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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