ECC 2015的乳腺癌领域热点集中在乳腺癌治疗和诊断方面的进展。其中9月27日15:15~16:15 手术切缘特别专场就“是否需要增加肝癌、胰腺癌、乳腺癌手术切缘以降低复发”进行了讨论，该话题具有很大争议，目前我们即将达成指南以减少治疗方面的差异。基因检测正在改变患者的治疗策略，在本次会议的几项壁报中，研究者根据基因突变检测结果改变了治疗路径。会议对乳腺癌筛查是否必要进行辩论，一项来自匈牙利的壁报显示乳腺癌筛查对于一些患者的死亡率没有影响。在转化医学和个体化医疗方面也有重要的讲题，研究者正在努力探索肿瘤进展的途径，并开发新药物来阻止肿瘤进展。

　　至于前哨淋巴结活检在乳腺癌中的作用，目前临床淋巴结阴性腋乳腺癌患者的标准治疗是前哨淋巴结活检，这是认为相比腋窝淋巴结清扫，前哨淋巴结活检把发病率从 20%~30%降低到<5%。因此尽管仍有争议，前哨淋巴结活检使用越来越多。比如新辅助治疗后需要做前哨淋巴结活检吗？Rubio博士相信在新辅助治疗术后做前哨淋巴结活检有必要，由于新化疗方案和靶向治疗，获得病理完全缓解的比例更高。这意味着原本有淋巴结阳性的患者转为阴性，因此腋窝前哨淋巴结仍然是降低发病率的一个很好的选择，应继续等待相关研究结果。此外，前哨淋巴结活检可用于复发性乳腺癌。若五年前做前哨淋巴结活检的乳腺癌患者复发，在这些情况下怎么进行腋窝管理？Rubio博士认为可以再做一次前哨淋巴结活检，不但可行而且结果非常准确，如果前哨淋巴结活检结果为阴性，则不需要做腋窝淋巴结清扫。目前有研究试图比较“单独采用前哨淋巴结而没有腋窝手术”的结果是否不同。但前哨淋巴结活检目前应是患者的治疗选择之一。

　　在乳腺癌患者的腋窝分期和管理方面，试验结果表明，如果淋巴结阳性，无论是做前哨淋巴结还是腋窝淋巴结清扫，患者的预后相同。目前腋窝淋巴结超声检查可能是手术前评估腋窝的最佳成像技术。一些研究表明，在手术前做腋窝超声，若超声引导下细针穿刺细胞学检查（FNA）检查发现一个阳性淋巴结，这些患者通常有更多的阳性淋巴结，通常是高级别的肿瘤。所以对于乳腺癌术前腋窝分期，腋窝超声技术是指导腋窝淋巴结清扫或前哨淋巴结活检的一个很好的选择。目前还有其他的成像方式可用，如MRI和 PET。 PET比腋窝超声的特异性更好，但非常昂贵。总之，我们需要超声技术实施FNA检查，目前乳腺癌腋窝超声检查是更好的选择。

访谈原文

　　Oncology Frontier: Could you introduce the hot topics at ESMO 2015 related to breast cancer?

　　《肿瘤瞭望》：请你介绍ESMO 2015乳腺癌相关的热点话题？

　　Dr Rubio: This has been a really interesting meeting because we have seen how much treatment and diagnostics in breast cancer have improved. There have been some important topics and one of them was a session on excisional margins for liver， pancreatic and breast cancers where the community is trying to arrive at a consensus on whether we need wider margins to decrease local recurrences. It is a highly debatable topic and we are getting closer to having guidelines that will mean there will be less variability in that treatment aspect. Another issue we have seen is that genetic testing is changing treatment strategies for patients. There are a couple of posters which show us that we can change the way we treat our patients depending on genetic mutations. We have also seen a great debate on whether screening mammograms are worth doing. There is a poster from a Hungarian group that shows that in some patients it has no impact on mortality. So whether we should still be doing screening mammograms is something we are discussing. There are important topics related to translational and personalized medicine. I think it is important that we are trying to discover the pathways that the tumors use to progress and develop new drugs to block that progression.

　　Rubio博士：本次会议在乳腺癌治疗和诊断方面获得进展。其中9月27日15:15~16:15 手术切缘特别专场就“是否需要增加肝癌、胰腺癌、乳腺癌手术切缘以降低复发”进行了讨论（Rubio博士的讲题是“在乳腺癌治疗中，切缘大小是否重要”），该话题具有很大争议，目前我们即将达成指南以减少治疗方面的差异。基因检测正在改变患者的治疗策略，在本次会议的几项壁报中，研究者根据基因突变检测结果改变了治疗路径。会议对乳腺癌筛查是否必要进行辩论，一项来自匈牙利的壁报显示乳腺癌筛查对于一些患者的死亡率没有影响。在转化医学和个体化医疗方面也有重要的讲题，我们正在努力探索肿瘤进展的途径，并开发新药物来阻止肿瘤进展。

　　Oncology Frontier:  What is the current role of sentinel node biopsy in breast cancer?

