早期乳腺癌前哨淋巴结活检：最近发表和正在进行的随机研究

　　前哨淋巴结活检被作为早期乳腺癌患者淋巴结分期的标准手术。过去十年以来，若干随机研究一直在评估其作用和适应证。

　　2017年8月27日，欧洲乳腺癌专科学会（原欧洲乳腺病学会）和乳腺中心网络《乳腺》在线发表意大利那不勒斯腓特烈二世大学、圣拉斐尔大学医院的研究报告，回顾了最近发表和正在进行的前哨淋巴结活检随机研究。

• 腋窝淋巴结管理正对手术不断进行减法。

• 对于淋巴结阴性、非T4期浸润性乳腺癌，前哨淋巴结活检的作用目前仍无定论。

• 对于前哨淋巴结阳性患者，前哨淋巴结活检作为腋窝单一治疗的意义基本肯定。

• 对于新辅助治疗，前哨淋巴结活检仍然存在争议。

　　最近发表的四项随机对照研究：前哨淋巴结活检±放疗对于腋窝肿瘤负荷较低的早期乳腺癌患者有效（IBCSG 23-01、AATRM 048/13/2000、ACOSOG Z0011、EORTC 10981-22023 AMAROS）。

　　正在进行的九项随机对照研究：

• 四例正在评定前哨淋巴结活检对前哨淋巴结阳性患者的作用（POSNOC、SINODAR、BOOG 2013-07、SENOMAC）。

• 三项评估术前淋巴结造影阴性患者能否省去前哨淋巴结活检（SOUND、GBG75 INSEMA、BOOG 2013-08）。

• 两例正在研究前哨淋巴结活检用于新辅助治疗患者（NSABP B-51、Alliance A11202）。

　　综上所述，腋窝淋巴结活检±腋窝放疗已被证明对早期乳腺癌少量腋窝转移局部复发、无病生存、总体生存的效果不逊色于腋窝淋巴结完全清扫。

　　目前为止，正在进行的研究结果将确定：腋窝淋巴结累及有限患者的适当治疗、新辅助治疗患者前哨淋巴结活检的作用和时机、术前淋巴结造影阴性的早期乳腺癌患者能否避免腋窝手术。

Breast. 2017 Aug 27;36:14-19. [Epub ahead of print]

Sentinel node biopsy in early breast cancer. A review on recent and ongoing randomized trials.

Esposito E, Di Micco R, Gentilini OD.

University of Naples Federico II, Naples, Italy; San Raffaele Scientific and University Hospital, Milan, Italy.

HIGHLIGHTS

• A change in the management of axillary nodes with a progressive de-escalation of surgery is being observed.

• The role of SLNB to stage node-negative, non-T4 invasive breast cancers is currently undiscussed.

• The relevance of SLNB has been almost overcome by its role as single axillary treatment in positive-SLN patients.

• SLNB in the neoadjuvant setting is still debated.

INTRODUCTION: Sentinel Lymph Node Biopsy (SLNB) is regarded as the standard procedure for nodal staging in patients with early breast cancer. In the last decade several randomized trials have been evaluating its role and indications.

MATERIALS AND METHODS: This article reviews recent and ongoing randomized trials on SLNB.

RESULTS: Four randomized controlled trials have recently shown evidence that SLNB either alone or followed by radiation therapy is effective for the management in patients with low axillary tumor burden in early breast cancer. Nine randomized controlled trials on SLNB are ongoing: four assessing its role in case of positive sentinel node, three evaluating whether SLNB itself can be omitted when the preoperative nodal imaging is negative, two are studying SLNB in the neoadjuvant setting.

DISCUSSION AND CONCLUSION: SLNB either alone or with axillary radiotherapy has been shown to be non-inferior to complete axillary dissection in terms of local recurrence, disease-free survival and overall survival in early breast cancer with minimally metastatic axilla. So far, results from ongoing trials are going to confirm the appropriate treatment in patients with limited axillary nodal involvement, the role and the timing of SLNB within the neoadjuvant setting and to define whether surgery can be avoided in the axilla in early stage breast cancer patients with negative preoperative imaging.

KEYWORDS: Sentinel node biopsy, Breast cancer, Randomized trials

PMID: 28854395

DOI: 10.1016/j.breast.2017.08.006