背景:恶性潜能不确定的乳腺病变(B3)包括非典型导管和小叶增生,小叶原位癌,扁平上皮异型,乳头状病变,放射状疤痕和纤维上皮病变以及其他罕见的杂项病变。他们在组织学上进行分类具有挑战性,需要专业培训和多学科投入。它们可能与原位或浸润性乳腺癌(BC)共存,并增加随后BC发展的风险。管理应侧重于适当的分类和管理,同时避免过度治疗。这些指南的目的是提供有关B3病变的诊断和管理的最新信息。根据更新的文献综述证据。
方法:这些指南提供了可应用于临床实践的实用建议,包括建议等级和证据水平。所有部分都是根据更新的文献综述编写的,并在共识会议上进行了讨论。评审专家编写委员会坚持了《国际评审准则》中的23项,研究和评估(AGREE)工具。
结果:本指南报道的针芯活检(CNB)或真空辅助活检(VAB)诊断B3病变后的进一步处理建议,根据非典型性的存在而变化,病变的大小,采样尺寸,和患者偏好。在CNB或VAB之后,真空辅助切除或手术切除的选择应由多学科团队进行评估,与患者共同决策对于个性化进一步治疗至关重要.B3乳腺病变的手术干预正在降级,并且纳入真空辅助切除术(VAE)将减少对进一步方法进行手术干预的需要。根据组织学诊断,与患者的沟通可能有所不同。是否存在非典型,或由于成像不一致而升级的风险。建议使用书面信息资源来帮助患者理解这些问题,并进行口头交流。生活方式干预对BC发病率有显著影响,因此需要对因B3病变诊断而BC风险增加的女性建议生活方式干预。
结论:这些指南提供了最新的诊断概述,现代多学科乳腺实践中B3病变的管理和预后。
BACKGROUND: Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these
guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence.
METHODS: These
guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a
consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool.
RESULTS: Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this
guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion.
CONCLUSIONS: These
guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.