中国抗癌协会. 乳腺癌前哨淋巴结活检规范化操作指南（2022精要版）[J]. 中国肿瘤临床, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 引用本文: 中国抗癌协会. 乳腺癌前哨淋巴结活检规范化操作指南（2022精要版）[J]. 中国肿瘤临床, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 China Anti-Cancer Association. Guidelines for standardized practice of sentinel lymph node biopsy in breast cancer (2022 abridged version)[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 Citation: China Anti-Cancer Association. Guidelines for standardized practice of sentinel lymph node biopsy in breast cancer (2022 abridged version)[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY , 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 中国抗癌协会. 乳腺癌前哨淋巴结活检规范化操作指南（2022精要版）[J]. 中国肿瘤临床, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 引用本文: 中国抗癌协会. 乳腺癌前哨淋巴结活检规范化操作指南（2022精要版）[J]. 中国肿瘤临床, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 China Anti-Cancer Association. Guidelines for standardized practice of sentinel lymph node biopsy in breast cancer (2022 abridged version)[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 Citation: China Anti-Cancer Association. Guidelines for standardized practice of sentinel lymph node biopsy in breast cancer (2022 abridged version)[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY , 2022, 49(22): 1135-1142. doi: 10.12354/j.issn.1000-8179.2022.20221052 乳腺癌是女性最常见的恶性肿瘤，区域淋巴结状况作为重要的预后指标，可指导患者的淋巴结分期，并对后续治疗策略产生影响。前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）标志着乳腺癌淋巴结外科处理进入微创时代，但其安全有效替代腋窝淋巴结清扫术应建立在规范化操作前提下。中国抗癌协会乳腺癌专业委员会组织业内专家依据循证医学方法制定《乳腺癌前哨淋巴结活检规范化操作指南》，内容涉及SLNB适应证、示踪剂选择与应用、组织标本处理、腋窝SLNB、新辅助治疗与SLNB、内乳SLNB。本指南将为乳腺癌相关医务工作者的临床实践提供有益指导和参考。

乳腺癌 /  前哨淋巴结活检 / Abstract: Breast cancer is the most common malignant tumor in women. Regional lymph node status is an important prognostic indicator that guides staging of tumors and influences application of adjuvant therapy. Minimally invasive lymph node surgery in breast cancer begins with sentinel lymph node biopsy (SLNB), which is established based on the premise of a standardized operation as a safe and effective replacement for axillary lymph node dissection. The Committee of Breast Cancer Society of China Anti-Cancer Association invited authoritative experts nationwide to participate in the preparation of the Guidelines for Standardized Practice of Sentinel Lymph Node Biopsy in Breast Cancer based on evidence-based medicine, which focuses on the indications for SLNB, tracer selection and application, tissue specimen processing, axillary SLNB, neoadjuvant therapy and SLNB, and internal mammary SLNB. The guideline aims to provide the most effective references for practitioners to achieve the best outcomes for patients with breast cancer.

Key words: breast cancer /  sentinel lymph node biopsy (SLNB) /  guideline  适应证禁忌证豁免SLNB 早期浸润性乳腺癌炎性乳腺癌肿瘤完整切除并经石蜡组织病理充分评估为DCIS性别不限临床ALN阳性（cN+）并经穿刺证实年龄≥70岁（合并疾病），cT1N0M0，HR阳性HER-2阴性，辅助治疗不受腋窝状态影响 ^g cN0 ^a cN+新辅助治疗后仍为阳性cN0且影像学评估腋淋巴结阴性 ^h 单灶或多中心性病变cN2～3新辅助治疗后ycN0*−DCIS全乳切除术，或保乳术切除原发肿瘤后
影响SLNB成功率和准确性 ^b −−cN0新辅助治疗后ycN0−−穿刺证实的cN1新辅助治疗后ycN0 ^c −−妊娠患者 ^d −−保乳术联合SLNB后同侧乳房复发/再发 ^e −−ALN临床查体阴性但影像学1～2枚异常并
穿刺证实转移 ^f −− ^a ：临床查体和影像学检查可疑的ALN可通过超声引导下的细针穿刺或空芯针活检进行评估，细胞学或病理组织学阴性患者仍可进入SLNB流程； ^b ：DCIS为穿刺组织病理或术中冰冻组织病理诊断； ^c ：必须符合新辅助治疗前，穿刺阳性淋巴结放置标记夹并在术中检出/未置标记夹需采用核素+染料双示踪剂同时检出3枚及以上SLN； ^d ：采用核素示踪剂的SLNB对胎儿的安全性已获得证实，因可能有过敏不推荐使用蓝染料示踪剂； ^e ：保乳术联合SLNB（SLN阴性替代ALND）后同侧乳房复发/再发患者，再次（repeat，r）SLNB准确性和安全性已获得初步认可； ^f ：综合2021版NCCN指南、2021版加拿大安大略及ASCO前哨淋巴结活检指南，依据中国专家意见本指南一般推荐； ^g ：若不行SLNB，可豁免前哨不行ALN处理； ^h ：前瞻性研究正在进行中，目前鼓励参加严格设计的临床试验；*：经新辅助治疗后临床ALN阴性