Zusammenfassung
Beim invasiven Mammakarzinom ist die konventionelle axilläre Lymphonodektomie der operative Goldstandard. Sie dient der histopathologischen Tumorklassifikation, der Prognoseabschätzung, der lokoregionären Tumorkontrolle sowie der adjuvanten Therapieentscheidung, ist jedoch mit einer nicht unerheblichen Morbidität verbunden. Die Sentinellymphknotenbiopsie kann als minimal-invasives Verfahren die Morbidität entscheidend senken. Hierbei wird der Nodalstatus durch Entnahme von sog. Sentinellymphknoten bestimmt. Das sind Lymphknoten, die nach radioaktiver (Technetium) und Farbmarkierung (Patentblau V) im lymphatischen Drainagegebiet des Tumors detektiert werden können. Die Methode setzt sich zunehmend bei Patientinnen mit frühem Mammakarzinom in der klinischen Routine durch. Die Implementierung des Sentinelverfahrens als operativer Standard sollte unter qualitätsgesicherten Bedingungen interdisziplinär unter Einbeziehung von Nuklearmedizinern, Operateuren, Pathologen und Radiologen nach onkologischen Gesichtspunkten durchgeführt werden. Experimentelle Verfahren wie die Sentinellymphknotenmarkierung mittels Immunoszintigraphie oder die MR-Lymphographie bedürfen noch weiterer Evaluation.
Abstract
Lymphatic mapping in breast cancer treatment is important for histopathological tumor classification, evaluation of individual prognosis, and serves for local tumor control. Adjuvant therapeutic decisions should be based on it. Axillary dissection is still the so called “golden standard” in operative breast cancer treatment. But minimal invasive selective lymphadenectomy is an attractive approach to reduce axillary morbidity. The lymphatic flow is visualized by injection of radioactive tracer (Technetium) or dye (Patentblau V). The first lymph node on a direct drainage pathway from the primary tumor is identified as sentinel lymph node. The sentinel lymph node biopsy has to be implemented for early breast cancer treatment under terms of quality assurance and interdisciplinary involvement of nuclear physicians, surgeons, pathologists and radiologists. As a new experimental approach Technetium labeled specific antibodies are used as tracer for immunoscintigraphy. Another new technique uses the magnetic resonance imaging system. These novel approaches for lymphatic mapping needs further evaluation.
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Finas, D., Diesing, D., Diedrich, K. et al. Techniken zur Markierung des Sentinellymphknotens beim Mammakarzinom. Gynäkologe 38, 877–884 (2005). https://doi.org/10.1007/s00129-005-1748-3
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DOI: https://doi.org/10.1007/s00129-005-1748-3