2016年5月6日，勤快的美國(guó)國(guó)家綜合癌癥網(wǎng)絡(luò)（NCCN）悄悄地將乳腺癌臨床實(shí)踐指南更新到了2016年第2版。

　　2016年第2版與2016年第1版比較，更新如下：

BINV-1

• 檢查：由“生育咨詢，如絕經(jīng)前”改為“生育顧慮咨詢，如絕經(jīng)前”

• WORKUP, changed "Fertility counseling if premenopausal" to "Counseling for fertility concerns if premenopausal."

BINV-2

• 考慮影像檢查用于系統(tǒng)（全身）分期，明確刪除“或MRI”

• Clarified imaging for systemic staging, removed "or MRI."

BINV-5

• 系統(tǒng)（全身）輔助治療-激素受體陽(yáng)性-HER2陽(yáng)性疾病，刪除腳注“y”所說(shuō)的“證據(jù)支持激素受體陽(yáng)性乳腺癌絕經(jīng)前女性手術(shù)或放射切除卵巢獲益程度與單用CMF相似。參見輔助內(nèi)分泌療法（BINV-J）和術(shù)前/輔助療法方案（BINV-K）”

• SYSTEMIC ADJUVANT TREATMENT - HORMONE RECEPTOR-POSITIVE - HER2-POSITIVE DISEASE, removed footnote "y" stating "Evidence supports that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal women with hormone receptor-positive breast cancer is similar to that achieved with CMF alone. See Adjuvant Endocrine Therapy (BINV-J) and Preoperative/Adjuvant Therapy Regimens (BINV-K)."

BINV-9

• 將腳注“如果雌激素受體陽(yáng)性，考慮內(nèi)分泌療法，以降低風(fēng)險(xiǎn)和消除疾病復(fù)發(fā)小風(fēng)險(xiǎn)”移至流程。

• Moved the following footnote to the algorithm: "If ER-positive, consider endocrine therapy for risk reduction and to diminish the small risk of disease recurrence."

BINV-11

• 臨床陰性腋窩淋巴結(jié)考慮腋窩影像學(xué)檢查，明確加入“超聲波”

• Clarified imaging by adding "with ultrasound."

BINV-12

• 術(shù)前系統(tǒng)（全身）療法刪除聲明“內(nèi)分泌療法單用芳香酶抑制劑（絕經(jīng)后女性優(yōu)先選擇；絕經(jīng)前女性與卵巢抑制一起給予）或他莫昔芬可被考慮用于激素受體陽(yáng)性患者”，并鏈接至BINV-L（同樣適用于BINV-15）

• Removed the statement "[Endocrine therapy alone with an aromatase inhibitor (preferred option for postmenopausal women; given along with ovarian suppression for premenopausal women) or tamoxifen may be considered for patients with hormone-receptor positive disease]" and linked to BINV-L (also applies to BINV-15)

• 腳注“jj”明確“影像研究”加入（乳房攝影和/或乳腺M(fèi)RI）

• Footnote "jj" clarified "imaging studies" by adding (mammogram and/or breast MRI).

BINV-15

• 術(shù)前系統(tǒng)（全身）療法刪除聲明“內(nèi)分泌療法單用芳香酶抑制劑（絕經(jīng)后女性優(yōu)先選擇；絕經(jīng)前女性與卵巢抑制一起給予）或他莫昔芬可被考慮用于激素受體陽(yáng)性患者”，并鏈接至BINV-L

• Removed the statement "[Endocrine therapy alone with an aromatase inhibitor (preferred option for postmenopausal women; given along with ovarian suppression for premenopausal women) or tamoxifen may be considered for patients with hormone-receptor positive disease]" and linked to BINV-L

BINV-22

• “含有曲妥珠單抗的化療”改為“HER2靶向化療”

• Changed trastuzumab containing chemotherapy to HER2-targeted chemotherapy.

BINV-N

• 加入“選擇性雌激素受體調(diào)節(jié)劑”

• Added "Selective ER modulators."

IBC-1

• 新增注腳k：“準(zhǔn)確評(píng)估術(shù)前系統(tǒng)（全身）療法對(duì)乳腺內(nèi)腫瘤或局部淋巴結(jié)的效果是困難的，并應(yīng)包括體檢和最初腫瘤分期時(shí)異常的影像學(xué)表現(xiàn)（乳房攝影和/或乳腺M(fèi)RI）。術(shù)前影像學(xué)檢查方法選擇應(yīng)由多學(xué)科小組決定。”

• Added a new footnote, "The accurate assessment of in-breast tumor or regional lymph node response to preoperative systemic therapy is difficult, and should include physical examination and performance of imaging studies (mammogram and/or breast MRI) that were abnormal at the time of initial tumor staging. Selection of imaging methods prior to surgery should be determined by the multidisciplinary team."

討論（Discussion）

• 討論部分已被更新，以反映上述流程的變化。

• The discussion section has been updated to reflect changes in the algorithm.