Department of Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel.
Radiology Associates of Albuquerque, Albuquerque, NM, USA; Department of Radiology, University of New Mexico, Albuquerque, NM, USA.
Am J Surg. 2014 Jan;207(1):24-31. doi: 10.1016/j.amjsurg.2013.05.014. Epub 2013 Oct 7.
Upgrade rates of high-risk breast lesions after screening mammography were examined.
The Breast Cancer Surveillance Consortium registry was used to identify all Breast Imaging Reporting and Data System category 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women.
High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (n = 685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia, and 2% in papillary lesions). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, and those associated with lobular neoplasia were mostly (56%) invasive. During a further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery.
Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on Breast Imaging Reporting and Data System category 4 mammograms among asymptomatic women do not justify surgical excision.
本研究旨在探讨筛查性乳房 X 线摄影后高危乳腺病变的升级率。
本研究使用乳腺癌监测联盟的注册数据库，确定所有乳腺影像报告和数据系统（BI-RADS）分类 4 评估后行针吸活检的高危病变。对所有女性进行随访。
在 957 例针吸活检中发现了高危病变，其中 53%进行了切除。大多数（n=685）为非典型导管增生（ADH），173 例为小叶肿瘤，99 例为乳头状病变。病变类型与升级为癌症的比例相关（ADH 为 18%，小叶肿瘤为 10%，乳头状病变为 2%）。在 ADH 的绝经前妇女中，升级与家族史相关。与 ADH 相关的癌症大多为（82%）导管原位癌，与小叶肿瘤相关的癌症大多为（56%）浸润性癌。在进一步的 2 年随访中，接受随访手术的妇女中有 1%确诊为癌症，未接受手术的妇女中有 3%确诊为癌症。
尽管手术率较低，但在随访期间仍有较低的癌症发生率。无症状妇女 BI-RADS 分类 4 乳房 X 线摄影诊断的良性乳头状病变不需要手术切除。
