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乳腺癌腋窝淋巴结的术前精准评估和外科处理是近期乳腺外科研究热点。手术方式呈现显著的降阶梯趋势。腋窝外科由传统的腋窝淋巴结清扫转向创伤更小的前哨淋巴结活检,并在影像评估加持下进一步走向选择性“免手术”时代。本文系统梳理ACOSOG Z0011、AMAROS、SENOMAC、SOUND和INSEMA等关键临床研究,并深入探讨手术与放疗的平衡策略、新辅助治疗后的靶向腋窝清扫技术及人工智能与液体活检在精准评估中的应用前景。
Abstract:[1] 龙欣甜,文洪梅,李云飞,等.云南省23 354例乳腺癌患者生存状况分析[J].实用肿瘤杂志, 2025, 40(1):6-13.
[2] Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer:overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10):927-933.
[3] Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis:the ACOSOG Z0011(alliance) randomized clinical trial[J]. JAMA, 2017, 318(10):918-926.
[4] Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer-primary results of the INSEMA trial[J].N Engl J Med, 2025, 392(11):1051-1064.
[5] Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes:the SOUND randomized clinical trial[J]. JAMA Oncol, 2023, 9(11):1557-1564.
[6] 李超男,胡跃.乳腺癌腋窝手术的降阶梯之路[J].实用肿瘤杂志, 2026, 41(1):7-12.
[7] Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation[J]. N Engl J Med, 2002, 347(8):567-575.
[8] Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01):10-year follow-up of a randomised, controlled phase 3 trial[J]. Lancet Oncol, 2018, 19(10):1385-1393.
[9] Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3 non-inferiority trial[J]. Lancet Oncol, 2014, 15(12):1303-1310.
[10] Donker M, Straver ME, van Tienhoven G, et al. Comparison of the sentinel node procedure between patients with multifocal and unifocal breast cancer in the EORTC10981-22023 AMAROS Trial:identification rate and nodal outcome[J]. Eur J Cancer, 2013, 49(9):2093-2100.
[11] de Boniface J, Filtenborg Tvedskov T, Rydén L, et al.Omitting axillary dissection in breast cancer with sentinel-node metastases[J]. N Engl J Med, 2024, 390(13):1163-1175.
[12] Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age70 years or older with early breast cancer:long-term follow-up of CALGB 9343[J]. J Clin Oncol, 2013, 31(19):2382-2387.
[13] Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA):a prospective, multicentre cohort study[J]. Lancet Oncol,2013, 14(7):609-618.
[14] Boughey JC. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer:the ACOSOG Z1071(alliance) clinical trial[J].JAMA, 2013, 310(14):1455.
[15] Kuemmel S, Heil J, Rueland A, et al. A prospective, multicenter registry study to evaluate the clinical feasibility of targeted axillary dissection (TAD) in node-positive breast cancer patients[J]. Ann Surg, 2022, 276(5):e553-e562.
[16] Park KU, Somerfield MR, Anne N, et al. Sentinel lymph node biopsy in early-stage breast cancer:ASCO guideline update[J]. J Clin Oncol, 2025, 43(14):1720-1741.
[17] Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer:American Society of Clinical Oncology clinical practice guideline update[J]. J Clin Oncol, 2017, 35(5):561-564.
[18] Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer:American Society of Clinical Oncology clinical practice guideline update[J]. J Clin Oncol, 2014, 32(13):1365-1383.
[19] Kunkler IH, Williams LJ, Jack WJL, et al. Breast-conserving surgery with or without irradiation in women aged65 years or older with early breast cancer (PRIME Ⅱ):a randomised controlled trial[J]. Lancet Oncol, 2015, 16(3):266-273.
[20] Giuliano AE. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis:a randomized clinical trial[J]. JAMA, 2011,305(6):569.
[21] Gentilini O, Botteri E, Dadda P, et al. Physical function of the upper limb after breast cancer surgery. Results from the SOUND (Sentinel node vs. Observation after axillary Ultra-souND) trial[J]. Eur J Surg Oncol, 2016, 42(5):685-689.
[22] Reimer T, Glass A, Botteri E, et al. Avoiding axillary sentinel lymph node biopsy after neoadjuvant systemic therapy in breast cancer:rationale for the prospective, multicentric EUBREAST-01 trial[J]. Cancers, 2020, 12(12):3698.
