Таргетная аксиллярная диссекция при раке молочной железы: обзор различных методик выполнения и их эффективности. Систематический обзор

Зайцев Н.А., Колядина И.В., Бикеев Ю.В., Родионова М.В., Хохлова С.В., Родионов В.В. Таргетная аксиллярная диссекция при раке молочной железы: обзор различных методик выполнения и их эффективности. Систематический обзор. Современная Онкология. 2025;27(4):320–325. DOI: 10.26442/18151434.2025.4.203397

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Zaytsev NA, Kolyadina IV, Bikeev YuV, Rodionova MV, Khokhlova SV, Rodionov VV. Targeted axillary dissection in breast cancer: An overview of various techniques and their effectiveness. Systematic review. Journal of Modern Oncology. 2025;27(4):320–325. DOI: 10.26442/18151434.2025.4.203397

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Аннотация

Появление эффективной неоадъювантной системной терапии позволило добиться значимых успехов в лечении рака молочной железы (МЖ), особенно наиболее агрессивных подтипов этого заболевания: тройного негативного и HER2-положительного. Высокая эффективность неоадъювантного этапа лечения привела к высокой частоте достижения полного патоморфологического ответа в первичной опухоли и лимфоузлах, что способствовало деэскалации хирургии как на самой МЖ, так и на регионарном лимфоколлекторе. Особое место в клинической практике заняла таргетная аксиллярная диссекция (ТАД) как современный метод хирургического стадирования у пациенток с раком МЖ и метастатическим поражением лимфоузлов, получивших неоадъювантную системную терапию. В систематическом обзоре проанализированы результаты ряда исследований, где сравнивали различные методики выполнения ТАД, при этом особое внимание уделяли сравнению одноэтапного (маркировке пораженных лимфоузлов до начала химиотерапии) и двухэтапного (маркировке до химиотерапии с последующей пред- или интраоперационной локализацией) подходов, а также оценке эффективности различных типов маркеров, включая радиоактивные зерна (¹²⁵I), магнитные метки, углеродные суспензии, металлические клипсы и др. Обзор позволил выявить существенную гетерогенность имеющихся протоколов и подчеркнул необходимость проведения рандомизированных контролируемых исследований для стандартизации методики ТАД, оценки ее долгосрочной онкологической безопасности и определения оптимальных подходов к маркировке лимфоузлов.

Ключевые слова: неоадъювантная системная терапия, биопсия сигнальных лимфатических узлов, таргетная аксиллярная диссекция, маркировка пораженных лимфатических узлов, деэскалация хирургического лечения

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The introduction of effective neoadjuvant systemic therapy contributed to significant advances in the treatment of breast cancer, especially the most aggressive subtypes of this disease – triple negative and HER2-positive. The high effectiveness of the neoadjuvant therapy led to a high rate of the pathological complete response in the primary tumor and lymph nodes, which contributed to the de-escalation of surgery on both the breast and the regional lymphatic collector. Targeted axillary dissection (TAD) has taken a special place in clinical practice as a modern method of surgical staging in patients with breast cancer and metastatic lymph node involvement after neoadjuvant systemic therapy. A systematic review analyzed the results of several studies comparing different TAD techniques, with special attention paid to comparing one-stage (labeling of affected lymph nodes before chemotherapy) and two-stage (labeling before chemotherapy with subsequent pre- or intraoperative localization) approaches, as well as assessing the effectiveness of various markers, including radioactive seed implants (¹²⁵I), magnetic tags, carbon suspensions, metal staples, etc. The review highlighted the significant heterogeneity of the available protocols and emphasized the need for randomized controlled trials to standardize the TAD methodology, assess its long-term oncological safety, and establish optimal approaches to lymph node labeling.

Keywords: neoadjuvant systemic therapy, biopsy of sentinel lymph nodes, targeted axillary dissection, labeling of involved lymph nodes, deescalation of surgical treatment

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1. Morozov DA, Kolyadina IV, Poddubnaya IV, et al. Features of response to modern neoadjuvant chemotherapy with dual anti-HER2 blockade (trastuzumab and pertuzumab) in the patients with HER2-positive breast cancer stage II–III. Journal of Modern Oncology. 2022;23(4):603-10 (in Russian). DOI:10.26442/18151434.2021.4.201297
2. Kolyadina IV. Following in the footsteps of SABCS 2022: top 12 advanced breast cancer studies that could change our clinical practice: A review. Journal of Modern Oncology. 2023;25(1):46-54 (in Russian). DOI:10.26442/18151434.2023.1.202102
3. Kolyadina IV, Poddubnaya IV. Key studies that have changed the history and treatment of early HER2+ breast cancer: focus on individual therapy. Tumors of female reproductive system. 2021;16(3):46-56 (in Russian). DOI:10.17650/1994-4098-2020-16-3-46-55
4. Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014;260(4):608-14. DOI:10.1097/SLA.0000000000000924
5. Kolyadina IV, Danzanova TY, Khokhlova SV, et al. Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer. Journal of Modern Oncology. 2020;22(1):46-52 (in Russian). DOI:10.26442/18151434.2020.1.200018
6. Kolyadina IV, Poddubnaya IV, Pavlikova OA, Komov DV. Features of surgical treatment of patients with breast cancer receiving preoperative systemic therapy. Journal of Modern Oncology. 2016; 18(1):50-4 (in Russian).
7. Simons JM, van Nijnatten TJA, van der Pol CC, et al. Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2019;269(3):432-42. DOI:10.1097/SLA.0000000000003075
8. Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72. DOI:10.1016/S0140-6736(13)62422-8
9. von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796-804. DOI:10.1200/JCO.2011.38.8595
10. Mougalian SS, Hernandez M, Lei X, et al. Ten-Year Outcomes of Patients With Breast Cancer With Cytologically Confirmed Axillary Lymph Node Metastases and Pathologic Complete Response After Primary Systemic Chemotherapy. JAMA Oncol. 2016;2(4):508-16. DOI:10.1001/jamaoncol.2015.4935
11. Fayanju OM, Ren Y, Thomas SM, et al. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018;268(4):591-601. DOI:10.1097/SLA.0000000000002953
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Авторы

Н.А. Зайцев*¹, И.В. Колядина^1,2, Ю.В. Бикеев¹, М.В. Родионова¹, С.В. Хохлова^1,2, В.В. Родионов¹

¹ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Российская Федерация
²ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
*n.zaytsev.md@yandex.ru

________________________________________________

Nikita A. Zaytsev*¹, Irina V. Kolyadina^1,2, Yury V. Bikeev¹, Maria V. Rodionova¹, Svetlana V. Khokhlova^1,2, Valerii V. Rodionov¹

¹Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
²Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
*n.zaytsev.md@yandex.ru

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