2016年5月6日，勤快的美國國家綜合癌癥網絡（NCCN）悄悄地將乳腺癌臨床實踐指南更新到了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，如絕經前”改為“生育顧慮咨詢，如絕經前”

• 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-激素受體陽性-HER2陽性疾病，刪除腳注“y”所說的“證據支持激素受體陽性乳腺癌絕經前女性手術或放射切除卵巢獲益程度與單用CMF相似。參見輔助內分泌療法（BINV-J）和術前/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“如果雌激素受體陽性，考慮內分泌療法，以降低風險和消除疾病復發(fā)小風險”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考慮腋窩影像學檢查，明確加入“超聲波”

• Clarified imaging by adding "with ultrasound."

BINV-12

• 術前系統(tǒng)（全身）療法刪除聲明“內分泌療法單用芳香酶抑制劑（絕經后女性優(yōu)先選擇；絕經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MRI）

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

BINV-15

• 術前系統(tǒng)（全身）療法刪除聲明“內分泌療法單用芳香酶抑制劑（絕經后女性優(yōu)先選擇；絕經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節(jié)劑”

• Added "Selective ER modulators."

IBC-1

• 新增注腳k：“準確評估術前系統(tǒng)（全身）療法對乳腺內腫瘤或局部淋巴結的效果是困難的，并應包括體檢和最初腫瘤分期時異常的影像學表現（乳房攝影和/或乳腺MRI）。術前影像學檢查方法選擇應由多學科小組決定?！?/p>

• 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.