Az emlőrák sebészi terápiáját napjainkban és a jövőben is az egyre precízebb diagnosztikus módszerek és az egyre hatásosabb onkológiai kezelési eljárások határozzák meg. Az emlőmegtartás és az onkoplasztikai elvek alkalmazása egyre szélesebb körű; az axilla sebészi kezelésében az őrszemnyirokcsomó-biopszia az elsődleges, az axillaris blokkdissectio (ABD) indikációja tovább szűkült, és a sugárkezelés bizonyos esetekben az ABD alternatívája lett. Közleményünkben a III. Emlőrák-konszenzuskonferencia tartalmára épülve, a legfrissebb nemzetközi tanulmányok és szakértői javaslatokat figyelembe véve foglaljuk össze az emlőrák sebészi kezelésével kapcsolatos ajánlásainkat.
Lazar G, Besznyak I, Boross G, Farsang Z, Gulyas G, Jakab F, Maraz R, Markus B, Toth L: Az emlőrák korszerű sebészi kezelése – II. Konszenzuskonferencia. Magy Onkol 2010; 54: 227–34, Magy Seb 2010; 63: 132–40
Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel Members: Tailoring therapies – improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer Ann Oncol 2015; 26: 1533–46
Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, Zackrisson S, Cardoso F; ESMO Guidelines Committee: Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; Suppl 5: v8–30
National Comprehensive Cancer Network (NCCN) Guidelines. Breast Cancer. Version 1.2016, 11/18/15. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed: 18 November 2015
Zagouri F, Liakou P, Bartsch R, Peccatori FA, Tsigginou A, Dimitrakakis C, Zografos GC, Dimopoulos MA, Azim HA Jr: Discrepancies between ESMO and NCCN breast cancer guidelines: An appraisal. Breast 2015; 24: 513–23
Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel members: Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer. Ann Oncol 2013; 24: 2206–23
Narod SA: The impact of contralateral mastectomy on mortality in BRCA1 and BRCA2 mutation carriers with breast cancer. Breast Cancer Res Treat 2011; 128: 581–3
Nijenhuis MV, Rutgers E: Conservative surgery for multifocal/multicentric breast cancer. Breast 2015; 24 Suppl 2: S96–9
Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, Sosnovskikh I, Intra M, Mazzarol G, Musmeci S, Veronesi P, Galimberti V, Luini A, Viale G, Goldhirsch A, Veronesi U: Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat 2009; 113: 577–83
Mallon P, Feron JG, Couturaud, B, Fitoussi A, Lemasurier P, Guihard T, Cothier-Savay I, Reyal F: The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg 2013; 131: 969–84
Hennigs A, Hartmann B, Rauch G, Golatta M, Tabatabai P, Domschke C, Schott S, Schütz F, Sohn C, Heil J: Long-term objective esthetic outcome afterbreast-conserving therapy. Breast Cancer Res Treat 2015; 153: 345–51
Losken A, Dugal CS, Styblo TM, Carlson GW: A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 2014; 72: 145–9
Association of Breast Surgery at BASO; Association of Breast Surgery at BAPRAS; Training Interface Group in Breast Surgery, Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F, Gooch H, Harcourt D, Martin L, Rainsbury D, Rayter Z, Sheppard C, Smith J, Weiler-Mithoff E, Winstanley J, Church J: Oncoplastic breast surgery – a guide to good practice. Eur J Surg Oncol 2007; 33 Suppl 1: S1–23
Coates AS, Thürlimann B, Senn HJ; Panel members: Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009. Ann Oncol 2009; 20: 1319–29
Mátrai Z, Gulyás G, Kásler M: Az emlőrák korszerű sebészete. Medicina Könyvkiadó, Budapest, 2015
Rezai M, Knispel S, Kellersmann S, Lax H, Kimmig R, Kern P: Systematization of oncoplastic surgery: Selection of surgical techniques and patient-reported outcome in a Cohort of 1,035 patients. Ann Surg Oncol 2015; 22: 3730–7
Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M; Society of Surgical Oncology; American Society for Radiation Oncology: Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 2014; 32: 1507–15
Houssami N, Morrow M: Margins in breast conservation: a clinician’s perspective and what the literature tells us. J Surg Oncol 2014; 110: 2–7
Masannat YA, Bains SK, Pinder SE, Purushotham AD: Challenges in the management of pleomorphic lobular carcinoma in situ of the breast. Breast 2013; 22: 194–6
