Zusammenfassung
Das Konzept der Wächterlymphknoten-Biopsie (Sentinel-Lymph-Node-Biopsie) bei Brustkrebspatientinnen entwickelt sich schnell zu einem diagnostischen Standard [1]. Die rasche Akzeptanz dieser Methode im klinischen Alltag ist das Ergebnis vieler Faktoren: Sicherheit, Verminderung der Morbidität und Verminderung der Lymphknotenanzahl, die dem Pathologen zugesandt werden mit einer dann mehr fokussierten und sensitiveren histopathologischen Auswertung. Die Wächterlymphknoten sind diejenigen Lymphknoten, die im Falle einer vom Tumor ausgehenden Metastasierung am wahrscheinlichsten Tumorzellen enthalten. Aufgrund dessen kann die histopathologische Auswertung dieser Wächterlymphknoten sehr genau andere Metastasen in der gleichen Lymphabflussregion vorhersagen und wesentliche Beiträge zur lokalen und systemischen Therapieentscheidung liefern. Die SLN-Biopsie beeinhaltet die Markierung sowie nachfolgende Resektion der Sentinel Lymph Node (SLN), die die Region des Primärtumors drainieren. Diese Lymphknoten können mittels Sondentechnik und Szintigraphie nach radioaktiver Markierung und/oder durch Visualisierung mit Patentblau-Farbe nachgewiesen werden. Die axilläre Lymphknotendissektion (ALND) und die damit verbundene hohe Morbidität kann bei Patientinnen mit einem negativen Befund der Wächterlymphknoten vermieden werden. Trotz des Erfolges und der Akzeptanz des SLN-Konzeptes bleiben einige Kontroversen und Fragen unbeantwortet. In dieser Übersicht werden einige dieser relevanten klinischen Aussagen diskutiert.
Abstract
The concept of sentinel lymph node (SLN) biopsy in breast cancer patients is rapidly becoming the standard of care [1]. The fast assent of this technique in clinical practise is the result of multiple factors, including accuracy of the technique, decreased morbidity, and supplying the pathologist with only few nodes which allows a more focused and sensitive histopathologic evaluation. The sentinel nodes are those most likely to contain tumour cells that have spread from the tumour. Histopathological evaluation of these nodes therefore can be an accurate predictor for metastases in the respective lymph node basin and can guide regional and systemic treatment. The SLN-biopsy concerns the identification and subsequent resection of the initial lymph nodes (SLN) which are draining the primary tumour. These nodes can be identified by radioguided lymphatic mapping and/or by visualisation of the nodes with vital blue dyes. Axillary lymph node dissection (ALND) and its morbidity can be avoided in patients with negative SLN. Despite the success and acceptance of lymphatic mapping, some controversies and questions remain unanswered. In this review, some of the most relevant clinical issues will be discussed.
Schlüsselwörter
Mammakarzinom - Wächterlymphknoten-Biopsie
Key words
breast carcinoma - sentinel lymph node biopsy
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