Die Bedeutung des Lymphknotenbefalls beim Mammakarzinom für den Onkologen

The importance of axillary lymph node metastases in breast cancer patients

Summary

Axillary node status is the most important prognostic information regarding treatment and prognosis for breast cancer patients. Localisation and number of involved lymphnodes add further information and are of prognostic relevance as well. The problem of the involvement of different axilla levels as well as skip metastases are discussed. Sentinel lymphnode dissection is still considered investigational as well as axilla downstaging by preoperative chemotherapy. New prognostic markers are helpful in individual situations but are not yet considered as standard procedures. Conclusions of practical relevance are summarised.

Zusammenfassung

In dieser Übersichtsarbeit wird die Bedeutung des Befalls axillärer Lymphknoten beim Mammakarzinom dargelegt. Die Frage der Lokalisation, der Anzahl befallener Lymphknoten, das Problem der Skip-Metastasierung ebenso wie die „Sentinel”-Lymphknotendissektion werden bezüglich prognostischer und therapierelevanter Information diskutiert. Downstaging durch präoperative Chemotherapie ebenso wie der Einsatz neuer prognostischer Marker sind noch nicht standardmäßig etabliert. Es werden allgemeine Empfehlungen für die klinische Praxis formuliert.

Key words

Breast - cancer - axillary - lymph nodes

Schlüsselwörter

Mammakarzinom - Lymphknoten - Axilla

Literatur

• 1 Carter C L. et al . Relation of tumor size, lymph node status and survival in 24′740 breast cancer cases.  Cancer. 1989;  63 181-187
• 2 Cote R J, Rosen P P, Lesser M L, Old L J, Osborne M P. Prediction of early relapse in patient with operable breast cancer by detection of occult bone marrow micrometastases.  J Clin Oncol. 1991;  9 1749-1756
• 3 Cote R J, Peterson H F, Chaiwun B, Gelber R D, Goldhirsch A, Castiglione M, Gusterson B, Neville A M. for the International Breast Cancer Study Group . Role of immunohistochemical detection of lymph-node metastases in management of breast cancer.  Lancet. 1999;  354 896-900
• 4 Craig D A, Elledge R M. Caution concerning micrometastatic breast carcinoma in Sentinel Lymph Nodes.  Cancer. 1999;  86 990-996
• 5 Diel I J, Kaufmann M, Costa S D. et al . Micrometastatic breast cancer cells in bone marrow at primary surgery - prognostic value in comparison to nodal status.  J Natl Cancer Institute. 1996;  88 1652-1658
• 6 Fisher B, Bauer M, Wickerham L, Redmond C K, Fisher E R. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: An NSABP update.  Cancer. 1983;  52 1551-1557
• 7 Halsted W S. The results of radical operations for the cure of cancer of the breast.  Ann Surg. 1907;  46 1-19
• 8 Harris J R, Hellman S, Henderson I C, Kinne D W. Breast diseases. 2nd edn. Lippincott, Philadelphia 1991
• 9 Goldhirsch A, Glick J H, Gelber R D, Senn H. Meeting highlights: International consensus panel on the treatment of primary breast cancer.  J Natl Cancer Institute. 1998;  90 1601-1608
• 10 Nemoto T, Vana J, Bedwani R N. et al . Management and survival of female breast cancer: Results of a national survey by the American College of Surgeons.  Cancer. 1980;  45 2917-2924
• 11 Nemoto T, Vana J, Bedwani R N. et al . Breast cancer in the medial half; Results of the 1978 national survey of the American College of Surgeons.  Cancer. 1983;  51 1333-1338
• 12 Redding W H, Coombes R C, Monaghan P. et al . Detection of micrometastases in patients with primary breast cancer.  Lancet. 1983;  II 1271-1274
• 13 Rosen P P, Martin L L, Kinne D W,. et al . Discontinuous or “skip” metastasen in breast carcinoma; Analysis of 1.228 axillary dissections.  Ann Surg. 1983;  197 276-283
• 14 Singletary E S. Educational Book of ASCO. 1998; 1092-9118
• 15 Veronesi U, Marubini E, Mariani L, Valagussa P, Zucali R. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial.  Eur J Cancer. 1999;  35 1320-1325
• 16 Veronesi U, Paganelli G, Viale G, Zurrida S, Robertson C, Sacchini V, Vernonesi P, Orvieto E, De Cicco C, Intra M, Tosi G, Scarpa D. Sentinel lymph node biopsy and axillary dissection in breast cancer. Results in a large series.  J Natl Cancer Institute. 1999;  91 368-373
• 17 Veronesi U, Rilke F, Luini A. et al . Distribution of axillary node metastases by level of invasion.  Cancer. 1987;  59 682-687