PDF(Pubmed)
Abstract：
This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.
摘要：
这项回顾性研究调查了组织病理学结果，升级率，和高风险乳腺病变的无病生存率（DFS），包括非典型导管增生（ADH或DIN1b）和小叶原位肿瘤（LIN），以下真空辅助乳腺活检（VABB）和手术切除。该研究解决了这些病变所带来的挑战，因为它们与同步或邻近的乳腺癌（BC）以及未来BC风险增加有关。这项研究,包括320名接受立体定向VABB的患者，重点关注246名诊断为ADH（120）或LIN（126）的个体。病理评估,按英国B编码系统分类，进行了，和活检样本与相应的切除标本进行比较，以确定原位癌或浸润性癌的升级率。对于诊断为ADH或LIN，一致进行手术切除。最后,在LIN和ADH组之间评估和比较患者随访以确定复发体征，定义为组织学证实的相同或相反侧的乳腺病变。结果显示，176例(71.5%)患者术后没有升级，与LIN1相比，ADH表现出更高的原位病理学升级率（非典型小叶增生，ALH)/LIN2(低级别小叶原位癌，LCIS）（38%与20%,分别,p值=0.002)。只考虑没有升级的患者，10年的DFS为77%，64%,ADH为72%，LIN1和LIN2患者，分别(p值=0.92)。这项研究强调了多学科方法的重要性，认识到VABB不断演变的作用。它强调需要认真跟进,特别是对于小叶病变，为临床医生导航高风险乳腺病变的复杂景观提供有价值的见解。研究结果主张在管理这些病变时提高意识和警惕性，有助于BC护理临床策略的不断完善。
