医学
腋窝
乳腺癌
前哨淋巴结
腋窝淋巴结清扫术
哨兵节点
乳房切除术
放射治疗
腋窝淋巴结
外科肿瘤学
普通外科
局部广泛切除术
外科
癌症
内科学
作者
Carlos A. Garcia‐Etienne,Alberta Ferrari,Angelica Della Valle,Marco Lucioni,Elisa Ferraris,Giuseppe Di Giulio,Luigi Squillace,Elisabetta Bonzano,Angioletta Lasagna,Gianpiero Rizzo,Richard Tancredi,Andrea Scotti Foglieni,Francesca Dionigi,Maurizia Grasso,Eloisa Arbustini,Giorgio Cavenaghi,Paolo Pedrazzoli,Andrea Riccardo Filippi,Paolo Dionigi,Adele Sgarella
出处
期刊:Ejso
[Elsevier]
日期:2020-01-01
卷期号:46 (1): 15-23
被引量:29
标识
DOI:10.1016/j.ejso.2019.08.013
摘要
The surgical approach to the axilla in breast cancer has been a controversial issue for more than three decades. Data from recently published trials have provided practice-changing recommendations in this scenario. However, further controversies have been triggered in the surgical community, resulting in heterogeneous diffusion of these recommendations. The development of clinical guidelines for the management of the axilla in patients with breast cancer is a work in progress. A multidisciplinary team discussion was held at the research hospital Policlinico San Matteo from the Università degli Studi di Pavia with the aim to update recommendations for the management of the axilla in patients with breast cancer. An evidence-based approach is presented. Our multidisciplinary panel determined that axillary dissection after a positive sentinel lymph node biopsy may be avoided in cN0 patients with micro/macrometastasis to ≤2 sentinel nodes, with age ≥40y, lesions ≤3 cm, who have not received neoadjuvant chemotherapy and have planned breast conservation (BCS) with whole breast radiotherapy (WBRT). Cases with gross (>2 mm) ECE in SLNs are evaluated on individual basis for completion ALND, axillary radiotherapy or omission of both. Patients fulfilling the criteria listed above who undergo mastectomy, may also avoid axillary dissection after multidisciplinary discussion of individual cases for consideration of axillary irradiation. Women 70 years or older with hormone receptors positive invasive lesions ≤3 cm, clinically negative nodes, and serious or multiple comorbidities who undergo BCS with WBRT, may forgo axillary staging/surgery (if mastectomy or larger tumor, comorbidities and life expectancy are taken into account).
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