2016年5月6日,勤快的美国国家综合癌症网络(NCCN)悄悄地将乳腺癌临床实践指南更新到了2016年第2版。
2016年第2版与2016年第1版比较,更新如下:
BINV-1
检查:由“生育咨询,如绝经前”改为“生育顾虑咨询,如绝经前”
WORKUP, changed "Fertility counseling if premenopausal" to "Counseling for fertility concerns if premenopausal."
BINV-2
考虑影像检查用于系统(全身)分期,明确删除“或MRI”
Clarified imaging for systemic staging, removed "or MRI."
BINV-5
系统(全身)辅助治疗-激素受体阳性-HER2阳性疾病,删除脚注“y”所说的“证据支持激素受体阳性乳腺癌绝经前女性手术或放射切除卵巢获益程度与单用CMF相似。参见辅助内分泌疗法(BINV-J)和术前/辅助疗法方案(BINV-K)”
SYSTEMIC ADJUVANT TREATMENT - HORMONE RECEPTOR-POSITIVE - HER2-POSITIVE DISEASE, removed footnote "y" stating "Evidence supports that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal women with hormone receptor-positive breast cancer is similar to that achieved with CMF alone. See Adjuvant Endocrine Therapy (BINV-J) and Preoperative/Adjuvant Therapy Regimens (BINV-K)."
BINV-9
将脚注“如果雌激素受体阳性,考虑内分泌疗法,以降低风险和消除疾病复发小风险”移至流程。
Moved the following footnote to the algorithm: "If ER-positive, consider endocrine therapy for risk reduction and to diminish the small risk of disease recurrence."
BINV-11
临床阴性腋窝淋巴结考虑腋窝影像学检查,明确加入“超声波”
Clarified imaging by adding "with ultrasound."
BINV-12
术前系统(全身)疗法删除声明“内分泌疗法单用芳香酶抑制剂(绝经后女性优先选择;绝经前女性与卵巢抑制一起给予)或他莫昔芬可被考虑用于激素受体阳性患者”,并链接至BINV-L(同样适用于BINV-15)
Removed the statement "[Endocrine therapy alone with an aromatase inhibitor (preferred option for postmenopausal women; given along with ovarian suppression for premenopausal women) or tamoxifen may be considered for patients with hormone-receptor positive disease]" and linked to BINV-L (also applies to BINV-15)
脚注“jj”明确“影像研究”加入(乳房摄影和/或乳腺MRI)
Footnote "jj" clarified "imaging studies" by adding (mammogram and/or breast MRI).
BINV-15
术前系统(全身)疗法删除声明“内分泌疗法单用芳香酶抑制剂(绝经后女性优先选择;绝经前女性与卵巢抑制一起给予)或他莫昔芬可被考虑用于激素受体阳性患者”,并链接至BINV-L
Removed the statement "[Endocrine therapy alone with an aromatase inhibitor (preferred option for postmenopausal women; given along with ovarian suppression for premenopausal women) or tamoxifen may be considered for patients with hormone-receptor positive disease]" and linked to BINV-L
BINV-22
“含有曲妥珠单抗的化疗”改为“HER2靶向化疗”
Changed trastuzumab containing chemotherapy to HER2-targeted chemotherapy.
BINV-N
加入“选择性雌激素受体调节剂”
Added "Selective ER modulators."
IBC-1
新增注脚k:“准确评估术前系统(全身)疗法对乳腺内肿瘤或局部淋巴结的效果是困难的,并应包括体检和最初肿瘤分期时异常的影像学表现(乳房摄影和/或乳腺MRI)。术前影像学检查方法选择应由多学科小组决定。”
Added a new footnote, "The accurate assessment of in-breast tumor or regional lymph node response to preoperative systemic therapy is difficult, and should include physical examination and performance of imaging studies (mammogram and/or breast MRI) that were abnormal at the time of initial tumor staging. Selection of imaging methods prior to surgery should be determined by the multidisciplinary team."
讨论(Discussion)
讨论部分已被更新,以反映上述流程的变化。
The discussion section has been updated to reflect changes in the algorithm.
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