Вопросы объема лимфодиссекции при раке молочной железы после неоадъювантного системного лечения

Закономерным следствием достижений системной предоперационной терапии рака молочной железы является деэскалация хирургического лечения. Все большее распространение  получают удаление и исследование ограниченного количества подмышечных лимфатических узлов (ЛУ) после неоадъювантной терапии и отказ от лимфаденэктомии при отсутствии метастатического поражения. Проведенные исследования доказали информативность и безопасность стандартных методик биопсии сигнальных ЛУ после неоадъювантного лечения при сN0. При cN1 и регрессе изменений в результате неоадъювантного лечения стандартные методики оценки состояния ЛУ оказались несостоятельны. Применение комбинированных методов двойной детекции и увеличение количества исследованных ЛУ до 3 и более повысили информативность методики и позволили снизить частоту ложноотрицательных результатов. Отдаленные результаты, вопросы методологии исследования ЛУ, лучевой терапии в этой группе пациентов требуют дальнейшего изучения.

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