Abstract：
Evidence-based clinical guidelines are essential to maximize patient benefit and to reduce clinical uncertainty and inconsistency in clinical practice. Gaps in the evidence base can be addressed by data acquired in routine practice. At present, there is no international consensus on management of women diagnosed with atypical lesions in breast screening programmes. Here, we describe how routine NHS breast screening data collected by the Sloane atypia project was used to inform a management pathway that maximizes early detection of cancer and minimizes over-investigation of lesions with uncertain malignant potential. A half-day consensus meeting with 11 clinical experts, 1 representative from Independent Cancer Patients\' Voice, 6 representatives from NHS England (NHSE) including from Commissioning, and 2 researchers was held to facilitate discussions of findings from an analysis of the Sloane atypia project. Key considerations of the expert group in terms of the management of women with screen detected atypia were: (1) frequency and purpose of follow-up; (2) communication to patients; (3) generalizability of study results; and (4) workforce challenges. The group concurred that the new evidence does not support annual surveillance mammography for women with atypia, irrespective of type of lesion, or woman\'s age. Continued data collection is paramount to monitor and audit the change in recommendations.
摘要：
循证临床指南对于最大限度地提高患者的利益和减少临床不确定性和临床实践中的不一致性至关重要。证据库的差距可以通过常规实践中获得的数据来解决。目前,对于在乳房筛查计划中诊断为非典型病变的妇女的管理，国际上没有共识。这里,我们描述了如何使用Sloane非典型性项目收集的常规NHS乳腺筛查数据来提供管理途径,该途径可最大限度地早期发现癌症,并最大限度地减少对具有不确定恶性潜能的病变的过度调查.与11位临床专家举行为期半天的共识会议,1名来自独立癌症患者的代表，来自NHS英格兰（NHSE）的6名代表，包括来自调试，并举行了2名研究人员，以促进对斯隆非典型项目分析结果的讨论。专家组在筛查发现非典型性妇女的管理方面的主要考虑因素是：（1）随访的频率和目的；（2）与患者的沟通；（3）研究结果的普遍性；（4）劳动力挑战。该小组同意，新证据不支持对非典型性女性进行年度乳房X光检查，无论病变类型如何，或者女人的年龄。继续收集数据对于监测和审计建议的变化至关重要。
