切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 108 -112. doi: 10.3877/cma.j.issn.1674-0807.2025.02.008

综述

乳腺癌前哨淋巴结活组织检查的临床应用
李昕宇1, 李玉东1, 刘强1,()   
  1. 1. 510220 广州,中山大学孙逸仙纪念乳腺肿瘤医院乳腺外科
  • 收稿日期:2024-03-22 出版日期:2025-04-01
  • 通信作者: 刘强

Clinical application of sentinel lymph node biopsy in breast cancer

Xinyu Li, Yudong Li, Qiang Liu()   

  • Received:2024-03-22 Published:2025-04-01
  • Corresponding author: Qiang Liu
引用本文:

李昕宇, 李玉东, 刘强. 乳腺癌前哨淋巴结活组织检查的临床应用[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 108-112.

Xinyu Li, Yudong Li, Qiang Liu. Clinical application of sentinel lymph node biopsy in breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(02): 108-112.

乳腺癌前哨淋巴结活组织检查(SLNB)作为乳腺外科的标准术式之一,随着癌症系统治疗和微创外科技术的不断发展,已成为临床评估腋窝阴性患者淋巴结分期的金标准。SLNB在保证患者生存预后的同时,可以有效地降低术后患肢相关功能障碍等并发症的发生率。国际多项大型前瞻性临床研究探索乳腺癌腋窝手术降阶梯治疗的选择,对临床实践提出了大胆假设。Z0011研究在早期乳腺癌中的研究结果使得前哨淋巴结阳性患者成功豁免腋窝淋巴结清扫,而SOUND研究进一步提出影像学阴性的患者有机会免除SLNB,使得腋窝无侵入性操作成为可能。特殊分型的患者可显著获益于新辅助治疗,关于这部分患者能否豁免腋窝淋巴结清扫甚至SLNB的临床试验仍在开展中。本文将从不同阶段的乳腺癌患者SLNB的应用、发展和未来趋势进行总结。

