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乳腺癌新辅助化疗后前哨淋巴结活检的研究进展
作者: 王骥1  吴瑞2  刘晓1  秦安1 
Authors: Wang Ji1, Wu Rui2, Liu Xiao1, Qin An1
单位: 1南京医科大学附属无锡人民医院甲乳外科214023;2南京医科大学第一临床医学院210029
Units: 1Department of Thyroid and Breast Surgery, the Affiliated Wuxi People′s Hospital of Nanjing Medical University, Wuxi 214023, China; 2The First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
关键词: 乳腺肿瘤;肿瘤辅助疗法;前哨淋巴结活组织检查;腋窝淋巴结清扫术;内乳前哨淋巴结活检
Keywords: Breast neoplasms;Neoadjuvant therapy;Sentinel lymph node biopsy;Axillary lymph node dissection;Internal mammary sentinel lymph node biopsy
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出版年,卷(期):页码:2020,47(1):54-60
摘要:

 关于乳腺癌新辅助化疗(NAC)后前哨淋巴结活检(SLNB)的可行性及安全性,临床上仍有争议。临床淋巴结阴性(cN0)患者NAC后SLNB可行且安全,而临床淋巴结阳性(cN+)患者需慎重考虑。NAC后SLNB的示踪方法除染料法和核素法外,临床研究还提出一些其他示踪法,如纳米碳和荧光染料等。NAC后SLNB患者的腋窝淋巴结(ALN)状态与分子分型、化疗反应和残余乳腺肿瘤大小等因素有关,应综合考虑多种因素决定是否需ALN清扫。采用术前放置定位夹、炭黑颗粒悬浮液标记等技术,可降低ALN的假阴性率。除ALN外,内乳淋巴结是乳腺癌转移的另一途径,内乳前哨淋巴结活检作为一项低侵袭性的诊断技术,可完善淋巴结和病理分期,从而指导临床治疗。本文将从可行性及安全性、示踪方法、ALN状态评估和降低假阴性率的方法等方面对NAC后SLNB的研究进展进行综述。

 The feasibility and safety of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for breast cancer are still controversial in clinical practice. SLNB after NAC is feasible and safe for patients with clinically nodenegative (cN0) breast cancer, while those with clinically nodepositive (cN+) should be carefully considered. In addition to methylene blue and 99mTcsulfur colloid tracing, some other tracing methods have been proposed in clinical studies, such as carbon nanoparticles and indocyanine green fluorescence tracing. The axillary lymph node (ALN) state of SLNB patients after NAC was associated with molecular subtyping, response to chemotherapy, residual breast tumor size, etc. Therefore, a number of factors should be considered to determine whether ALN dissection is needed. The false negative rate of SLNB after NAC can be reduced by some measures such as placing clips prior to surgery and preoperative tattooing with sterile black carbon suspension. Besides ALN, internal mammary lymph nodes  is another route for breast cancer metastasis. As a lowinvasive diagnostic technique, internal mammary sentinel lymph node biopsy  can complete lymph node staging and pathological staging to guide treatment. This review attempts to introduce the research progress of SLNB after NAC from multiple aspects such as feasibility and safety, tracer methods, assessment of ALN status and methods to reduce false negative rate.

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