially clinically positive ALN (cN

) after NAT. By removing ≥3 SLN

using dual tracers (such as radioactive isotopes combined with blue dye)

and conducting pathological assessment in combination with immunohistochemistry (IHC)

the FNR can be significantly reduced to an acceptable range (4.9%-9.1%). Moreover

various optimization schemes have been developed

such as marking ALN with radioactive iodine (MARI)

targeted axillary dissection (TAD)

and radioactive iodine seed placement in the axilla with SLNB (RISAS)

all of which demonstrate low FNR. Not only that

non-invasive imaging techniques such as positron emission tomography and computed tomography (PET/CT)

magnetic resonance imaging (MRI)

conventional ultrasound and contrast-enhanced ultrasound (CEUS) can all be used to evaluate the axillary response after NAT

with varying diagnostic efficacies. This art

icle summarized recent studies on the optimization of axillary management and SLNB diagnosis and treatment for breast cancer patients with cN

after NAT.

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Keywords

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