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DOI: 10.1055/s-2000-10053
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
Die chirurgische Axilladissektion
Technischer Standard oder obsolete Methode?Publikationsverlauf
Publikationsdatum:
31. Dezember 2000 (online)
![](https://www.thieme-connect.de/media/zblchir/200010/lookinside/thumbnails/10.1055-s-2000-10053-1.jpg)
Surgical axillary lymph node dissection.Still standard procedure or obsolete method?
Summary
Axillary lymph node status remains the single most important prognostic parameter and has crucial therapeutic implications in patients with breast carcinoma. Surgical dissection of the axilla is commonly regarded as the standard procedure of axillary staging, its sensitivity and specificity being 99 % and 100 %, respectively. Apart from giving reliable information on the individual prognosis axillary dissection also contributes to efficient local tumor control in the axilla, as it reduces the risk of local recurrence to less than 1.4 % if more than 10 lymph nodes are removed. Alternative, less or non-invasive axillary staging methods have either not yet been sufficiently standardized (immunoscintigraphy, PET-scan, prediction of axillary lymph node status by means of individual risk factors) or are associated with a considerable risk of false-negative staging (up to 50 % of patients with positive axillary lymph nodes are not detected by palpation alone, ultrasonography or CT-scan). The basic principles of axillary sampling and axilloscopic dissection are questionable because the number of lymph nodes removed during these procedures is commonly less than 10. With its sensitivity/specificity being comparable to that of standard axillary dissection sentinel lymph node biopsy represents a highly promising approach which will in the future potentially lead to significant optimization of the clinical management of patients with breast cancer, especially those diagnosed in early stages (T1 a, T1 b and T1 c).
Zusammenfassung
Nach wie vor ist der axilläre Lymphknotenstatus entscheidender prognostischer Parameter beim invasiven Mammakarzinom sowie weitgehend therapiebestimmend. Anerkanntes Standardverfahren zur Evaluierung des axillären Lymphknotenstatus ist die chirurgische Axilladissektion, deren Sensitivität sowie Spezifität bei 99 % bzw. 100 % liegen. Neben verläßlicher Prognosestellung leistet das Verfahren einen wesentlichen Beitrag zur effizienten lokalen Tumorkontrolle in der Axilla, da es die Wahrscheinlichkeit des axillären Tumorrezidivs auf weniger als 1,4 % zu reduzieren vermag, falls mehr als 10 Lymphknoten entnommen werden. Alternative, weniger bzw. nicht-invasive und somit belastungsärmere axilläre Stagingverfahren sind entweder noch unzureichend standardisiert (Immunszintigraphie, PET-Scan, Expertensysteme) oder mit einem nicht unbeträchtlichen Risiko falsch-negativer Stagingergebnisse verbunden (bis zu 50 % der Patientinnen mit positiven axillären Lymphknoten werden durch alleinige klinische Untersuchung, Ultraschalluntersuchung der Axilla oder CT nicht erkannt). Andere Verfahren wie etwa das axilläre Sampling oder die endoskopische Axilladissektion erscheinen aufgrund eines zweifelhaften Grundprinzips (Entnahme von meist weit weniger als 10 Lymphknoten) ebenso fragwürdig wie unverläßlich und kommen nicht als sinnvolle Alternativen zur Standarddissektion in Betracht. Derzeit vielversprechendstes Alternativverfahren ist die Sentinel-Lymphknotendiagnostik, die insbesondere bei Patientinnen im Frühstadium der Erkrankung (T1 a, T1 b, ev. T1 c) aufgrund einer der Standarddissektion vergleichbaren Sensitivität/Spezifität in Zukunft zu einer entscheidenden Optimierung des klinischen Mammakarzinom-Managements beitragen könnte.
Key words
Axilla - lymph node dissection - breast cancer - sentinel lymph node - alternative methods
Schlüsselwörter
Axilla - Lymphknotendissektion - Mammakarzinom - Sentinel-Lymphknoten - Alternative Methoden
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Dr. Th. Bachleitner-Hofmann
Universitätsklinik für Allgemeinchirurgie
Währinger Gürtel 18-20
A-1090 Wien