Lewis Jason T, Hartmann Lynn C, Vierkant Robert A, Maloney Shaun D, Shane Pankratz V, Allers Teresa M, Frost Marlene H, Visscher Daniel W
Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Am J Surg Pathol. 2006 Jun;30(6):665-72. doi: 10.1097/00000478-200606000-00001.
Breast papillomas may be single or multiple and associated with atypical ductal or lobular hyperplasias (ADH/ALH). The risk of breast carcinoma development in patients with papillomas, particularly those with multiple or atypical lesions, is incompletely defined. Fibrocystic lesions were histopathologically classified in a benign breast disease cohort of 9155 who underwent biopsy from 1967 to 1991, with papilloma assessment in 9108. Individuals with papillomas (N=480) were classified into 4 groups: single papilloma (SP, N=372), single papilloma with ADH or ALH (SP+A, N=54), multiple (>5) papillomas (MP, N=41), and multiple papillomas with ADH or ALH (MP+A, N=13). Those without papillomas were classified as nonproliferative (NP, N=6053), proliferative without atypia (PDWA, N=2308), and ADH/ALH [atypical hyperplasia (AH), N=267]. The relative risk of cancer development within our cohort was compared to that expected in the general population using standardized incidence ratios. The relative risk of breast cancer development associated with SP [2.04, 95% confidence interval (CI) 1.43-2.81] was greater than NP (1.28, 95% CI 1.16-1.42) but similar to PDWA (1.90, 95% CI 1.66-2.16). The risk associated with SP+A (5.11, 95% CI 2.64-8.92) was highly elevated but not substantively different than atypical hyperplasia (4.17, 95% CI 3.10-5.50). Patients with MP are at increased risk compared with PDWA or SP (3.01, 95% CI 1.10-6.55), particularly those with MP+A (7.01, 95% CI 1.91-17.97). There was a marginal increase in breast cancer risk (16%) among patients with proliferative disease if a papilloma was present, but this did not reach statistical significance (P=0.29). The observed frequency of ipsilateral (vs. contralateral) breast cancer development in papilloma subsets was not significantly different than other patient groups. We conclude that SP imparts a cancer risk similar to conventional proliferative fibrocystic change. The presence of papilloma in, or associated with, atypia does not modify the risk connotation of ADH/ALH overall. MP constitutes a proliferative breast disease subset having unique clinical and biologic behavior.
乳腺乳头状瘤可以是单发或多发的，并与非典型导管或小叶增生（ADH/ALH）相关。乳头状瘤患者，尤其是那些有多发或非典型病变的患者，发生乳腺癌的风险尚未完全明确。在1967年至1991年接受活检的9155例良性乳腺疾病队列中，对纤维囊性病变进行了组织病理学分类，其中9108例进行了乳头状瘤评估。有乳头状瘤的个体（N = 480）被分为4组：单发乳头状瘤（SP，N = 372）、伴有ADH或ALH的单发乳头状瘤（SP + A，N = 54）、多发（>5个）乳头状瘤（MP，N = 41）以及伴有ADH或ALH的多发乳头状瘤（MP + A，N = 13）。没有乳头状瘤的个体被分为非增殖性（NP，N = 6053）、无非典型性的增殖性（PDWA，N = 2308）和ADH/ALH[非典型增生（AH），N = 267]。使用标准化发病率比，将我们队列中癌症发生的相对风险与一般人群中预期的风险进行比较。与SP相关的乳腺癌发生相对风险[2.04，95%置信区间（CI）1.43 - 2.81]高于NP（1.28，95% CI 1.16 - 1.42），但与PDWA（1.90，95% CI 1.66 - 2.16）相似。与SP + A相关的风险（5.11，95% CI 2.64 - 8.92）显著升高，但与非典型增生（4.17，95% CI 3.10 - 5.50）相比没有实质性差异。与PDWA或SP相比，MP患者的风险增加（3.01，95% CI 1.10 - 6.55），尤其是那些MP + A患者（7.01，95% CI 1.91 - 17.97）。如果存在乳头状瘤，增殖性疾病患者的乳腺癌风险有轻微增加（16%），但未达到统计学意义（P = 0.29）。乳头状瘤亚组中同侧（与对侧相比）乳腺癌发生的观察频率与其他患者组没有显著差异。我们得出结论，SP赋予的癌症风险与传统的增殖性纤维囊性改变相似。在非典型性中存在或与之相关的乳头状瘤总体上不会改变ADH/ALH的风险内涵。MP构成了具有独特临床和生物学行为的增殖性乳腺疾病亚组。
