前哨淋巴结活检术在乳腺癌特殊临床状况下的应用  

Sentinel Lymph Node Biopsy in Breast Cancer Patients with Special Clinical Scenarios

作　　者：林辉(综述)[1] 张斌(综述)[1] 汤小川(综述)[1] 曹旭晨(审校)[1] 

机构地区：[1]乳腺癌防治教育部重点实验室 天津市肿瘤防治重点实验室 天津医科大学附属肿瘤医院乳腺一科,天津市300060

出　　处：《中国肿瘤临床》2009年第9期530-532,537,共4页Chinese Journal of Clinical Oncology

基　　金：天津市科委科研基金资助(编号:06YFJMJC08200)

摘　　要：以往认为SLNB仅适用于单一病灶的早期乳腺癌,内乳淋巴结、多灶性/多中心乳腺癌、导管原位癌(DCIS)均不宜SLNB。本文主要对上述问题实行SLNB的可能性做一综述。内乳前哨淋巴结活检(IMSLNB)可提供腋窝外的淋巴结状态信息,尤其某些孤立IMLN受累患者可能改变术后辅助治疗策略。前哨淋巴结(SLN)是整个乳房组织的第一站引流的淋巴结而非针对于某一个病灶,这使多灶性/多中心乳腺癌患者行SLNB成为可能,可获得较满意成功率和准确率。SLNB不必用于所有DCIS患者,而对于伴浸润性癌高危因素如年轻、CNB诊断的DCIS、肿物较大(≥4cm)、高级别DCIS而且欲行乳房切除术的DCIS患者可考虑SLNB。Sentinel lymph node biopsy （SLNB）, once thought to be applicable only in single-fOcus early stage breast cancer, is suitable for internal mammary lymph nodes （IMLN） and patients with multicentric/multifocal disease and ductal carcinoma in situ （DCIS）. This review addresses the application of SLNB in these patients. IMSLN biopsy has the potential to provide further nodal staging and thereby alter adjuvant Ioco-regional treatment as well as systemic therapy in a small subset of patients. In breast tissue, the SLN represents the first draining node of the breast parenchyma as a whole and not the specific tumor. SLNB in multifocal/multicentric disease appears to be feasible with satisfactory success and accuracy rates. SLNB has some value in assisting surgeons in the effort to find a variant lymphatic drain area and may change the treatment suggested for patients treated with mastectomy and axillary staging by SLNB. SLNB should not be performed on all patients with a diagnosis of DCIS but should be considered in those with a higher possibility of undetected invasive disease such as those who are younger, those who are diagnosed by core needle biopsy, those who are found to have large tumors （≥4 cm） along with high grade DCIS, or those treated with mastectomy.

关 键 词：乳腺癌 前哨淋巴结活检 内乳淋巴结 多灶性/多中心乳腺癌 导管原位癌 

分 类 号：R737.9[医药卫生—肿瘤] R737.33[医药卫生—临床医学]