目的:与异型性有关的纤维腺瘤(FAs)很少见。由于报告导管原位癌(DCIS)或浸润性恶性肿瘤的手术升级率的数据有限,因此在图像引导活检中诊断为非典型性的FAs管理共识指南不存在。因此,这些病变通常接受手术切除。
方法:这项单机构回顾性研究确定了涉及非典型导管增生(ADH)的FAs病例,不典型小叶增生(ALH),和/或2014年1月至2023年4月在图像引导活检中诊断的小叶原位癌(LCIS),以确定升级率。排除了与FAs相邻但不涉及的偶然非典型性病例。
结果:在图像引导活检中诊断出的1736个FA中,32例(1.8%)为异型性FAs,其中43.8%(14/32)为ALH,28.1%(9/32)ADH,18.8%(6/32)LCIS,6.3%(2/32)LCIS+ALH,和3.1%(1/32)未指明的非典型性。最常见的影像学发现是肿块。大多数情况下,81.3%(26/32),随后接受手术切除活检。1例涉及并与FA相邻的ADH在切除时升级为低级别DCIS涉及的FA,整体手术升级率为3.8%。没有病例升级为侵袭性恶性肿瘤。对于那些省略手术切除的人,在平均73个月的随访中,在FA活检部位没有随后的恶性肿瘤诊断.
结论:涉及非典型性的放射学-病理学一致FAs病例的升级率较低,为3.8%,应进行多学科审查。需要进行更大的多机构分析,以确定非典型性切除指南是否应适用于涉及FA的非典型性。
OBJECTIVE: Fibroadenomas (FAs) involved by atypia are rare. Consensus guidelines for management of FAs involved by atypia when diagnosed on image-guided biopsy do not exist because of limited data reporting surgical
upgrade rates to ductal carcinoma in situ (DCIS) or invasive malignancy. Therefore, these lesions commonly undergo surgical excision.
METHODS: This single-institution retrospective study identified cases of FAs involved by atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) diagnosed on image-guided biopsy between January 2014 and April 2023 to determine
upgrade rates. Cases with incidental atypia adjacent to but not involving FAs were excluded.
RESULTS: Among 1736 FAs diagnosed on image-guided biopsy, 32 cases (1.8%) were FAs involved by atypia including 43.8% (14/32) ALH, 28.1% (9/32) ADH, 18.8% (6/32) LCIS, 6.3% (2/32) LCIS + ALH, and 3.1% (1/32) unspecified atypia. The most common imaging finding was a mass. Most cases, 81.3% (26/32), underwent subsequent surgical excisional biopsy. A single case of ADH involving and adjacent to an FA was upgraded to FA involved by low-grade DCIS on excision for an overall surgical
upgrade rate of 3.8%. There were no cases upgraded to invasive malignancy. For those omitting surgical excision, there was no subsequent malignancy diagnosis at the FA biopsy site over a mean follow-up of 73 months.
CONCLUSIONS: Cases of radiologic-pathologic concordant FAs involved by atypia have a low
upgrade rate of 3.8% and should undergo multidisciplinary review. Larger multi-institutional analysis is needed to determine whether guidelines for excision of atypia should apply to atypia involving FAs.