早期乳腺癌前哨淋巴结活检的前沿进展

医学影像技术的飞速发展提高了早期乳腺癌腋窝淋巴结影像学诊断的能力，能够检测到腋窝淋巴结更早、更小的转移灶，通过影像学引导下穿刺活检明确淋巴结的转移状况，从而为患者提供更完善的术前腋窝分期。对于术前超声影像学检查为腋窝淋巴结阴性的患者是否可以避免术中腋窝前哨淋巴结活检，目前有两项大型临床试验正在进行中。山东大学附属山东省肿瘤医院乳腺病中心通过微泡超声造影显像技术引导腋窝前哨淋巴结术前穿刺活检，正在探索一种高效、准确和超微创的腋窝前哨淋巴结活检技术。术前影像学检查大大提高了临床腋窝淋巴结阳性患者的检出率，但也让一部分患者失去了通过腋窝前哨淋巴结活检替代腋窝淋巴结清扫的机会，对临床查体淋巴结阴性但超声发现可疑淋巴结并通过穿刺活检确诊转移的患者是否适合前哨淋巴结活检，本文也进行了相关的探讨和研究。另外，对内乳前哨淋巴结活检的相关研究结果进行了汇总。

Recent advances in sentinel lymph node biopsy for early stage breast cancer

With the rapid development of medical imaging techniques, the diagnosis of axillary lymph node metastases is improved in early stage breast cancer. The smaller and earlier metastatic lesion can be detected and identified by fine needle aspiration cytology or core needle biopsy, which may provide the entire axillary staging for patient. There are two prospective, multicenter, international randomized trials to compare axillary sentinel lymph node biopsy with no surgical staging for patients with negative axillary ultrasound imaging. Our center used contrastenhanced ultrasonography with microbubbles to identify the location of sentinel lymph node and guide its biopsy, which aimed to find an ultra-minimally invasive sentinel lymph node biopsy technique. The pre-operation imaging detection increased the detection rate of clinically positive axillary lymph node. However, it led some patients to lose the chance that they could receive axillary sentinel lymph node biopsy instead of axillary lymph node dissection. We also discussed whether sentinel lymph node biopsy suited cT1-2N0 patients who had 1-2 abnormal axillary lymph nodes detected by imaging technique and confirmed by fine needle aspiration cytology or core needle biopsy. Furthermore, the studies about internal mammary sentinel lymph node biopsy were reviewed.