PDF(Pubmed)
Abstract：
UNASSIGNED: B3-lesions of the breast are a heterogeneous group of neoplasms, associated with a higher risk of breast cancer. Recent studies show a low upgrade rate into malignancy after subsequent open surgical excision (OE) of most B3-lesions when proven by vacuum-assisted biopsy (VAB). However, there is a lack of long-term follow-up data after VAB of high-risk lesions. The primary aim of this study was to demonstrate whether follow-up of B3 lesions is a beneficial and reliable alternative to OE in terms of long-term outcome. The secondary aim was to identify patient and lesion characteristics of B3 lesions for which OE is still necessary.
UNASSIGNED: This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the t test and Fisher\'s exact test. A p value of <0.05 was considered statistically significant.
UNASSIGNED: The median follow-up interval was 59 months (range: 24-143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31-119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (p < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (p > 0.12).
UNASSIGNED: With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6-7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.
UNASSIGNED: This retrospective multicenter study was conducted at 8 Swiss breast centers between 2010 and 2019. A total of 278 women (mean age: 53.5 ± 10.7 years) with 286 B3-lesions who had observation only and who had at least 24 months of follow-up were included. Any event during follow-up (ductal carcinoma in situ [DCIS], invasive cancer, new B3-lesion) was systematically recorded. Data from women who had an event during follow-up were compared with those who did not. The results for the different B3 lesions were analyzed using the t test and Fisher\'s exact test. A p value of <0.05 was considered statistically significant.
UNASSIGNED: The median follow-up interval was 59 months (range: 24-143 months) with 52% (148/286) having a follow-up of more than 5 years. During follow-up, in 42 women, 44 suspicious lesions occurred, with 36.4% (16/44) being invasive cancer and 6.8% (3/44) being DCIS. Thus, 6.6% (19/286) of all women developed malignancy during follow-up after a median follow-up interval of 6.5 years (range: 31-119 months). The initial histology of the B3 lesion influenced the subsequent occurrence of a malignant lesion during follow-up (p < 0.038). The highest malignancy-developing rate was observed in atypical ductal hyperplasia (ADH) (24%, 19/79), while all other B3-lesions had malignant findings ipsi- and contralateral between 0% and 6%. The results were not influenced by the VAB method (Mx-, US-, magnetic resonance imaging-guided), the radiological characteristics of the lesion, or the age or menopausal status of the patient (p > 0.12).
UNASSIGNED: With a low risk of <6% of developing malignancy, VAB followed by long-term follow-up is a safe alternative to OE for most B3-lesions. A higher malignancy rate only occurred in ADH (24%). Based on our results, radiological follow-up should be bilateral, preferable using the technique of initial diagnosis. As we observed a late peak (6-7 years) of breast malignancies after B3-lesions, follow-up should be continued for a longer period (>10 years). Knowledge of these long-term outcome results will be helpful in making treatment decisions and determining the optimal radiological follow-up interval.
摘要：
■B3-乳腺病变是一组异质性肿瘤，与更高的乳腺癌风险有关。最近的研究表明，经过真空辅助活检（VAB）证实，大多数B3病变在随后的开放式手术切除（OE）后，恶性升级率很低。然而,缺乏高危病变VAB后的长期随访数据.这项研究的主要目的是证明在长期结果方面，B3病变的随访是否是OE的有益且可靠的替代方法。次要目的是确定仍然需要OE的B3病变的患者和病变特征。
■这项回顾性多中心研究是在2010年至2019年期间在8个瑞士乳腺中心进行的。总共有278名妇女（平均年龄：53.5±10.7岁），有286个B3病变，仅进行了观察，并进行了至少24个月的随访。随访期间的任何事件（导管原位癌[DCIS]，浸润性癌症,系统记录新的B3病变）。将随访期间发生事件的女性的数据与未发生事件的女性进行比较。使用t检验和Fisher精确检验分析不同B3病变的结果。<0.05的p值被认为是统计学上显著的。
■中位随访间隔为59个月（范围：24-143个月），52％（148/286）的随访时间超过5年。随访期间,42名女性,44例可疑病灶发生,其中36.4%(16/44)为浸润性癌，6.8%(3/44)为DCIS。因此，所有女性中有6.6％（19/286）在中位随访时间为6.5年（范围：31-119个月）后的随访期间发展为恶性肿瘤。B3病变的初始组织学影响了随访期间恶性病变的后续发生（p<0.038）。在非典型导管增生（ADH）中观察到最高的恶性肿瘤发生率（24％，19/79),而所有其他B3病变的同侧和对侧的恶性发现均在0%至6%之间。结果不受VAB方法的影响(Mx-，US-,磁共振成像引导)，病变的放射学特征，或患者的年龄或更年期状态（p>0.12）。
■发生恶性肿瘤的风险<6%，对于大多数B3病变，VAB随后进行长期随访是OE的安全替代品。仅ADH的恶性率较高（24％）。根据我们的结果,放射学随访应该是双边的，最好使用初步诊断技术。正如我们观察到B3病变后乳腺恶性肿瘤的晚期高峰（6-7年），随访应持续更长的时间（>10年）。了解这些长期结果结果将有助于做出治疗决策和确定最佳的放射学随访间隔。
■这项回顾性多中心研究是在2010年至2019年期间在8个瑞士乳腺中心进行的。总共有278名妇女（平均年龄：53.5±10.7岁），有286个B3病变，仅进行了观察，并进行了至少24个月的随访。随访期间的任何事件（导管原位癌[DCIS]，浸润性癌症,系统记录新的B3病变）。将随访期间发生事件的女性的数据与未发生事件的女性进行比较。使用t检验和Fisher精确检验分析不同B3病变的结果。<0.05的p值被认为是统计学上显著的。
■中位随访间隔为59个月（范围：24-143个月），52％（148/286）的随访时间超过5年。随访期间,42名女性,44例可疑病灶发生,其中36.4%(16/44)为浸润性癌，6.8%(3/44)为DCIS。因此，所有女性中有6.6％（19/286）在中位随访时间为6.5年（范围：31-119个月）后的随访期间发展为恶性肿瘤。B3病变的初始组织学影响了随访期间恶性病变的后续发生（p<0.038）。在非典型导管增生（ADH）中观察到最高的恶性肿瘤发生率（24％，19/79),而所有其他B3病变的同侧和对侧的恶性发现均在0%至6%之间。结果不受VAB方法的影响(Mx-，US-,磁共振成像引导)，病变的放射学特征，或患者的年龄或更年期状态（p>0.12）。
■发生恶性肿瘤的风险<6%，对于大多数B3病变，VAB随后进行长期随访是OE的安全替代品。仅ADH的恶性率较高（24％）。根据我们的结果,放射学随访应该是双边的，最好使用初步诊断技术。正如我们观察到B3病变后乳腺恶性肿瘤的晚期高峰（6-7年），随访应持续更长的时间（>10年）。了解这些长期结果结果将有助于做出治疗决策和确定最佳的放射学随访间隔。
