早期乳腺癌前哨淋巴结活检阳性患者的腋窝管理研究进展

志浩 翟(青海大学，中国)
晓武 王(青海大学，中国)

摘要

为了全面审视早期乳腺癌前哨淋巴结阳性患者的腋窝处理策略。研究表明，在特定条件下（前哨淋巴结微转移或宏转移不超过两枚），可以避免腋窝淋巴结清扫术（axillary lymph node dissection,ALND），或考虑腋窝放疗（axillary radiation therapy，A RT）作为替代方案。对于接受新辅助化疗（neoadjuvant chemotherapy，NAC）的患者，若NAC前阳性但NAC后转阴性，可通过增加前哨淋巴结活检术（Sentinel Lymph Node Biopsy，SLNB）淋巴结数量、使用染料和核素示踪法提高检出率，以及应用靶向腋窝淋巴结切除术（targeted axillary dissection，TA D），在与患者充分沟通后考虑SLNB替代ALND。对于NAC前后腋窝淋巴结均阳性的患者，推荐继续进行ALND。对于高肿瘤负荷、腋窝淋巴结明显肿大的患者，以及不符合Z0011标准的T3、T4期患者，建议进行腋窝超声联合超声引导下淋巴结穿刺活检，以避免不必要的SLNB。

关键词

乳腺肿瘤；前哨淋巴结活检；腋窝淋巴结清扫；新辅助治疗

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DOI: http://dx.doi.org/10.12345/yzlcyxzz.v8i11.34530