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用于风险评估和预防的乳腺组织取样

Breast-tissue sampling for risk assessment and prevention.

作者信息

Fabian C J, Kimler B F, Mayo M S, Khan S A

机构信息

Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KA 66160, USA.

出版信息

Endocr Relat Cancer. 2005 Jun;12(2):185-213. doi: 10.1677/erc.1.01000.

Abstract

Breast tissue and duct fluid provide a rich source of biomarkers to both aid in the assessment of short-term risk of developing breast cancer and predict and assess responses to prevention interventions. There are three methods currently being utilized to sample breast tissue in asymptomatic women for risk assessment: nipple-aspirate fluid (NAF), random periareolar fine-needle aspiration (RPFNA) and ductal lavage. Prospective single-institution trials have shown that the presence of atypical cells in NAF fluid or RPFNA specimens is associated with an increased risk of breast cancer. Furthermore, RPFNA-detected atypia has been observed to further stratify risk based on the commonly used Gail risk-assessment model. A prospective trial evaluating risk prediction on the basis of atypical cells in ductal-lavage fluid is ongoing. The ability of other established non-genetic biomarkers (mammographic breast density; serum levels of bioavailable estradiol, testosterone, insulin-like growth factor-1 and its insulin like growth factor binding protein-3) to stratify risk based on the Gail model is as yet incompletely defined. Modulation of breast intra-epithelial neoplasia (i.e. hyperplasia with or without atypia) with or without associated breast-tissue molecular markers, such as proliferation, is currently being used to evaluate response in Phase II chemoprevention trials. RPFNA has been the method most frequently used for Phase II studies of 6-12 months duration. However, ductal lavage, RPFNA and random and directed core needle biopsies are all being utilized in ongoing multi-institutional Phase II studies. The strengths and weaknesses of each method are reviewed.

摘要

乳腺组织和导管液提供了丰富的生物标志物来源,有助于评估患乳腺癌的短期风险,并预测和评估对预防干预措施的反应。目前有三种方法用于对无症状女性的乳腺组织进行采样以进行风险评估:乳头抽吸液(NAF)、随机乳晕周围细针抽吸(RPFNA)和导管灌洗。前瞻性单机构试验表明,NAF液或RPFNA标本中存在非典型细胞与乳腺癌风险增加相关。此外,已观察到RPFNA检测到的非典型性可根据常用的盖尔风险评估模型进一步分层风险。一项基于导管灌洗液中非典型细胞评估风险预测的前瞻性试验正在进行中。其他已确立的非基因生物标志物(乳腺钼靶密度;生物可利用雌二醇、睾酮、胰岛素样生长因子-1及其胰岛素样生长因子结合蛋白-3的血清水平)根据盖尔模型分层风险的能力尚未完全明确。目前,在II期化学预防试验中,正在使用对乳腺上皮内瘤变(即伴有或不伴有非典型性的增生)进行调节,并结合或不结合相关乳腺组织分子标志物(如增殖)来评估反应。RPFNA一直是用于为期6至12个月的II期研究中最常用的方法。然而,导管灌洗、RPFNA以及随机和定向核心针活检都在正在进行的多机构II期研究中得到应用。本文综述了每种方法的优缺点。

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