乳腺小叶原位癌和不典型小叶增生的处理——综述。

Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast--a review.

机构信息

Wycombe General Hospital, Department of Breast Surgery, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK.

出版信息

Eur J Surg Oncol. 2011 Apr;37(4):279-89. doi: 10.1016/j.ejso.2011.01.009.

DOI:10.1016/j.ejso.2011.01.009

PMID:21306860

Abstract

OBJECTIVES

To determine the incidence of malignancy (invasive carcinoma or DCIS) in patients diagnosed with lobular neoplasia (B3) on core needle biopsy (CNB) of breast lesions by reviewing the published literature.

METHODS

Medline, Embase, OVID-database and reference lists were searched to identify and review all English-language articles addressing the management of LN diagnosed on CNB. Studies on mixed breast pathologies were excluded.

RESULTS

Of 1229 LN diagnosed on CNB, 789 (64%) underwent surgical excision. 211 (27%) of excisions contained either DCIS or invasive disease. 280 of the excision specimens were classified as ALH, 241 as LCIS, 22 as pleomorphic LCIS and 246 unspecified LN on the original CNB. After surgical excision, 19% of the ALH cases, 32% of the LCIS cases and 41% of the PLCIS cases, contained malignancy. 29% of the unspecified LNs were upgraded to malignancy. The higher incidence of malignancy within excision specimens for LCIS and PLCIS compared to ALH was significant (P < 0.04, <0.003 respectively).

CONCLUSION

There is a significant underestimation of malignancy in patients diagnosed with breast LN on CNB. 27% cases of CNB-diagnosed LN were found to contain malignancy following surgical excision. All patients diagnosed with LN on CNB should be considered for surgical excision biopsy.

摘要

目的

通过回顾已发表的文献，确定在乳腺病变的核心针活检（CNB）中诊断为小叶肿瘤性病变（B3）的患者中恶性肿瘤（浸润性癌或 DCIS）的发生率。

方法

检索 Medline、Embase、OVID 数据库和参考文献列表，以确定并回顾所有涉及 CNB 诊断的 LN 管理的英文文章。排除混合性乳腺病变的研究。

结果

在 1229 例 CNB 诊断的 LN 中，789 例（64%）进行了手术切除。211 例（27%）切除标本中含有 DCIS 或浸润性疾病。280 例切除标本在原始 CNB 中被分类为 ALH，241 例为 LCIS，22 例为多形性 LCIS，246 例为未指定的 LN。手术后，ALH 病例中 19%、LCIS 病例中 32%和 PLCIS 病例中 41%的病例含有恶性肿瘤。29%的未指定 LN 升级为恶性肿瘤。LCIS 和 PLCIS 切除标本中恶性肿瘤的发生率高于 ALH，差异有统计学意义（P<0.04，<0.003）。