Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Nat Rev Clin Oncol. 2015 Apr;12(4):227-38. doi: 10.1038/nrclinonc.2015.8. Epub 2015 Jan 27.
High-risk breast lesions, which comprise benign lesions and in situ carcinomas (lobular carcinoma in situ and ductal carcinoma in situ), are clinically, morphologically, and biologically heterogeneous and are associated with an increased risk of invasive breast cancer development, albeit to varying degrees. Recognition and proactive management of such lesions can help to prevent progression to invasive disease, and might, therefore, reduce breast cancer incidence, morbidity, and mortality. However, this opportunity comes with the possibility of overdiagnosis and overtreatment, necessitating risk-based intervention. Notably, despite the progress in defining the molecular changes associated with carcinogenesis, alterations identifying the individuals with high-risk lesions that will progress to invasive carcinoma remain to be identified. Thus, until reproducible clinicopathological or molecular features predicting an individual's risk of breast cancer are found, management strategies must be defined by population-level risks as determined by models such as the Gail or IBIS models, as well as patient attitudes toward the risks and benefits of interventions. Herein, we review the contemporary approaches to diagnosis and management of high-risk breast lesions. Progress in this area will ultimately be dependent on the ability to individualize risk prediction through better definition of the key drivers in the carcinogenic process.
高危乳腺病变包括良性病变和原位癌（乳腺小叶原位癌和导管原位癌），在临床上、形态上和生物学上具有异质性，并且与浸润性乳腺癌发展的风险增加相关，尽管程度不同。识别和积极管理这些病变有助于预防进展为浸润性疾病，因此可能降低乳腺癌的发病率、患病率和死亡率。然而，这一机会伴随着过度诊断和过度治疗的可能性，需要基于风险的干预。值得注意的是，尽管在确定与癌变相关的分子变化方面取得了进展，但仍需确定哪些具有高危病变的个体将进展为浸润性癌。因此，在找到能够预测个体患乳腺癌风险的可重复的临床病理或分子特征之前，管理策略必须根据 Gail 或 IBIS 等模型确定的人群风险来定义，以及患者对干预风险和益处的态度。本文综述了高危乳腺病变的当代诊断和管理方法。该领域的进展最终将取决于通过更好地定义致癌过程中的关键驱动因素来实现个体化风险预测的能力。
