乳腺癌分子分型与腋窝淋巴结外科处理

目的探讨乳腺癌分子分型是否影响腋窝淋巴结的术式选择。方法检索有关乳腺癌分子分型与腋窝淋巴结转移情况的文献并进行综述。结果三阴型乳腺癌患者的前哨淋巴结与非前哨淋巴结阳性率均较低，luminalB型和HER-2过表达型患者的腋窝淋巴结转移率较高，尤其是luminalB型乳腺癌患者，其前哨淋巴结阳性率、非前哨淋巴结阳性率均较其他分子分型高，对于行保乳手术的老年患者，当仅有1～2枚前哨淋巴结转移时，可免行腋窝淋巴结清扫；对于肿瘤体积较大的年轻患者，即使前哨淋巴结阴性，非前哨淋巴结阳性的可能性仍然较大，行腋窝淋巴结清扫可能会使这部分患者受益。结论对于腋窝淋巴结的术式选择，乳腺癌分子分型也是需要考虑的因素之一。

Molecular Classification of Breast Cancer and Surgical Management of Axiuary Lymph Node

Objective To explore influence of molecular classification of breast cancer on surgical treatment of axillary lymph nodes. Method The related literatures which discussed the relation between molecular classi- fication and axillary lymph node metastasis were reviewed and analyzed. Results The triple negative breast cancer had a lower rate of sentinel lymph node or non-sentinel lymph node metastasis. The axillary lymph node metastasis rate was higher in the luminal B or HER-2 overexpression subtypes. Especially, luminal B subtype＇ had a higher risk of sentinel lymph node or non-sentinel lymph node metastasis as compared with the other subtypes, Elderly patients with breast conserving operation could be free for axillary lymph node dissection when only 1-2 sentinel lymph node metastases. There was still a positive possibility of non-sentinel lymph node for younger patients with a larger tumor size, even if the sentinel lymph node negative, the lymph node dissection may benefit these patients. Conclusion Breast cancer molecular classification should be considered for the surgery selection of axillary lymph node dissection.