2014年ESMO大会于9月26日-30日在西班牙马德里召开。会上公布的一项由国际癌症网络、不孕和怀孕及德国乳腺癌研究小组进行的研究，对孕期乳腺癌患者前哨淋巴结活检的安全性进行了分析。（摘要号266PD_PR）
相关研究：[ESMO2014]孕期癌症放化疗会影响儿童发育吗？
研究目的
怀孕期间前哨淋巴结活检的远期安全性还未被充分研究，主要是由于担心胎儿的安全性。研究显示胎儿的风险很小。我们的目的是研究母亲的安全性（疗效和结果）。
研究方法
我们从前瞻性的欧洲数据库中找出了在怀孕期间进行前哨淋巴结活检的乳腺癌患者，并回顾病例以记录前哨淋巴结活检的技术和结果，包括局部和远期复发情况以及生存期。
研究结果
我们总共找出了97位符合条件的女性患者(INCIP n = 83; GBG n = 14)。在怀孕前、怀孕的头三个月、中间三个月、后三个月确诊为乳腺癌的患者人数分别为2, 34, 36 和19例（6位患者确诊时间不明）。确诊年龄的中位数为35岁（范围为28-45）。
所有患者的临床分期为N0 (cT1-2: 95.9%; cT3-4: 4.1%)。前哨淋巴结活检技术如下：99mTC 单独使用白蛋白纳米胶体法(n = 71; 73.2%), 单独使用蓝染法 (n = 1; 1.0%), 联合技术 (n= 9; 9.3%), 所用技术不明 (n = 16; 16.5%)。一位患者活检不成功，随后进行了腋窝淋巴结清扫。前哨淋巴结的中位数为2.2个（范围0-7）。22位患者发现了阳性的前哨淋巴结（6个微小转移、2个孤立肿瘤细胞，其中4位患者未进行腋窝淋巴结清扫），18位患者随后进行了腋窝淋巴结清扫。
中位随访时间为35个月（范围1-148），无病生存期的中位数为40.8个月。8位患者出现了局部-区域复发：对侧乳腺(n = 1;1.0%), 同侧乳腺 (n = 4; 4.1%), 胸壁 (n = 1; 1.0%), 腋窝 (n = 2; 2.1%)。4位 (4.1%)患者出现了远处转移，其中3位(3.1%)死于乳腺癌。2位患者出现了腋窝复发，其中一位患者拒绝术后进一步辅助治疗，另一位患者进行了标准的辅助治疗，确诊12个月后出现了同侧腋窝复发。
结论
怀孕期间前哨淋巴结活检后腋窝复发率很低。对于淋巴结阴性的早期乳腺癌患者而言，在怀孕期间可以考虑应用这种分期方法，来代替标准的腋窝淋巴结清扫。
英文原文
266PD_PR SENTINEL LYMPH NODE BIOPSY FOR BREAST CANCER TREATMENT DURING PREGNANCY - ON BEHALF OF THE INTERNATIONAL NETWORKOF CANCER, INFERTILITY AND PREGNANCY (INCIP) AND THE GERMAN BREAST GROUP (GBG)
Aim: The long term safety of sentinel lymph node (SLN) biopsy during pregnancy is insufficiently explored, mainly due to fear for fetal safety. Studies have shown that fetal risk is minimal.We aimed to investigate maternal safety (efficacy and outcome).
Methods: Women diagnosed with breast cancer who underwent SLN biopsy during pregnancy were identified from prospective European databases. Chart review was performed to record technique and outcome of SLN biopsy, local and distant recurrence, and survival.
Results: We identified a total of 97 women (INCIP n = 83; GBG n = 14). Breast cancer diagnosis was made before pregnancy, in the first, second, and third trimester in 2, 34, 36 and 19 patients respectively (unknown n = 6). Median age at diagnosis was 35 years (range 28-45). All patients had clinically N0 disease (cT1-2: 95.9%; cT3-4: 4.1%). The SLN detection techniques were as follows: 99mTC albumin nanocolloid-only (n = 71; 73.2%), blue dye-only (n = 1; 1.0%), combined technique (n= 9; 9.3%), and unknown (n = 16; 16.5%). Mapping was unsuccessful in one patient, who had subsequent axillary lymph node dissection (ALND). Mean number of SLN’s was 2.2 (range 0-7). Positive SLN’s were found in 22 patients (6 micrometastases and 2 isolated tumor cells, of which 4 patients did not undergo ALND), 18 subsequent ALND’s were performed. The median follow-up was 35 months (range 1 to 148), and median disease free survival was 40.8 months. Eight patients experienced a loco-regional relapse: contralateral breast (n = 1;1.0%), ipsilateral breast (n = 4; 4.1%), chest wall (n = 1; 1.0%), axilla (n = 2; 2.1%). Four (4.1%) patients developed distant metastases, of whom 3 (3.1%) died of breast cancer. Of the 2 patients who had an axillary recurrence, one patient refused all further adjuvant treatment after primary surgery, one patient had standard adjuvant treatment and ipsilateral axillary recurrence occurred 12 months after diagnosis.
Conclusions: SLN biopsy during pregnancy has a low axillary recurrence rate. This staging method can be considered during pregnancy instead of standard ALND for early stage, clinically node negative breast cancer.
会议专题》》》2014年ESMO大会专题报道
