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Aktuelle Veränderungen der S3-Leitlinie Mammakarzinom

Operative Therapie

Current amendments to the S3 guidelines on breast cancer

Surgical therapy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die aktuellen Änderungen der S3-Leitlinie zur operativen Therapie des Mammakarzinoms basieren auf publizierten Daten klinischer Studien und systematischer Literaturrecherchen sowie Übernahmen aus internationalen Leitlinien, die methodisch ähnlich erarbeitet wurden wie die deutschen S3-Leitlinien. Die beiden wichtigsten Veränderungen sind: Die Mindestabstände des Tumorgewebes zum gesunden Gewebe nach brusterhaltender Operation mit nachfolgender Bestrahlung sind beim invasiven Mammakarzinom und begleitenden duktalen Carcinoma in situ (DCIS) 1 mm und beim reinen DCIS 2 mm. Es ist möglich, auf die axillare Lymphonodektomie zu verzichten: als Einzelfallentscheidung bei bis zu zwei befallenen Wächterlymphknoten („sentinel lymph nodes“, SN) bei klinisch und bildgebend unauffälligen axillaren Lymphknoten und brusterhaltender Operation mit geplanter Nachbestrahlung der Brust.

Abstract

The amendments of the S3 guidelines from 2012 in the field of breast cancer surgery are based on data from published clinical studies, systematic reviews of international literature and international guidelines, such as NZGG 2009, SIGN 2005 and NICE 2009. The main changes are: the margins of tumor-free tissue around breast cancer after breast conserving surgery followed by radiotherapy of the whole breast are 1 mm for invasive cancer and surrounding ductal carcinoma in situ (DCIS) and 2 mm for purely DCIS. For selected patients (not more than two sentinel lymph nodes with metastases, no clinical and radiological signs of suspect lymph nodes, breast conserving surgery followed by irradiation of the whole breast) axillary lymph node extirpation in cases of positive sentinel lymph nodes (pN1sn) can be avoided. An extra irradiation of the axilla in cases of positive sentinel nodes and no consecutive axillary lymphonodectomy should be avoided.

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  1. Frauenheilkunde und Geburtshilfe und Brustzentrum-City, Sankt Gertrauden-Krankenhaus, Paretzer Str. 12, 10713, Berlin, Deutschland

    J.-U. Blohmer

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Correspondence to J.-U. Blohmer.

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Blohmer, JU. Aktuelle Veränderungen der S3-Leitlinie Mammakarzinom. Gynäkologe 45, 438–442 (2012). https://doi.org/10.1007/s00129-011-2917-1

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