[23] Mamounas EP, Bandos H, White JR, et al. Omitting regional nodal irradiation after response to neoadjuvant chemotherapy[J]. N Engl J Med, 2025, 392(21):2113-2124.
[24] Heidinger M, Knauer M, Tausch C, et al. Tailored axillary surgery-A novel concept for clinically node positive breast cancer[J]. Breast, 2023, 69:281-289.
[25] Geng C, Chen X, Pan XH, et al. The feasibility and accuracy of sentinel lymph node biopsy in initially clinically node-negative breast cancer after neoadjuvant chemotherapy:a systematic review and meta-analysis[J]. PLoS One, 2016, 11(9):e0162605.
[26] Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer:the SN FNAC study[J]. J Clin Oncol, 2015, 33(3):258-264.
[27] Caudle AS, Yang WT, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes:implementation of targeted axillary dissection[J]. J Clin Oncol, 2016, 34(10):1072-1078.
[28] Simons JM, van Pelt MLMA, Marinelli AWKS, et al. Excision of both pretreatment marked positive nodes and sentinel nodes improves axillary staging after neoadjuvant systemic therapy in breast cancer[J].Br J Surg, 2019,106(12):1632-1639.
[29] Montagna G, Mrdutt MM, Sun SX, et al. Omission of axillary dissection following nodal downstaging with neoadjuvant chemotherapy[J]. JAMA Oncol, 2024, 10(6):793-798.
[30] Lee J, Park S, Bae SJ, et al. Micrometastases in axillary lymph nodes in breast cancer, post-neoadjuvant systemic therapy[J]. Breast Cancer Res, 2024, 26(1):120.
[31] Shin DS, Ryu JM, Lee SK, et al. Nonsentinel lymph node metastases in cases of micrometastasis detected by sentinel lymph node biopsy after neoadjuvant chemotherapy[J]. Cancer, 2025, 131(1):e35567.
[32] Guo XH, Zhang J, Gong XL, et al. Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy:Is it necessary?[J]. Breast, 2024, 73:103671.
[33] Di Micco R, Hartmann S, Banys-Paluchowski M, et al.Diagnostic performance of axillary ultrasound after neoadjuvant chemotherapy in initially node-positive breast cancer patients-results from the prospective AXSANA registry trial[J]. Eur J Cancer, 2025, 226:115607.
[34] Wu SY, Li JW, Wang YJ, et al. Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer:a prospective diagnostic and prognostic study[J]. Int J Surg, 2023, 109(7):1863-1870.
[35] Loonis AT, Chesebro AL, Bay CP, et al. Positive predictive value of axillary lymph node cortical thickness and nodal, clinical, and tumor characteristics in newly diagnosed breast cancer patients[J]. Breast Cancer Res Treat, 2024,203(3):511-521.
[36] Simons JM, van Nijnatten TJA, van der Pol CC, et al.Diagnostic accuracy of different surgical procedures for axillary staging after neoadjuvant systemic therapy in node-positive breast cancer:a systematic review and meta-analysis[J]. Ann Surg, 2019, 269(3):432-442.
[37] Balasubramanian I, Fleming CA, Corrigan MA, et al. Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis[J]. Br J Surg, 2018,105(10):1244-1253.
[38] Giuliano AE, Connolly JL, Edge SB, et al. Breast cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J]. CA Cancer J Clin, 2017, 67(4):290-303.
[39] Straver ME, Meijnen P, van Tienhoven G, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial[J]. Ann Surg Oncol, 2010, 17(7):1854-1861.
[40] van Roozendaal LM, Vane ML, van Dalen T, et al. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up:a Dutch randomized controlled multicentre trial (BOOG 2013-08)[J]. BMC Cancer, 2017,17(1):459.
[41] van Roozendaal LM, de Wilt JH, van Dalen T, et al. The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy:a Dutch randomized controlled multicentre trial (BOOG2013-07)[J]. BMC Cancer, 2015, 15(1):610.
[42] Li JJ, Cheng JY, Liu GY, et al. Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer:a prospective phase Ⅱ trial[J]. Cancer Biol Med, 2022, 19(7):1100-1108.
