乳腺癌腋窝手术治疗的新趋势

Zoltán Horváth, Attila Paszt, Zsolt Simonka, Melinda Látos, László Kaizer, Sándor Hamar, András Vörös, Katalin Ormándi, Zsuzsanna Fejes, Judit Oláh, György Lázár
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引用次数: 0

摘要

乳腺肿瘤的肿瘤外科治疗包括转移性腋窝淋巴结的切除。近30年来,腋窝淋巴结的诊断和治疗也发生了重大变化。1993年前哨淋巴结活检的引入,使得相当一部分患者安全地省去了高发病率的腋窝块清扫,同样,乳腺癌的分期以及肿瘤和复杂治疗也明显更加准确。前哨淋巴结活检引入后不久,术中也出现了前哨淋巴结检查(如印记细胞学),这大大减少了两会的手术数量,从而大大减轻了患者负担和手术费用。我们的研究结果表明,在治疗腋窝的患者中,需要腋窝块解剖的患者越来越少,并且随着替代腋窝放疗的使用增加,这一比例将进一步降低。前哨淋巴结的印迹细胞学检查考虑到目前的指导方针,不再提供明显的好处,其常规使用是不合理的。根据最新的国际建议,术中检查前哨淋巴结可能与乳房切除术(术后不计划放疗)和新辅助治疗有关。我们的研究结果表明,术前腋窝超声检测可疑淋巴结可以预测疾病的分期。根据我们的研究结果证实,在接受新辅助治疗的患者中,除了术前肿瘤大小(≤20mm, P = 0.002)外,术前淋巴结大小(≤15mm, P = 0.04)也可用于预测疾病分期为0-1期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
New trends in the surgical treatment of axilla in breast cancer

Oncosurgical treatment of breast tumors involves the removal of metastatic axillary lymph nodes. In the last 30 years, the diagnosis and treatment of axillary lymph nodes have also undergone significant changes. The introduction of sentinel lymph node biopsy in 1993 made axillary block dissection with high morbidity safely omitted in a significant proportion of patients, and similarly, the staging of breast tumors and thus oncology and complex treatment became significantly more accurate. Shortly after the introduction of sentinel lymph node biopsy, intraoperative examination of sentinel lymph nodes (e.g. imprint cytology) also appeared, which significantly reduced the number of surgeries performed in the two sessions, thereby significantly reducing patient burden and surgical costs. The results of our study indicate that axillary block dissection is required in the treatment of axilla in an ever-decreasing group of patients and this proportion will decrease further in the future, with the increasing use of alternative axillary radiotherapy. The imprint cytological examination of sentinel lymph nodes taking into account current guidelines, no longer provides demonstrable benefits and its routine use is not justified. According to the latest international recommendations, intraoperative examination of the sentinel lymph node may be indicated in connection with mastectomy (when postoperative radiotherapy is not planned) and after neoadjuvant treatment. Our results suggest that the detection of suspected lymph nodes during preoperative axillary ultrasound may predict the stage of the disease. Based on our research results confirm that in patients receiving neoadjuvant therapy, in addition to the preoperative size of the tumour (≤20 mm, P = 0.002), the preoperative size of the lymph node (≤15 mm, P = 0.04) may also be used to predict that the stage of the disease is N0-1.

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