Flanagan MR, Rendi MH, Calhoun KE, Anderson BO, Javid SH: Pleomorphic lobular carcinoma in situ: Radiologic-pathologic features and clinical management. Ann Surg Oncol 2015; 22: 4263–9
Takács T, Paszt A, Simonka Z, Abrahám S, Borda B, Ottlakán A, Ormándi K, Lázár M, Vörös A, Kahán Z, Lazar G: Radioguided occult lesion localisation versus wire-guided lumpectomy in the treatment of non-palpable breast lesions. Pathol Oncol Res 2013; 19: 267–73
Chan BK, Wiseberg-Firtell JA, Jois RH, Jensen K, Audisio RA: Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev 2015; 12: CD009206
Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, Benson AB 3rd, Bosserman LD, Burstein HJ, Cody H 3rd, Hayman J, Perkins CL, Podoloff DA, Giuliano AE; American Society of Clinical Oncology Clinical Practice: Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2014; 32: 1365–83
Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, McCall LM, Morrow M:: Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. JAMA 2011; 305: 569–75
Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, Cataliotti L, Westenberg AH, Klinkenbijl JH, Orzalesi L, Bouma WH, van der Mijle HC, Nieuwenhuijzen GA, Veltkamp SC, Slaets L, Duez NJ, de Graaf PW, van Dalen T, Marinelli A, Rijna H, Snoj M, Bundred NJ, Merkus JW, Belkacemi Y, Petignat P, Schinagl DA, Coens C, Messina CG, Bogaerts J, Rutgers EJ: Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 1303–10
Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, Gentilini O, Mastropasqua MG, Mazzarol G, Massarut S, Garbay JR, Zgajnar J, Galatius H, Recalcati A, Littlejohn D, Bamert M, Colleoni M, Price KN, Regan MM, Goldhirsch A, Coates AS, Gelber RD, Veronesi U; International Breast Cancer Study Group Trial 23-01 investigators: Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): A phase 3 randomised controlled trial. Lancet Oncol 2013; 14: 297–305
Sávolt A, Polgár Cs, Musonda P, Mátrai Z, Rényi-Vámos F, Tóth L, Kásler M, Péley G: Does the result of completion axillary lymph node dissection influence the recommendation for adjuvant treatment in sentinel lymph node-positive patients? Clin Breast Cancer 2013; 13: 364-70
Kim T, Giuliano AE, Lyman GH: Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006; 106: 4–16
Niebling MG, Pleijhuis RG, Bastiaannet E, Brouwers AH, van Dam GM, Hoekstra HJ: A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping. Eur J Surg Oncol 2016; 42: 466–73
He PS, Li F, Li GH, Guo C, Chen TJ: The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: a systematic review. BMC Cancer 2016; 16: 107
Maráz R, Boross G, Pap-Szekeres J, Rajtár M, Ambrózay E, Cserni G: Internal mammary sentinel node biopsy in breast cancer. Is it indicated? Pathol Oncol Res 2014; 20: 169–77
Sabel MS: The need for axillary lymph node dissection in T1/Tbreast cancer surgery–counterpoint. Cancer Res. 2013; 73: 7156-60
Van Uden DJ, van Laarhoven HW, Westenberg AH, de Wilt JH, Blanken-Peeters CF: Inflammatory breast cancer: an overview. Crit Rev Oncol Hematol 2015; 93: 116–26
Guidroz JA, Scott-Conner CE, Weigel RJ: Management of pregnant women with breast cancer. J Surg Oncol 2011; 103: 337–40
Mátrai Z, Bánhidy F, Téglás M, Kovács E, Sávolt A, Udvarhelyi N, Bartal A, Kásler M: Sentinel lymph node biopsy in pregnancy-associated breast cancer. Orv Hetil 2013; 154: 1991–7
Gropper AB, Calvillo KZ, Dominici L, Troyan S, Rhei E, Economy KE, Tung NM, Schapira L, Meisel JL, Partridge AH, Mayer EL: Sentinel lymph node biopsy in pregnant women with breast cancer. Ann Surg Oncol 2014; 21: 2506–11
Lee HB, Han W: Unique features of young age breast cancer and its management. J Breast Cancer 2014; 17: 301–7
Kroman N, Holtveg H, Wohlfahrt J, Jensen MB, Mouridsen HT, Blichert-Toft M, Melbye M: Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer 2004; 100: 688–93
Patten DK, Sharifi LK, Fazel M: New approaches in the management of male breast cancer. Clin Breast Cancer 2013; 13: 309–14
Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, Loman N, Olsson H, Johannsson O, Borg A, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjäkoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF: Average risks of breast and ovarian cancer associated with BRCAor BRCAmutations detected in case series unselected for family history: a combined analysis of studies. Am J Hum Genet 2003; 72: 1117–30
Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL: Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA 2014; 312: 902–14
Guth U, Myrick ME, Viehl CT, Weber WP, Lardi AM, Schmid SM: Increasing rates of contralateral prophylactic mastectomy – a trend made in USA? Eur J Surg Oncol 2012; 38: 296–301
Yao K, Winchester DJ, Czechura T, Huo D: Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998–2002. Breast Cancer Res Treat 2013; 142: 465–76
Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA: Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer 2013; 119: 1402–11
Kronowitz SJ: State of the art and science in postmastectomy breast reconstruction. Plast Reconstr Surg 2015; 135: 755–71
Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV: Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997; 15: 2483–93
Van Nes JG, Putter H, Julien JP, Tubiana-Hulin M, van de Vijver M, Bogaerts J, de Vos M, van de Velde CJ; Cooperating Investigators of the EORTC: Preoperative chemotherapy is safe in early breast cancer, even after years of follow-up; clinical and translational results from the EORTC trial 10902. Breast Cancer Res Treat 2009; 115: 101–13
Kaufmann M, von Minckwitz G, Mamounas EP, Cameron D, Carey LA, Cristofanilli M, Denkert C, Eiermann W, Gnant M, Harris JR, Karn T, Liedtke C, Mauri D, Rouzier R, Ruckhaeberle E, Semiglazov V, Symmans WF, Tutt A, Pusztai L: Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol 2012; 19: 1508–16
Ataseven B, Lederer B, Blohmer JU, Denkert C, Gerber B, Heil J, Kühn T, Kümmel S, Rezai M, Loibl S, von Minckwitz G: Impact of multifocal or multicentric disease on surgery and locoregional, distant and overall survival of 6,breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol 2015; 22: 1118–27
Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, Lebeau A, Liedtke C, von Minckwitz G, Nekljudova V, Schmatloch S, Schrenk P, Staebler A, Untch M: Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013; 14: 609–18
Boileau JF, Poirier B, Basik M, Holloway CM, Gaboury L, Sideris L, Meterissian S, Arnaout A, Brackstone M, McCready DR, Karp SE, Trop I, Lisbona A, Wright FC, Younan RJ, Provencher L, Patocskai E, Omeroglu A, Robidoux A: Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC Study. J Clin Oncol 2015; 33: 258–64
Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, Leitch AM, Flippo-Morton TS, Kuerer HM, Bowling M, Hunt KK: Alliance for Clinical Trials in Oncology: Factors affecting sentinel lymph node identification rate after neoadjuvant chemotherapy for breast cancer patients enrolled in ACOSOG Z(Alliance). Ann Surg 2015; 261: 547–52
Galimberti V: Feasibility of sentinel node biopsy in breast cancer after neoadjuvant treatment. Breast 2015; 24(Suppl 1): PG 9.02
Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van’t Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E: ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†. Ann Oncol 2014; 25: 1871–88
Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JM, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, Paik S, Perez EA, Press MF, Spears PA, Vance GH, Viale G, Hayes DF; American Society of Clinical Oncology; College of American Pathologists: Recommendations for human epidermal growth factor receptor testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Update. Arch Pathol Lab Med 2014; 138: 241–56
Bussolati G, Annaratone L, Medico E, D’Armento G, Sapino A: Formalin fixation at low temperature better preserves nucleic acid integrity. PLoS One 2011; 6: e21043
Gündisch S, Annaratone L, Beese C, Drecol E, Marchiò C, Quaglino E, Sapino A, Becker KF, Bussolati G: Critical roles of specimen type and temperature before and during fixation in the detection of phosphoproteins in breast cancer tissues. Lab Invest 2015; 95: 561–71
Di Novi C, Minniti D, Barbaro S, Zampirolo MG, Cimino A, Bussolati G: Vacuum-based preservation of surgical specimens: an environmentally-safe step towards a formalin-free hospital. Sci Total Environ 2010; 408: 3092–5