Department of Pathology & Laboratory Medicine, College of Medicine, University of Florida, Jacksonville, FL 32209, USA.
Adv Anat Pathol. 2011 May;18(3):190-8. doi: 10.1097/PAP.0b013e31821698cc.
Breast cancer remains a global public health problem and is currently the most polarized cancer in the world. Attention to this disease, public awareness, and advances in breast imaging have made a positive impact on breast cancer screening and detection. The growing use of image-detected biopsies has led to increased diagnosis of ductal carcinoma in situ and high-risk proliferative breast lesions. This progress, however, has created a challenge for pathologists. In lieu of the fact that these entities are difficult to diagnose even in tissue sections taken from surgically excised lesions, pathologist are now expected to diagnose them in small and often fragmented tissue/cellular samples obtained from image-guided biopsies. In addition, some proliferative lesions are associated with an increased risk of finding neighboring malignancy when diagnosed on minimally invasive procedures. Therefore, classifying these lesions in small biopsies is difficult and risky. Some of the most challenging areas in diagnostic pathology includes the differentiation between atypical ductal hyperplasia and low-grade ductal carcinoma in situ, lobular neoplasia versus solid low-grade ductal carcinoma in situ, the correct interpretation of papillary lesions with atypia, and classifying the spectrum of columnar cell changes. Although these issues have been recognized for years, consensus criteria and uniform terminology for the diagnosis of these problematic lesions are far from being achieved. The purpose of this study is to review these "borderline" proliferative lesions in an effort to clarify some criteria and prompt the most needed discussion for consensus.
乳腺癌仍然是一个全球性的公共卫生问题，目前是世界上最两极分化的癌症。对这种疾病的关注、公众意识的提高以及乳腺成像技术的进步，对乳腺癌的筛查和检测产生了积极的影响。越来越多的使用影像检测活检导致了原位导管癌和高风险增殖性乳腺病变的诊断增加。然而，这一进展给病理学家带来了挑战。由于这些实体即使在从手术切除的病变中获取的组织切片中也难以诊断，因此现在病理学家需要在从影像引导活检获得的小而经常碎片化的组织/细胞样本中诊断这些实体。此外，一些增殖性病变在微创程序诊断时与发现邻近恶性肿瘤的风险增加有关。因此，在小活检中对这些病变进行分类具有挑战性。诊断病理学中最具挑战性的领域之一包括：非典型性导管增生和低级别原位导管癌、小叶肿瘤与实体低级别原位导管癌、具有非典型性的乳头状病变的正确解读、以及柱状细胞变化的分类。尽管这些问题已经存在多年，但对于这些有问题的病变的诊断，共识标准和统一术语还远未达成。本研究的目的是回顾这些“边界性”增殖性病变，以澄清一些标准，并为达成共识提出最需要的讨论。
