目的:芯针活检(CNB)标本中发现的纯扁平上皮异型(FEA)的最佳治疗是手术切除还是影像学随访仍存在争议。本研究旨在确定导管原位癌(DCIS)的升级率,浸润性癌或高危病变(非典型导管增生,不典型小叶增生,或小叶原位癌),并探讨了乳腺癌家族史与升级风险之间的关系。
方法:2011年3月至2017年12月在微钙化的立体定向CNB上发现纯FEA的病例,随后进行切除活检或定期成像。以95%置信区间(CI)确定升级为高风险病变的病例比例以及与乳腺癌家族史相关的升级几率。
结果:我们确定了622例纯FEA;101例(16.2%)接受了手术切除,269例(43.2%)接受了≥24个月的影像学随访。在这370人中,没有任何一个人(0%)的DCIS或浸润性癌症的升级,4.6%(17/370;95%CI:2.9%-7.2%)升级为高危病变.家族史和升级为高危病变之间的趋势无统计学意义(比值比1.72[95%CI:0.65%-4.57%])。
结论:在我们的研究中,单纯FEA向恶性肿瘤的升级率为0%。我们建议定期影像学随访是手术的适当替代方法。由于活检技术和病理学家对原发性活检的解释存在潜在差异,个别机构应在改变其FEA管理之前审核自己的结果。
OBJECTIVE: Whether the optimal management of pure flat epithelial atypia (FEA) found on core needle biopsy (CNB) specimens is surgical excision or imaging follow-up remains controversial. This study aimed to determine the upgrade rate to ductal carcinoma in situ (DCIS), invasive carcinoma or a high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ), and it explored the relationship between a family history of breast cancer and the risk of upgrade.
METHODS: Cases with pure FEA found on stereotactic CNB of microcalcifications between March 2011 to December 2017 were followed by excisional biopsy or periodic imaging. The proportion of cases upgraded to a high-risk lesion and the odds of upgrade as related to a family history of breast cancer were determined with 95% confidence intervals (CIs).
RESULTS: We identified 622 cases of pure FEA; 101 (16.2%) underwent surgical excision and 269 (43.2%) had imaging follow-up of ≥ 24 months. There were no upgrades to DCIS or invasive cancer in any of these 370 individuals (0%), and 4.6% (17/370; 95% CI: 2.9%-7.2%) were upgraded to a high-risk lesion. There was a nonstatistically significant trend between family history and upgrade to high-risk lesion (odds ratio 1.72 [95% CI: 0.65%-4.57%]).
CONCLUSIONS: In our study, the upgrade rate of pure FEA to malignancy was 0%. We suggest that regular imaging follow-up is an appropriate alternative to surgery. Because of potential differences in biopsy techniques and pathologist interpretation of the primary biopsy, individual institutions should audit their own results prior to altering their management of FEA.