Lavoué V, Bertel C, Tas P, Bendavid C, Rouquette S, Foucher F, Audrain O, Bouriel C, Levêque J
Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90243, 35203 Rennes cedex 2, France.
J Gynecol Obstet Biol Reprod (Paris). 2010 Feb;39(1):11-24. doi: 10.1016/j.jgyn.2009.09.007. Epub 2009 Oct 22.
The diagnosis of atypical epithelial hyperplasia (AEH) increases with breast cancer screening. AEH is divided in three groups: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia. The management of women with AEH is not consensual because of uncertainty about their diagnosis related to the type of the biopsy sampling (core needle biopsy or surgical excision) and their controversial clinical signification between risk marker and true precursor of breast cancer.
A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia, core needle biopsy, breast cancer, precursor lesion, hormonal replacement therapy. For each breast lesion, identified publications (English or French) were assessed for clinical practise in epidemiology, diagnosis and patient management.
With immunohistochemistry and molecular studies, AEH seems to be precursor of breast cancer. But, epidemiological studies show low rate of breast cancer in women with AEH. AEH were still classified as risk factor of breast cancer.
Because of high rate of breast cancer underestimation, surgical excision is necessary after the diagnosis of AEH at core needle biopsy. Surgical oncology rules and collaboration with radiologist are required for this surgery. A second operation was not required due to involved margins by AEH (except with pleiomorphic lobular neoplasia) because local control of breast cancer seems to be unchanged. Besides, hormonal replacement therapy for patient with AEH is not recommended because of lack of studies about this subject.
随着乳腺癌筛查的开展，非典型上皮增生（AEH）的诊断率有所上升。AEH分为三组：非典型导管增生、非典型柱状细胞病变、小叶肿瘤。由于活检取样类型（粗针活检或手术切除）导致诊断存在不确定性，以及其在乳腺癌风险标志物与真正前驱病变之间存在争议的临床意义，对于患有AEH的女性的治疗尚无共识。
对已发表的研究进行系统综述。使用以下关键词在Medline数据库进行基本检索：非典型导管增生、非典型柱状细胞病变、小叶肿瘤、粗针活检、乳腺癌、前驱病变、激素替代疗法。对于每种乳腺病变，对检索到的（英文或法文）出版物进行流行病学、诊断和患者管理方面的临床实践评估。
通过免疫组织化学和分子研究，AEH似乎是乳腺癌的前驱病变。但是，流行病学研究显示患有AEH的女性乳腺癌发病率较低。AEH仍被归类为乳腺癌的危险因素。
由于乳腺癌漏诊率较高，在粗针活检诊断为AEH后需要进行手术切除。该手术需要遵循外科肿瘤学原则并与放射科医生协作。由于AEH（多形性小叶肿瘤除外）切缘受累不需要进行二次手术，因为乳腺癌的局部控制似乎未受影响。此外，由于缺乏关于这一主题的研究，不建议对患有AEH的患者进行激素替代疗法。
