Zusammenfassung
Fragestellung: Nach einer Sentinel-Lymphknotenbiopsie (SNB) beim Mammakarzinom ist das therapeutische
Vorgehen in der Axilla im Falle eines intramammären Rezidivs oder eines Thoraxwandrezidivs
unklar. Die aktuellen Leitlinien geben keine Empfehlung für diese Situation. Methode: Wir sichteten die verfügbaren Literaturquellen, in denen ein operatives Restaging
des Lymphknotenstatus bei einem Rezidiv nach vorausgegangener Mammakarzinomoperation
beschrieben wurde. Ergebnisse: 22 Arbeiten konnten identifiziert werden, in denen eine erneute SNB durchgeführt
wurde. Die Patientinnenkollektive waren in Bezug auf die Voroperationen sehr inhomogen.
Die Detektion für einen neuen Sentinel Node (SN) wurde mit 45–97 % angegeben. Dabei
variierte die Detektion mit der Radikalität des vorausgegangenen Eingriffs. Auffallend
war eine hohe Rate an extraaxillären Re-SN (32,4 %). Klinisch relevant erschien die
Rate an histologisch metastatischen Re-SN, die mit 8–35 % angegeben wurde. Zusammenfassung: Die adäquate Behandlung der Lymphabflussgebiete bei einem Lokalrezidiv der Brust / Thoraxwand
nach vorausgegangener SNB ist nicht geklärt. Insbesondere ist der diagnostische und / oder
therapeutische Nutzen einer erneuten SNB unklar. Aufgrund der kleinen Fallzahlen und
der inhomogenen Patientinnenkollektive kann aus der heute verfügbaren Literatur keine
therapeutische Empfehlung für die Routine abgeleitet werden. Prospektive Studien sind
sinnvoll, um eine evidenzbasierte Empfehlung für diese zukünftig häufiger zu erwartende
Situation zu ermöglichen.
Abstract
Purpose: Proper therapeutic management of the axilla in the event of breast cancer recurrence
in the breast or thoracic wall following sentinel node biopsy (SNB) is unclear. Recommendations
are not given in the current guidelines. Methods: The available literature on the operative restaging of locoregional lymph nodes in
the event of relapse following breast cancer surgery was reviewed. Results: Twenty-two articles were identified which reported a second SNB after relapse. The
patient collectives differed widely with respect to previous surgery. Detection rates
of the new sentinel node (SN) ranged from 45 to 97 %. Detection varied, depending
on the extent of previous surgery. A high rate of extraaxillary re-SN was noticeable
(32.4 %). The reported rate of 8–35 % for histologically metastatic re-SN was clinically
relevant. Conclusion: Adequate therapy of the lymphatic pathways in the case of local recurrence in the
breast or thoracic wall following previous SNB is unclear. The diagnostic and/or therapeutic
advantage of a second SNB is particularly unclear. Due to the small and inhomogeneous
sample sizes reported in the current literature, a general recommendation for routine
clinical practice cannot be made. Prospective trials are needed to provide evidence-based
recommendations as such cases are expected to occur more often in future.
Schlüsselwörter
intramammäres Rezidiv - Sentinel Node - Reevaluation Lymphabflusswege
Key words
intramammary recurrence - sentinel node biopsy - reevaluation of lymphatic pathways
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Dr. med. Gisela Helms
Universitätsfrauenklinik Tübingen
Calwer Straße 7
72076 Tübingen
eMail: gisela.helms@med.uni-tuebingen.de