[43] Qu LM, Mei XL, Yi ZX, et al. An unsupervised learning model based on CT radiomics features accurately predicts axillary lymph node metastasis in breast cancer patients:diagnostic study[J]. Int J Surg, 2024, 110(9):5363-5373.
[44] Marino MA, Avendano D, Zapata P, et al. Lymph node imaging in patients with primary breast cancer:concurrent diagnostic tools[J]. Oncologist, 2020, 25(2):e231-e242.
[45] Bevilacqua JLB, Kattan MW, Fey JV, et al. Doctor, what are my chances of having a positive sentinel node?A validated nomogram for risk estimation[J]. J Clin Oncol,2007, 25(24):3670-3679.
[46] Yang HP, Xie F, Yang Y, et al. Use of Memorial Sloan Kettering Cancer Center nomogram to guide intraoperative sentinel lymph node frozen sections in patients with early breast cancer[J]. J Surg Oncol, 2019, 120(4):587-592.
[47] Li SY, Li YM, Fang YQ, et al. Contrast-enhanced ultrasound radiomics model for predicting axillary lymph node metastasis and prognosis in breast cancer:a multicenter study[J]. BMC Cancer, 2025, 25(1):1315.
[48] Zheng XY, Yao Z, Huang YN, et al. Deep learning radiomics can predict axillary lymph node status in early-stage breast cancer[J]. Nat Commun, 2020, 11:1236.
[49] Zhou LQ, Wu XL, Huang SY, et al. Lymph node metastasis prediction from primary breast cancer US images using deep learning[J]. Radiology, 2020, 294(1):19-28.
[50] Huang ZB, Mo SJ, Li GQ, et al. Prognosticating axillary lymph node metastasis in breast cancer through integrated photoacoustic imaging, ultrasound, and clinical parameters[J]. Breast Cancer Res, 2025, 27(1):123.
[51] Zhong XY, Deng JQ, Lu P, et al. Wearable device for axillary lymph node screening in breast cancer based on infrared thermography and artificial intelligence[J]. Breast Cancer Res, 2025, 27(1):104.
[52] Lee HB, Lee KH, Song SH, et al. A survey of practice patterns for clinical nodal staging prior to neoadjuvant chemotherapy in breast cancer[J]. Oncologist, 2023, 28(12):e1142-e1151.
[53] Abel MK, Greenwood H, Kelil T, et al. Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma[J]. npj Breast Cancer,2021, 7:25.
[54] Zhu T, Huang YH, Li W, et al. Multifactor artificial intelligence model assists axillary lymph node surgery in breast cancer after neoadjuvant chemotherapy:multicenter retrospective cohort study[J]. Int J Surg, 2023, 109(11):3383-3394.
[55] Corsi F, Albasini S, Sorrentino L, et al. Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+breast cancer:a multicentre study on 1,950 patients[J]. Breast, 2021,60:131-137.
[56] Magbanua MJM, Swigart LB, Wu HT, et al. Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival[J]. Ann Oncol, 2021, 32(2):229-239.
[57] Zhang XX, Li Y, Wang J, et al. Factors that affect the false negative rate of sentinel lymph node biopsy in breast cancer[J]. J Int Med Res, 2019, 47(10):4848-4859.
[58] Li XZ, Hu Y. Abstract P5-07-08:The ACOSOG Z0011criteria can be safely applied to Chinese patients:the SAHZU experience[J]. Clin Cancer Res, 2025, 31(S12):P5-7-08.
[59] Zhou M, Qiu J, Chen J, et al. Abstract P3-03-20:Which biopsy is preferred to stage the axilla under ultrasound guidance in early breast cancer patients:Fine-needle aspiration cytology or core needle biopsy?[J]. Cancer Res,2019, 79(S4):P3-3-20.
基本信息:
DOI:10.3785/syzlzz.2026.053
引用信息:
[1]周美琪,邱吉利,陈嘉妮.乳腺癌腋窝淋巴结精准评估和外科处理进展[J],2026,41(4):370-378.DOI:10.3785/syzlzz.2026.053.
基金信息:
浙江省自然科学基金(ZCLQN25H1607); 中国医药卫生事业发展基金(chmdf2025-xrky07-12)