Department of Pathology, Comprehensive Cancer Center, Bordeaux, France.
Mod Pathol. 2011 Sep;24(9):1198-206. doi: 10.1038/modpathol.2011.73. Epub 2011 May 20.
The necessity of excision is debatable when atypia are diagnosed at stereotactic vacuum-assisted breast biopsy (microbiopsy). Among the 287 surgical excisions performed at Institut Bergonié from 1999 to 2009, we selected a case-control study group of 151 excisions; 52 involving all the diagnosed cancers and 99 randomly selected among the 235 excisions without cancer, following atypical microbiopsy (24 flat epithelial atypia; 50 atypical ductal hyperplasia; 14 lobular neoplasia; 63 mixed lesions). Mammographical calcification (type, extension, complete removal) and histological criteria of epithelial atypia (type, number of foci, size/extension), topography and microcalcification extension at microbiopsy were compared according to the presence or absence of cancer at excision. Factors associated with cancer at excision were Breast Imaging Reporting and Data System (BI-RADS5) lesions, large and/or multiple foci of mammographical calcifications, histological type, number, size and extension of atypical foci. Flat epithelial atypia alone was never associated with cancer at excision. BI-RADS5, atypical ductal hyperplasia (alone or predominant) and >3 foci of atypia were identified as independent pejorative factors. There was never any cancer at excision when these pejorative factors were absent (n=31). Presence of one (n=59), two (n=23) or three (n=14) factors was associated with cancer in 24, 15 and 13 cases with an odds ratio=5.8 (95% CI: 3-11.2) for each additional factor. We recommend that mammographical data and histological characteristics be taken into account in the decision-making process after diagnosis of atypia on microbiopsy. With experienced senologists and strict histological criteria, some patients could be spared surgery resulting in significant patient, financial and time advantages.
在立体定向真空辅助乳腺活检（微创活检）诊断非典型性时，是否需要切除存在争议。在 1999 年至 2009 年期间，我们在 Bergonié 研究所进行了 287 例外科切除手术，从中选择了 151 例进行病例对照研究；52 例涉及所有诊断出的癌症，99 例是在非癌性微创活检（24 例扁平上皮非典型性；50 例非典型导管增生；14 例小叶肿瘤；63 例混合病变）后随机选择的。根据切除术后是否存在癌症，比较了乳腺 X 线摄影钙化（类型、范围、完全清除）和上皮非典型性的组织学标准（类型、病灶数量、大小/范围）、微创活检时的肿瘤位置和微钙化范围。与切除术后癌症相关的因素有乳腺影像报告和数据系统（BI-RADS5）病变、大的和/或多个乳腺 X 线摄影钙化灶、组织学类型、非典型病灶的数量、大小和范围。单纯扁平上皮非典型性与切除术后癌症无关。BI-RADS5、非典型导管增生（单独或主要）和>3 个非典型病灶被确定为独立的不良因素。当这些不良因素不存在时（n=31），切除术后从未发现癌症。当存在一个（n=59）、两个（n=23）或三个（n=14）不良因素时，分别有 24、15 和 13 例患者发生癌症，每个额外因素的比值比为 5.8（95%CI：3-11.2）。我们建议在微创活检诊断出非典型性后，根据乳腺 X 线摄影数据和组织学特征来制定决策。在有经验的超声科医生和严格的组织学标准的情况下，一些患者可以避免手术，从而带来显著的患者、经济和时间优势。
