Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press89610.17650/1994-4098-2021-17-4-56-65MAMMOLOGY. REVIEWSМАММОЛОГИЯ. ОБЗОРНЫЕ СТАТЬИQuestions of axillary region surgery in breast cancer patients after systemic neoadjuvant therapyВопросы объема лимфодиссекции при раке молочной железы после неоадъювантного системного леченияhttps://orcid.org/0000-0002-1187-7989BozhokA. A.БожокА. А.
Russian Federation

Alla Aleksandrovna Bozhok.

2 Litovskaya St., Saint Petersburg 194100; 4 Prospekt Kultury, Saint Petersburg 194100.

Божок Алла Александровна.

194100 Санкт-Петербург, ул. Литовская, 2; 190100 Санкт-Петербург, пр. Культуры, 4.

allabozhok@mail.ruTsarevO.  N.ЦаревО. Н.
Russian Federation

32 Barnaulskaya St., Tyumen 625041.

625041 Тюмень, ул. Барнаульская, 32.

MaysuradzeS. A.МайсурадзеС. А.
Russian Federation

32 Barnaulskaya St., Tyumen 625041.

625041 Тюмень, ул. Барнаульская, 32.

https://orcid.org/0000-0002-4728-6347GilA. I.ГильА. И.
Russian Federation

4 Prospekt Kultury, Saint Petersburg 194100.

190100 Санкт-Петербург, пр. Культуры, 4.

Saint Petersburg State Pediatric Medical University, Ministry of Health of RussiaСанкт-Петербургский государственный педиатрический медицинский университет Минздрава РоссииL.G. Sokolov Northwestern Research and Clinical Center, Federal Medical and Biological AgencyСеверо-западный окружной научно-клинический центр им. Л.Г. Соколова ФМБА РоссииMulticare Medical Center “Medical City”Многопрофильный клинический медицинский центр «Медицинский город»20122021174566520012022200120222021https://ojrs.abvpress.ru/ojrs/article/view/896

As a consequence of the advances in systemic neoadjuvant therapy of breast cancer is the de-escalation of surgical treatment.  The study of a limited number of axillary lymph nodes after neoadjuvant therapy and refusal of lymphadenectomy in the absence of metastatic lesions is becoming more common. The published studies have proven the informativeness and safety of standard techniques of sentinel lymph node biopsy after neoadjuvant treatment for cN0 patients. For group cN1 and regression of metastases after neoadjuvant treatment, standard sentinel lymph node biopsy techniques have failed. The use of combined methods of double detection and an increase in the number of examined lymph nodes to 3 and more increased the detection rate of sentinel node biopsy after neoadjuvant therapy and reduced false-negative rate. Long-term results, questions of methodology lymph nodes evaluation, radiation therapy in this group of patients require further investigation.

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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