دانلود رایگان مقاله انگلیسی تکنیک های تصویربرداری برای نمایش گره های لنفاوی زیر بغل در سرطان سینه - الزویر 2018

The presence and extent of axillary nodal metastases at the time of breast cancer diagnosis is a critical factor in disease prognosis and plays a central role in deciding the best treatment for patients. Accurate assessment of the axilla is therefore an essential component in staging breast cancer. Over the years, axillary staging has evolved from surgical axillary lymph node dissection (ALND), with its numerous associated long-term complications, to the much less-radical surgical sentinel lymph node excision biopsy (SLNB), the current reference standard. In parallel, radiological staging of the axilla has become increasingly more useful as our knowledge and techniques have improved. Preoperative axillary ultrasound is used widely to stage patients with breast cancer, providing an evaluation of node morphology and allowing targeted biopsy of abnormal nodes. This is important in helping stratify which patients should proceed directly to ALND and which should undergo SLNB first. Grey-scale ultrasound on its own is not perfect and can over- and underestimate axillary disease. Newer ultrasound techniques such as elastography may help to improve diagnostic confidence when visually assessing axillary nodes; for example, in more accurately assessing the extent of axillary disease burden or in differentiating benign reactive nodes from malignant nodes in equivocal cases. The use of intradermal “microbubbles” has shown great promise in being able to locate and biopsy the sentinel lymph node under ultrasound guidance, and raises the possibility that in the future such techniques may obviate the need for surgical SLNB in select patient populations.

Conclusions

Placing a greater emphasis on conservative management of axillary disease through staging by surgical SLNB for certain patient groups represents a significant move towards avoiding unnecessarily radical axillary surgery. This changing practice does not diminish the role of the radiologist in axillary staging. We must continue to refine our techniques to provide more accurate preoperative staging, aiding progress toward minimal intervention with preserved or enhanced patient outcome. More accurate preoperative axillary staging, perhaps developing radiological SLNB or non-invasive SLN assessment, using microbubbles for example, may obviate the need for surgical SLNB in select patient populations in the future.