Contesso G, Bertin F, Terrier P, Petit J Y, Le M
Institut Gustave-Roussy, Villejuif.
Rev Fr Gynecol Obstet. 1991 Jan;86(1):9-12.
For the pathologist, the term "mastopathy at risk" comprises a double aspect. On one hand, a good definition of the boundary between benign lesions and cancer. The latter uses mainly, and still now, morphological signs, and no "markers" enable an infallible differentiation. Certainly certain criteria are useful observations to distinguish between intra-canal and intralobular epithelial hyperplasia of the carcinomas in situ, or to recognize between a tubular carcinoma and certain adenosis foci. But it is often the pathologist's experience which makes the difference. On the other hand, a good knowledge of the epidemiological studies associating, to each of the anatomopathological entities constituting the fibro-cystic mastopathy, a risk factor for breast cancer. Indeed, the pathologist must indicate, in his report, these various entities in order to help the clinician take his therapeutic decision. The results of the study of a population of 3,305 women who have been examined at the Gustave Roussy Institute between 1970 and 1973 for benign mammary lesions, 401 on whom a biopsy was carried out, will illustrate this observation, revealing the importance of multiple fibro-adenosis foci, small cysts and lobe hyperplasias. But the histological details of these benign mastopathies must imperatively be integrated to the epidemiological and clinical data on the patient in order to adapt the therapeutic protocol for the best.
对于病理学家而言，“有风险的乳腺病”这一术语包含两个方面。一方面，要对良性病变与癌症之间的界限有一个良好的定义。目前，区分主要仍依靠形态学特征，尚无“标志物”能实现绝对无误的鉴别。当然，某些标准对于区分原位癌的导管内和小叶内上皮增生，或辨别管状癌与某些腺病病灶是有用的观察依据。但往往是病理学家的经验起到关键作用。另一方面，要充分了解流行病学研究，这些研究将构成纤维囊性乳腺病的每一种解剖病理学实体与乳腺癌的一个风险因素联系起来。实际上，病理学家必须在其报告中指出这些不同的实体，以帮助临床医生做出治疗决策。对1970年至1973年间在古斯塔夫·鲁西研究所接受检查的3305名患有良性乳腺病变的女性群体进行研究的结果，以及其中401名接受活检的女性的情况，将说明这一点，揭示出多个纤维腺病病灶、小囊肿和小叶增生的重要性。但是，这些良性乳腺病的组织学细节必须与患者的流行病学和临床数据相结合，以便最好地调整治疗方案。
