Onkologie – Präoperative interventionelle Abklärung des Lymphknotenstatus bei Patientinnen mit primärem Mammakarzinom

Der axilläre Lymphknotenstatus (axLN) gilt derzeit als der wichtigste Prognosefaktor für das Mammakarzinom und ist für die Festlegung des therapeutischen Gesamtkonzeptes von Bedeutung. Die Zielsetzung liegt in der prätherapeutisch möglichst korrekten Dignitätseinschätzung der axLN, um Übertherapien zu vermeiden. Nach den aktuellen S3-Leitlinien der Deutschen Krebsgesellschaft (DKG) und den Empfehlungen der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), ist für die klinisch als auch sonografisch unauffällige Axilla die Sentinel-Node-Biopsie mit hohen Empfehlungsgrad indiziert. Sie ist hingegen kontraindiziert bei cN+ ̶ in diesem Fall ist die komplette Lymphonodektomie indiziert [ 1 ], [ 2 ].

Dabei liegt die Herausforderung in der präoperativen Bewertung des Nodalstatus mit einer möglichst hohen Genauigkeit, um Übertherapien zu vermeiden, d.h. ungerechtfertigt eine komplette Lymphonodektomie durchzuführen. Patientinnen, die trotz eines negativen Lymphknotenstatus (pN0) eine Axilladissektion (AD) erhalten, sind den Risiken einer hohen Langzeitmorbidität ausgesetzt, ohne dass sie vom Eingriff therapeutisch profitieren.

• Literatur

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