Abstract：
Flat epithelial atypia (FEA), lobular neoplasia (LN), papillary lesions (PL), radial scar (RS) and atypical ductal hyperplasia (ADH) are lesions of uncertain malignant potential and classified as B3 lesions by the European guidelines for quality assurance in breast cancer screening and diagnosis. Current management is usually wide local excision (WE), surveillance may be sufficient for some. We investigated the upgrade rate of B3 lesions to breast malignancy in a subsequent resection specimen after diagnosis on core needle-or vacuum assisted biopsy (CNB-VAB) in a national population-based series.
Using data from the Belgian Cancer Registry (BCR) between January 1, 2013 and December 31, 2016, inclusion criteria were new diagnosis of a B3 lesion on CNB or VAB with subsequent histological assessment on a wider excision specimen. Histological agreement between first- and follow-up investigation was analyzed to determine the upgrade risk to ductal adenocarcinoma in situ (DCIS) or invasive breast cancer (IC) according to the type of B3 lesion.
Of 1855 diagnosed B3 lesions, 812 were included in this study: 551 after CNB-261 after VAB. After diagnosis on CNB and VAB, we found 19.0% and 14.9% upgrade to malignancy respectively. Upgrade risks after CNB and VAB were: FEA 39.5% and 17.6%; LN 40.5% and 4.3%; PL 10.4% and 12.5%; RS 25.7%and 0.0%; ADH 29.5% and 20.0%.
Based on the observed upgrade rate we propose three recommendations: first, resection of ADH, and FEA with WE; second, resection of RS and classical LN with therapeutic VAB and further surveillance when radio-pathological correlation is concordant; third, surveillance of PL.
Using data from the Belgian Cancer Registry (BCR) between January 1, 2013 and December 31, 2016, inclusion criteria were new diagnosis of a B3 lesion on CNB or VAB with subsequent histological assessment on a wider excision specimen. Histological agreement between first- and follow-up investigation was analyzed to determine the upgrade risk to ductal adenocarcinoma in situ (DCIS) or invasive breast cancer (IC) according to the type of B3 lesion.
Of 1855 diagnosed B3 lesions, 812 were included in this study: 551 after CNB-261 after VAB. After diagnosis on CNB and VAB, we found 19.0% and 14.9% upgrade to malignancy respectively. Upgrade risks after CNB and VAB were: FEA 39.5% and 17.6%; LN 40.5% and 4.3%; PL 10.4% and 12.5%; RS 25.7%and 0.0%; ADH 29.5% and 20.0%.
Based on the observed upgrade rate we propose three recommendations: first, resection of ADH, and FEA with WE; second, resection of RS and classical LN with therapeutic VAB and further surveillance when radio-pathological correlation is concordant; third, surveillance of PL.
摘要：
背景：扁平上皮异型（FEA），小叶瘤形成(LN),乳头状病变（PL），放射状瘢痕(RS)和不典型导管增生(ADH)是恶性潜能不确定的病变,根据欧洲乳腺癌筛查和诊断质量保证指南将其分类为B3级病变.目前的管理通常是广泛的局部切除术(WE)，监视对某些人来说可能就足够了。在全国人群系列中，我们调查了在核心针或真空辅助活检（CNB-VAB）诊断后，在随后的切除标本中B3病变向乳腺恶性肿瘤的升级率。
方法：使用比利时癌症登记处（BCR）2013年1月1日至2016年12月31日的数据，纳入标准是新诊断为CNB或VAB的B3病变，随后对更广泛的切除标本进行组织学评估。根据B3病变的类型，分析了首次和随访调查之间的组织学一致性，以确定原位导管腺癌（DCIS）或浸润性乳腺癌（IC）的升级风险。
结果：在1855个确诊的B3病变中，812包括在本研究中:VAB后CNB-261后551。在CNB和VAB诊断后，我们发现分别有19.0%和14.9%升级为恶性肿瘤。CNB和VAB后的升级风险分别为：FEA39.5%和17.6%；LN40.5%和4.3%；PL10.4%和12.5%；RS25.7%和0.0%；ADH29.5%和20.0%。
结论：根据观察到的升级率，我们提出了三个建议：第一，ADH切除术,和我们的FEA；第二，切除RS和经典LN并进行治疗性VAB，并在放射-病理相关性一致时进行进一步监测；第三，监控PL。
方法：使用比利时癌症登记处（BCR）2013年1月1日至2016年12月31日的数据，纳入标准是新诊断为CNB或VAB的B3病变，随后对更广泛的切除标本进行组织学评估。根据B3病变的类型，分析了首次和随访调查之间的组织学一致性，以确定原位导管腺癌（DCIS）或浸润性乳腺癌（IC）的升级风险。
结果：在1855个确诊的B3病变中，812包括在本研究中:VAB后CNB-261后551。在CNB和VAB诊断后，我们发现分别有19.0%和14.9%升级为恶性肿瘤。CNB和VAB后的升级风险分别为：FEA39.5%和17.6%；LN40.5%和4.3%；PL10.4%和12.5%；RS25.7%和0.0%；ADH29.5%和20.0%。
结论：根据观察到的升级率，我们提出了三个建议：第一，ADH切除术,和我们的FEA；第二，切除RS和经典LN并进行治疗性VAB，并在放射-病理相关性一致时进行进一步监测；第三，监控PL。