[1]
Sappey MPC. Anatomie, physiologie, pathologie de vaisseaux Lymphatiques[M]. Paris: Adrain Delahaye, 1874: 1-134
[2]
Suami H, Pan WR, Taylor GI. Historical review of breast lymphatic studies[J]. Clin Anat, 2009, 22(5): 531-536.
[3]
Halsted WS. The results of radical operations for the cure of carcinoma of the breast[J]. Ann Surg, 1907, 46(1):1-19.
[4]
Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer[J]. N Engl J Med, 1985, 312 (11): 665-673.
[5]
Gould EA, Winship T, Philbin PH, et al. Observations on a “sentinel node” in cancer of the parotid [J]. Cancer, 1960, 13: 77-78.
[6]
Cabanas RM. An approach for the treatment of penile carcinoma [J].Cancer, 1977, 39 (2): 456-466.
[7]
Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer [J]. Ann Surg, 1994,220(3): 391-398.
[8]
Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe [J]. Surg Oncol, 1993, 2 (6): 335-339.
[9]
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial [J]. Lancet Oncol, 2010, 11(10): 927-933.
[10]
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial [J]. J Natl Cancer Inst,2006, 98(9): 599-609.
[11]
Giuliano AE, Hawes D, Ballman KV, et al. Association of occult metastases in sentinel Lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer [J]. JAMA,2011, 306(4): 385-393.
[12]
Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update [J]. J Clin Oncol, 2017, 35(5): 561-564.
[13]
王永胜, 欧阳涛, 王启堂, 等. 中国前哨淋巴结活组织检查多中心协作研究CBCSG-001最新资料报告[J/CD]. 中华乳腺病杂志(电子版), 2009, 3(3): 265-272.
[14]
Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised,controlled phase 3 trial [J]. Lancet Oncol, 2018, 19(10): 1385-1393.
[15]
Sola M, Alberro JA, Fraile M, et al. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000 [J]. Ann Surg Oncol, 2013, 20(1): 120-127.
[16]
Giuliano AE, Ballman KV, Mccall L, et al. Effect of axillary dissection vs no axillary dissection on 10-Year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial [J]. JAMA,2017, 318(10): 918-926.
[17]
Carlson RW, Allred DC, Anderson BO, et al. Invasive breast cancer[J]. J Natl Compr Canc Netw, 2011, 9(2): 136-222.
[18]
Tinterri C, Gentile D, Gatzemeier W, et al. Preservation of axillary lymph nodes compared with complete dissection in T1-2 breast cancer patients presenting one or two metastatic sentinel lymph nodes: the SINODAR-ONE multicenter randomized clinical trial [J]. Ann Surg Oncol, 2022, 29(9): 5732-5744.
[19]
Boniface JD, Tvedskov TF, Christiansen P, et al. Omitting axillary dissection in breast cancer with sentinel-node metastases[J]. N Engl J Med, 2024, 390(13): 1163-1175.
[20]
Donker M, Van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer(EORTC 10981-22023 AMAROS): a randomised, multicentre, openlabel, phase 3 non-inferiority trial [J]. Lancet Oncol, 2014, 15(12):1303-1310.
[21]
Sávolt Á, Péley G, Mátrai Z, et al. Eight-year follow up result of the OTOASOR trial: the optimal treatment of the axilla-surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial [J]. Eur J Surg Oncol, 2017, 43(4): 672-679.
[22]
Goyal A, Mann GB, Miles E,et al. POSNOC-POsitive Sentinel NOde:adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes [J]. BMJ Open, 2021, 11(12):e054365.
[23]
Sun J, Mathias BJ, Lee MC, et al. Is it wise to omit sentinel node biopsy in elderly patients with breast cancer? [J]. Ann Surg Oncol,2021, 28(1): 320-329.
[24]
Gentilini OD, Botteri E, Veronesi P, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: The SOUND randomized clinical trial [J]. JAMA Oncol, 2023, 9(11):1557-1564.
[25]
Reimer T, Stachs A, Gerber B, et al. Patient-reported outcomes for the Intergroup Sentinel Mamma study (INSEMA): a randomised trial with persistent impact of axillary surgery on arm and breast symptoms in patients with early breast cancer [J]. EClinicalMedicine, 2022, 55:101756.
[26]
Jung JG, Ahn SH, Lee S, et al. No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS]:protocol of a prospective randomized clinical trial [J]. BMC Cancer,2022, 22(1): 189.
[27]
Hersh EH, King TA. De-escalating axillary surgery in early-stage breast cancer [J]. Breast, 2022, 62 Suppl 1: S43-S49.
[28]
Sun X, Wang XE, Zhang ZP, et al. Neoadjuvant therapy and sentinel lymph node biopsy in HER2-positive breast cancer patients: results from the PEONY trial [J]. Breast Cancer Res Treat, 2020, 180(2):423-428.
[29]
Tadros AB, Yang WT, Krishnamurthy S, et al. Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery [J].JAMA Surg, 2017, 152(7): 665-670.
[30]
Geng C, Chen X, Pan X, et al. The feasibility and accuracy of sentinel lymph node biopsy in initially clinically node-negative breast cancer after neoadjuvant chemotherapy: A systematic review and metaanalysis [J]. PLoS One, 2016, 11(9): e0162605.
[31]
Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy(SENTINA): a prospective, multicentre cohort study [J]. Lancet Oncol, 2013, 14(7): 609-618.
[32]
Gralow JR, Burstein HJ, Winer EP, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease [J]. J Clin Oncol, 2008, 26(5): 814-819.
[33]
Heidinger M, Weber WP. Axillary surgery for breast cancer in 2024[J]. Cancers (Basel), 2024, 16(9): 1623.
[34]
Boughey JC, Ballman KV, Le-petross HT, et al. Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy:Results from ACOSOG Z1071 (Alliance) [J]. Ann Surg, 2016, 263(4): 802-807.
[35]
Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study [J]. J Clin Oncol, 2015, 33(3): 258-264.
[36]
