Stellenwert der Sentinel-Node-Biopsie im Rahmen neoadjuvanter Therapiekonzepte beim Mammakarzinom: Überblick und aktuelles Studienkonzept

Zusammenfassung

Die Sentinel-Node-Biopsie (SNB) ist beim primär operierten Mammakarzinom als axilläre Stagingmaßnahme fest etabliert. Für Patientinnen, die eine primär systemische Therapie (PST) erhalten, wird die Datenlage für die Zuverlässigkeit der SNB als unsicher eingestuft. Daher wird bei diesen Patientinnen nach wie vor die klassische Axilladissektion (ALD) zur Sicherung der lokalen Kontrolle empfohlen. Etwa 40 % der Frauen, die eine PST erhalten, weisen einen negativen Nodalstatus auf und werden durch die Ausräumung der axillären Lymphknoten übertherapiert. Bei diesen Patientinnen wird der Vorteil der neoadjuvanten Therapie (Erhöhung der Rate an brusterhaltenden Operationen) durch den Nachteil einer erhöhten Schulter-Arm-Morbidität „erkauft“. Aus diesem Grunde erscheint es notwendig, die Wertigkeit der SNB im Rahmen neoadjuvanter Therapiekonzepte in einem prospektiven Studienansatz zu untersuchen. In dem vorliegenden Artikel sollen die aktuelle Datenlage zu der Thematik dargestellt und theoretische Fallstricke für die SNB im Rahmen eines neoadjuvanten Therapieplanes erörtert werden. Aus der Diskussion wird ein Studienkonzept (SENTINA-Studie) abgeleitet, nach dem die anstehenden Fragestellungen zielgerichtet untersucht werden können.

Abstract

Sentinel node biopsy (SNB) is a routinely established method for axillary staging in primary breast cancers. For patients undergoing primary systemic therapy (PST) the data on the reliability of SNB have been assessed as insufficient in international consensus recommendations (DGS, AGO). Thus, axillary dissection is still recommended in those patients to obtain local control. About 40 % of the patients receiving PST have a nodal negative axillary lymph node status and will be overtreated if they undergo classical axillary dissection. These patients accept the increased risk of shoulder arm morbidity in return for the benefits of PST (higher rate of breast conserving therapy). For that reason it is essential to analyze the role of SNB in neoadjuvant study concepts in a prospective setting. This report deals with the current data on this topic and elucidates theoretical pitfalls in the context of a neoadjuvant therapy plan. From this discussion a prospective trial (SENTINA = SENTInel node biopsy after NeoAdjuvant chemotherapy) emerges, which specifically addresses the questions at issue.

Schlüsselwörter

Sentinel‐Node‐Biopsie - primär systemische Chemotherapie - Mammakarzinom

Key words

Sentinel node biopsy - primary systemic chemotherapy - breast cancer

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