高危或B3乳腺病变被认为是具有不确定的恶性潜能的病变，占初始活检结果的5％至12％。我们试图对过去20年发表的研究进行系统评价和荟萃分析，以确定选定B3病变中VAB的汇总阳性预测值（PPV）。
本研究报告基于PRISMA指南和流行病学观察性研究的Meta分析。
本研究的主要结果是使用汇总估计值确定在确定B3乳腺病变的最终组织学诊断中VAB的PPV。次要结果是确定针规或2012年引入的小叶原位癌（LCIS）的重新分类是否影响汇总估计。
本综述包括78项纳入6,377个B3病变的研究，其中1214例在手术切除后升级为DCIS或侵袭性恶性肿瘤(19%)。非典型导管增生（ADH）和小叶瘤（LN）中VAB的合并PPV分别为0.79（CI0.76-0.83）和0.84（CI0.8-0.88）。扁平上皮异型症（FEA）的VAB，伴有/不伴有异型性的放射状瘢痕和乳头状病变的合并PPV均>90％（低估率7％，1%,分别为5%和3%)。针规大小和LCIS分类的变化似乎不会影响亚组分析的低估率。
这项荟萃分析的结果表明，对某些B3病变进行VAB治疗是合理的，特别是LN,FEA,放射状疤痕,当满足特定标准时，乳头状病变。手术切除应继续作为ADH的主要治疗手段。
High-risk or B3 breast lesions are considered lesions of uncertain malignant potential and comprise between 5 and 12% of initial biopsy results. We sought to perform a systematic
review and meta-analysis of studies published within the last twenty years to determine the pooled Positive Predictive Value (PPV) of VAB in selected B3 lesions.
The study report is based on the guidelines of PRISMA and Meta-Analysis of Observational Studies in Epidemiology.
The primary outcome of this study was to determine the PPV of VAB in determining final histological diagnosis in B3 breast lesions using pooled estimates. The secondary outcomes were to determine if needle gauge or the re-classification of Lobular Carcinoma in Situ(LCIS) introduced in 2012 influenced pooled estimates.
78 studies incorporating 6,377 B3 lesions were included in this
review, 1214 of which were upgraded to DCIS or invasive malignancy following surgical excision(19%). The pooled PPV of VAB in Atypical Ductal Hyperplasia(ADH) and Lobular Neoplasia(LN) were 0.79(CI 0.76-0.83) and 0.84(CI 0.8-0.88). VAB of Flat Epithelial Atypia(FEA), radial scar and papillary lesions with/without atypia all had a pooled PPV >90% (underestimation rates 7%, 1%, 5% and 3% respectively). Needle gauge size and the change in LCIS classification did not appear to influence underestimation rates on subgroup analysis.
Results from this meta-analysis suggests it is reasonable to perform VAB as definitive treatment for certain B3 lesions, specifically LN, FEA, radial scar, and papillary lesions when specific criteria are fulfilled. Surgical excision should continue as the mainstay of treatment for ADH.