Le-Petross HT, McCall LM, Boughey JC, et al. Axillary ultrasound identifies residual nodal disease after chemotherapy: results from the American college of surgeons oncology group Z1071 trial (Alliance)[J]. AJR Am J Roentgenol, 2018, 210(3): 669-676.
[37]
Donker M, Straver ME, Wesseling J, et al. Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure [J].Ann Surg, 2015, 261 (2): 378-382.
[38]
Caudle AS, Yang WT, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes:implementation of targeted axillary dissection [J]. J Clin Oncol, 2016,34(10): 1072-1078.
[39]
Zhang L, Cheng M, Lin Y, et al. Ultrasound-assisted carbon nanoparticle suspension mapping versus dual tracer-guided sentinel lymph node biopsy in patients with early breast cancer (ultraCars):phase III randomized clinical trial [J]. Br J Surg, 2022, 109(12):1232-1238.
[40]
Van la Parra RF, Kuerer HM. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials [J]. Breast Cancer Res, 2016, 18(1):28.
[41]
Montagna G, Mrdutt M, Botty A, et al. Oncological outcomes following omission of axillary lymph node dissection in node positive patients downstaging to node negative with neoadjuvant chemo-therapy: the OPBC-04/EUBREAST-06/OMA study [DB/OL].[2024-04-20].https://colab.ws/articles/10.1158/1538-7445.SABCS22-GS4-02.
[42]
Moo TA, Edelweiss M, Hajiyeva S, et al. Is low-volume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection[J]. Ann Surg Oncol, 2018, 25(6): 1488-1494.
[43]
Montagna G. Are nodal ITCs after neoadjuvant chemotherapy an indication for axillary dissection? The OPBC05/EUBREAST-14R/ICARO study [DB/OL].[2024-04-20].https://aacrjournals.org/cancerres/article/84/9_Supplement/GS02-02/743891/Abstract-GS02-02-Are-nodal-ITCs-after-neoadjuvant.
[44]
Davey MG, O'Flaherty C, Cleere EF, et al. Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis [J]. BJS Open, 2022, 6(2):zrac022.
[45]
Si J, Guo R, Wu J, et al. Axillary evaluation is not warranted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy [J]. Cancer Med, 2019,8(18):7586-7593.
[46]
Chiu CW, Chang LC, Su CM, et al. Precise application of sentinel lymph node biopsy in patients with ductal carcinoma in situ: A systematic review and meta-analysis of real-world data [J]. Surg Oncol, 2022, 45: 101880.
[47]
Munck F, Clausen EW, Balslev E, et al. Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ [J]. Br J Surg,2020, 107(1): 96-102.
[48]
Karakatsanis A, Eriksson S, Pistiolis L, et al. Delayed sentinel lymph node dissection in patients with a preoperative diagnosis of ductal cancer in situ by preoperative injection with superparamagnetic iron oxide(SPIO) nanoparticles: The SentiNot study [J]. Ann Surg Oncol,2023, 30(7): 4064-4072.
[49]
Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349 (6): 546-553.
[50]
Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27 [J]. J Clin Oncol, 2005, 23 (12): 2694-2702.
[51]
Classe JM, Loaec C, Gimbergues P, et al. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study [J].Breast Cancer Res Treat, 2019, 173 (2): 343-352.
[52]
Henke G, Knauer M, Ribi K, et al. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial [J]. Trials,2018, 19 (1): 667.
[53]
Simons JM, van Nijnatten TJA, Smidt ML, et al. Diagnostic accuracy of radioactive iodine seed placement in the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in node-positive breast cancer [J]. JAMA Surg, 2022, 157(11):991-999..
[54]
Kuemmel S, Heil J, Reinisch M, et al. Safety of targeted axillary dissection after neoadjuvant therapy in patients with node-positive breast cancer [J]. JAMA Surg, 2023, 158(8): 807-815.
[55]
Wu SY, Li JW, Liu GY, et al. Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy inbiopsy-proven node-positivebreastcancer:a prospective diagnostic and prognostic study [J]. Int J Surg, 2023,109(7): 1863-1870.
[1] 金钰婷, 苑龙, 齐晓伟, 姜军. 乳腺癌非根治性手术临床研究证据[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 65-69.
[2] 李金泽, 彭雅琪, 刘月平, 马力. 乳腺癌HER-2低表达及超低表达临床研究进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 70-75.
[3] 肖锦怡, 周金妹, 王涛. 2024年乳腺癌全身系统治疗十大热点[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 76-83.
[4] 柴效科, 周海存, 杨涛, 卫翀羿, 魏赟, 张旭, 隆建萍. HER-2状态与AR/p53/Ki-67表达对三阴性乳腺癌新辅助化疗疗效及预后的影响[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 84-91.
[5] 张国锋, 徐向升, 刘蕾, 张春, 孔蕾, 房立柱. 早期浸润性乳腺癌保留乳房患者的腋窝分期研究[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 92-96.
[6] 乔平, 杜华, 师迎旭. 选择性多聚腺苷酸化在乳腺癌中的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 113-118.
[7] 史福军, 魏巍, 林晓华, 廖玥, 郭志容. 单孔机器人辅助乳腺癌手术一例[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(02): 125-127.
[8] 慕春燕, 杨大伟, 张云东, 崔兆清. E1A结合蛋白P300与乳腺癌发生发展的关系研究进展[J/OL]. 中华普通外科学文献(电子版), 2025, 19(02): 111-115.
[9] 王子萌, 郑智, 闫笑生, 翟育豪, 张海翘, 徐瑞, 陈光勇, 刘小野, 尹杰, 张军. 胃癌前哨淋巴结研究的文献计量学与可视化分析[J/OL]. 中华普通外科学文献(电子版), 2025, 19(01): 34-41.
[10] 苏明, 唐丹萍, 王萍, 何谦. 乳腺癌改良根治术后即刻乳房重建的方法选择研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(02): 231-234.
[11] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[12] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[13] 李燕, 何丽, 侯倩男, 黄璐, 张强, 龚照林, 林永红. vNOTES 腹膜后前哨淋巴结活检在早期子宫内膜癌中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(01): 48-54.
[14] 颜军, 郭诗翔, 吴堃. 新辅助治疗后“二步法”改良Appleby 术治疗局部进展期胰体癌[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 274-280.
[15] 孙志鹏, 束斌, 王良, 黄鑫, 王鹏飞, 李广欣, 王小娟, 黎功, 杨世忠. 放疗联合靶向免疫新辅助治疗肝内胆管细胞癌的安全性与疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 92-96.
阅读次数
全文


摘要