　　《肿瘤瞭望》：前哨淋巴结活检在乳腺癌中的作用是什么？

　　Dr Rubio: Currently， the standard of care for patients with a clinically node-negative axilla is sentinel lymph node biopsy. Sentinel lymph node biopsies are here to stay I think because it has been shown that morbidity from axillary lymph node dissection has been reduced from 20-30% to <5%. So we are using more and more sentinel lymph node biopsies even though there are still some issues that we are debating. Is a sentinel lymph node biopsy needed after neoadjuvant therapy? I have a bias. I believe in sentinel lymph node biopsy after neoadjuvant therapy because with the new chemotherapy treatments and targeted therapy， we are seeing more complete pathologic responses. This means that patients who previously had a node-positive axilla will turn negative， so the sentinel lymph node is still a good option for decreasing morbidity. We are still waiting for long-term results on axillary dissection in this group of patients with neoadjuvant treatment. Another role for the sentinel lymph node is in recurrent breast cancer. We are starting to see patients who had a sentinel lymph node biopsy more than five years ago having a breast tumor recurrence. What do we do with the axilla in these cases? We can do another sentinel lymph node and we know it is feasible to do it and that the results are very accurate. This means we don’t need to do an axillary lymph node dissection if this sentinel lymph node is negative. We still have a lot of reliance on the sentinel lymph node and even though there are studies trying to compare whether the outcome will be different with the sentinel lymph node or no axillary surgery at all， we are still some way off knowing that. So nowadays， I feel a sentinel node biopsy should be one of the treatment options for patients.

　　Rubio博士：目前，临床淋巴结阴性腋乳腺癌患者的标准治疗是前哨淋巴结活检，这是认为相比腋窝淋巴结清扫，前哨淋巴结活检把发病率从 20%~30%降低到<5%。因此尽管仍有争议，前哨淋巴结活检使用越来越多。比如新辅助治疗后需要做前哨淋巴结活检吗？我相信在新辅助治疗术后做前哨淋巴结活检有必要，由于新化疗方案和靶向治疗，获得完全病理反应的比例更高。这意味着原本有淋巴结阳性的患者转为阴性，因此腋窝前哨淋巴结仍然是降低发病率的一个很好的选择。我们会继续等待研究结果。此外，前哨淋巴结活检可用于复发性乳腺癌。若五年前做前哨淋巴结活检的乳腺癌患者复发，在这些情况下怎么进行腋窝管理？可以再做一次前哨淋巴结活检，不但可行而且结果非常准确，如果前哨淋巴结活检结果为阴性，则不需要做腋窝淋巴结清扫。目前有研究试图比较“单独采用前哨淋巴结而没有腋窝手术”的结果是否不同。但是目前我认为前哨淋巴结活检应是患者的治疗选择之一。

　　Oncology Frontier:  What are your recommendations for staging and managing the axilla for women with breast cancer?

　　《肿瘤瞭望》：你对乳腺癌患者的腋窝分期和管理有何建议？

　　Dr Rubio: As we have trial results that say that patients’ outcomes will be the same whether we do an axillary lymph node dissection or sentinel lymph node biopsy if the sentinel lymph node is positive， we have been wondering whether we should do an axillary lymph node ultrasound. Currently， the axillary ultrasound is probably the best imaging technique we have to evaluate the axilla before surgery. There are some studies that have shown that when we do an axillary ultrasound before surgery and find there is a positive node by FNA， those patients usually have more positive nodes and usually a higher-grade stage of disease. So I think for staging the axilla before surgery， axillary ultrasound is a good option for directing patients toward an axillary lymph node dissection or a sentinel lymph node biopsy. There are other imaging modalities like MRI and PET. PET has a better specificity than axillary ultrasound but it is very expensive. In the end， you will need the ultrasound to perform an FNA anyway so at the moment， I think axillary ultrasound is the better option.

　　Rubio博士：试验结果表明，如果淋巴结阳性，无论是做前哨淋巴结还是腋窝淋巴结清扫，患者的预后相同。目前腋窝淋巴结超声检查可能是手术前评估腋窝的最佳成像技术。一些研究表明，在手术前做腋窝超声，若超声引导下FNA检查发现一个阳性淋巴结，这些患者通常有更多的阳性淋巴结，通常是高级别的肿瘤。所以对于乳腺癌术前腋窝分期，腋窝超声技术是指导腋窝淋巴结清扫或前哨淋巴结活检的一个很好的选择。目前还有其他的成像方式可用，如磁共振成像（MRI）和 PET。 PET比腋窝超声的特异性更好，但非常昂贵。总之，我们需要超声技术实施FNA检查，我认为目前乳腺癌腋窝超声检查是更好的选择。