乳腺癌委员会关于乳腺癌手术治疗的建议：妇科癌症工作组（AGO）更新2025

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-09-17 DOI:10.1016/j.ejso.2025.110445

Toralf Reimer , Thorsten Kuehn , Volkmar Mueller , Nina Ditsch , Tanja Fehm , Ute-Susann Albert , Rupert Bartsch , Ingo Bauerfeind , Vesna Bjelic-Radisic , Jens-Uwe Blohmer , Wilfried Budach , Peter Dall , Eva Maria Fallenberg , Peter A. Fasching , Michael Friedrich , Bernd Gerber , Oleg Gluz , Nadia Harbeck , Andreas Hartkopf , Joerg Heil , Marc Thill

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引用次数: 0

摘要

德国指南委员会（AGO：妇科癌症工作组）于2025年3月更新了其关于乳腺癌诊断和治疗的建议。关于肿瘤和肿瘤整形重建手术的章节与妇科整形，美学和重建手术工作组（AWOgyn）协调。最重要的变化包括将INSEMA和SOUND试验结果纳入指南。对于具有低风险特征的患者，定义为年龄≥50岁，绝经后状态，激素受体阳性/ her2阴性亚型，肿瘤分级G1-2，最大术前大小为2cm，无可疑腋下超声和临床检查，如果计划保乳手术和全乳照射，可以省略前哨淋巴结活检（SLNB）。在接受乳房切除术和术后放疗的1-2个大转移前哨淋巴结（sln）患者中，不再推荐完全性腋窝淋巴结清扫（ALND）。在新辅助全身治疗（NST）后，如果靶向腋窝清扫（TAD）显示前哨淋巴结和/或目标淋巴结（在NST前活检中标记并有大转移的淋巴结）出现大转移，则推荐使用ALND。前哨淋巴结和/或靶淋巴结中有孤立肿瘤细胞的患者不应在NST后接受ALND。对于ypN1mi状态，应该根据具体情况决定是否执行完成ALND。肿瘤整形手术是安全的，在某些情况下可以代替乳房切除术。

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AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025

The German Guideline Commission (AGO: Working Group on Gynecologic Cancers) updated its recommendations on the diagnosis and treatment of breast cancer in March 2025. Chapters on oncological and oncoplastic-reconstructive surgery are coordinated with the Working Group for Plastic, Aesthetic, and Reconstructive Surgery in Gynecology (AWOgyn). The most important changes include the incorporation of INSEMA and SOUND trial results into the guidelines. In patients with low-risk characteristics, defined as age ≥50 years, postmenopausal status, hormone receptor-positive/HER2-negative subtype, tumor grading G1-2 with a maximum preoperative size of 2 cm, and unsuspicious axillary ultrasound and clinical examination, the sentinel lymph node biopsy (SLNB) can be omitted if breast-conserving surgery and whole-breast irradiation are planned. In patients with 1–2 macrometastatic sentinel lymph nodes (SLNs) undergoing a mastectomy and postoperative irradiation, completion axillary lymph node dissection (ALND) is no longer recommended. After neoadjuvant systemic therapy (NST), ALND is recommended if the targeted axillary dissection (TAD) shows macrometastases in the sentinel and/or in the target lymph node (the node that was marked and had a macrometastasis in the biopsy before NST). Patients with isolated tumor cells in the sentinel and/or target lymph node should not receive ALND after NST. In case of ypN1mi status, the decision to perform a completion ALND should be made on a case-by-case basis. Oncoplastic surgery is safe and may replace a mastectomy in select cases.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.