背景：影像引导核心活检诊断的高危乳腺病变的处理仍存在争议。我们实施了一个由乳腺病理学家参加的高风险乳腺会议，成像仪,和外科医生前瞻性地审查所有当代病例，以便为手术切除或每隔6个月随访至少2年的影像学提供共识建议。
方法：5月之间，2015年6月,2019年，讨论了127个高危病变。在这127个案例中，116具有一致的放射学-病理学（rad-path）发现。其余11例患者的rad-path结果不一致。在116个和谐案例中，由于在分析之前缺乏第一次成像随访,6例被排除。在剩下的110名患者中，43例导管不典型增生(ADH),12例小叶原位癌（LCIS），19例不典型小叶增生（ALH），33有放射状疤痕（RS），2有扁平上皮异型性（FEA），1例黏液囊肿样病变（ML）。如果有>2个ADH病灶或<90％的相关钙化被切除，我们建议切除ADH。对于LCIS或ALH患者，如果LCIS或ALH与微钙化相关或LCIS广泛,我们建议切除.当活检<1/2病变时，我们建议切除RS。我们建议所有FEA和ML患者进行6个月的随访。
结果：根据会议得出的关于切除的共识，切除的27例ADH中，9例升级为浸润性癌或导管原位癌。在建议切除的6例LCIS病例中,没有升级。九个切除的放射状疤痕显示没有升级。此外,3名ADH患者，2与ALH，1与LCIS，2例RS接受了自愿切除，没有升级。所有其他患者（13例ADH，5LCIS,17ALH,22RS,2FEA和1ML)随访成像，在随访期间（187-1389天）均未发现疾病进展的证据。所有11例rad路径不一致病例均被切除，其中2例升级为癌症。
结论：这项前瞻性研究的结果表明，在建立预定义的坚定指南并进行严格的rad-path相关性后，与观察相比，可以成功地将高风险乳腺病变分类为手术。
BACKGROUND: The management of high-risk breast lesions diagnosed on image-guided core biopsy remains controversial. We implemented a high-risk breast conference attended by breast pathologists, imagers, and surgeons to prospectively review all contemporary cases in order to provide a consensus recommendation to either surgically excise or follow on imaging at 6-month intervals for a minimum of 2 years.
METHODS: Between May, 2015 and June, 2019, 127 high-risk lesions were discussed. Of these 127 cases, 116 had concordant radiology-pathology (rad-path) findings. The remaining 11 patients had discordant rad-path findings. Of the 116 concordant cases, 6 were excluded due to lack of the first imaging follow-up until analysis. Of the remaining 110 patients, 43 had atypical ductal hyperplasia (ADH), 12 had lobular carcinoma in situ (LCIS), 19 had atypical lobular hyperplasia (ALH), 33 had radial scar (RS), 2 had flat epithelial atypia (FEA), and 1 had mucocele-like lesion (ML). We recommended excision for ADH if there were > 2 ADH foci or < 90% of the associated calcifications were removed. For patients with LCIS or ALH, we recommended excision if the LCIS or ALH was associated with microcalcifications or the LCIS was extensive. We recommended excision of RS when < 1/2 of the lesion was biopsied. We recommended all patients with FEA and ML for 6-month follow-up.
RESULTS: Following conference-derived consensus for excision, of the 27 ADH excised, 9 were upgraded to invasive carcinoma or ductal carcinoma in situ. Of the six LCIS cases recommended for excision, none were upgraded. Nine excised radial scars revealed no upgrades. Additionally, 3 patients with ADH, 2 with ALH, 1 with LCIS, and 2 with RS underwent voluntary excision, and none were upgraded. All other patients (13 with ADH, 5 LCIS, 17 ALH, 22 RS, 2 FEA and 1 ML) were followed with imaging, and none revealed evidence of disease progression during follow-up (187-1389 days). All 11 rad-path discordant cases were excised with 2 upgraded to carcinoma.
CONCLUSIONS: The results of this prospective study indicate that high-risk breast lesions can be successfully triaged to surgery versus observation following establishment of predefined firm guidelines and performance of rigorous rad-path correlation.
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