2016年12月12日，美国临床肿瘤学会官方期刊《临床肿瘤学杂志》在线发表华盛顿大学、弗雷德哈钦森癌症研究中心、美国临床肿瘤学会、加利福尼亚希望之城、德克萨斯谢丽尔帕金斯、佛蒙特大学癌症中心、洛杉矶雪松西奈医学中心起草的《早期乳腺癌患者前哨淋巴结活检》临床实践指南更新，对早期乳腺癌患者前哨淋巴结活检提供了最新的推荐意见。
该指南于2012年～2016年7月对PubMed和Cochrane数据库的随机对照研究、系统回顾、荟萃分析和临床实践指南进行了检索。指南更新专家组审核了筛选出的8篇摘要，这些最新文献回顾再次肯定2014年推荐意见如下：
无前哨淋巴结转移的女性，不应该接受腋窝淋巴结清扫术。
拟行保乳手术联合全乳放疗的1～2个前哨淋巴结转移女性，不应该接受腋窝淋巴结清扫术（在大多数情况下）。
拟行乳房切除术的前哨淋巴结转移女性，应该接受腋窝淋巴结清扫术。
上述三项推荐意见基于随机对照研究。
可手术乳腺癌和多中心肿瘤、导管原位癌、拟行乳房切除术、曾行乳房和/或腋窝手术、接受术前/新辅助全身疗法的女性，可以接受前哨淋巴结活检。
大型或局部晚期浸润性乳腺癌（肿瘤大小T3/T4）、炎性乳腺癌、导管原位癌（拟行保乳手术时）、怀孕女性，不应该接受前哨淋巴结活检。
J Clin Oncol. 2016 Dec 12. [Epub ahead of print]
Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.
Gary H. Lyman, Mark R. Somerfield, Linda D. Bosserman, Cheryl L. Perkins, Donald L. Weaver, Armando E. Giuliano.
Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; American Society of Clinical Oncology, Alexandria, VA; City of Hope, Duarte, CA; Cheryl L. Perkins, Dallas, TX; University of Vermont and Vermont Cancer Center, Burlington, VT; Cedars-Sinai Medical Center, Los Angeles, CA.
Purpose: To provide current recommendations on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer.
Methods: PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from 2012 through July 2016. An Update Panel reviewed the identified abstracts.
Results: Of the eight publications identified and reviewed, none prompted a change in the 2014 recommendations, which are reaffirmed by the updated literature review.
Conclusion: Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendations are based on randomized controlled trials. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ, who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or are pregnant should not undergo SNB.
DOI: 10.1200/JCO.2016.71.0947
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