Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2012 Feb;198(2):256-63. doi: 10.2214/AJR.11.7717.
This article focuses on four high-risk lesions: lobular neoplasia, benign papilloma, radial scar, and flat epithelial atypia. Controversies exist in the management after core biopsy of each of these lesions--whether to perform immediate surgical excision so as not to miss an associated malignancy or imaging follow-up because concomitant malignancy is low. This review is staged in two parts per lesion. The first is from data gathered during the last two American Roentgen Ray Society annual meetings from the audience response system querying practice management styles per diagnostic lesion. The second part is a brief review of selected articles recommending either follow-up or surgery. The strengths and weaknesses of each article are discussed.
Our opinion is that neither recommendation, surgical excision or follow-up, is well substantiated in the literature and that our ignorance is not serving the needs of women worldwide. The time is now for a prospective trial.
本文重点介绍了四种高风险病变：小叶肿瘤、良性乳头状瘤、放射状瘢痕和扁平上皮不典型性。在对这些病变的核心活检后，对于每一种病变的处理方式都存在争议，是进行立即手术切除以避免遗漏相关恶性肿瘤，还是进行影像学随访，因为伴发恶性肿瘤的风险较低。本综述分两部分对每一种病变进行分期。第一部分是根据过去两年美国放射学会年会中观众通过响应系统查询的关于每种诊断性病变的临床管理方式的数据汇总。第二部分是对建议随访或手术的一些精选文章的简要回顾。文章的优缺点都进行了讨论。
我们的观点是，文献中既没有支持手术切除也没有支持随访的充分证据，我们的无知并不能满足全世界女性的需求。现在是进行前瞻性试验的时候了。
