Foley N M, Racz J M, Al-Hilli Z, Livingstone V, Cil T, Holloway C M B, Romics L, Matrai Z, Bennett M W, Duddy L, Nofech-Mozes S, Slodkowska E, Mallon E A, Dawson N, Roche T, Relihan N, Hill A D K, Redmond H P, Corrigan M A
Breast Research Centre, Cork University Hospital, Cork, Ireland.
Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S385-90. doi: 10.1245/s10434-015-4773-z. Epub 2015 Aug 4.
Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary.
A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata.
A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer.
This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.
乳腺乳头状病变相对少见，但具有异质性，涵盖从良性到非典型性及恶性的病变。关于这些病变的最佳管理存在争议。在缺乏更准确的风险分层模型的情况下，尽管大多数病变被证明是良性的，但传统管理指南仍推荐手术切除。本研究旨在确定切除的乳腺乳头状瘤的恶性率，并阐明是否存在无需手术切除的人群。
在获得机构伦理批准后，于2009年至2013年对经核心活检诊断的乳腺乳头状瘤和乳头状病变进行了一项多中心国际回顾性研究。记录患者的人口统计学、组织病理学和放射学检查结果。所有数据制成表格，并使用Stata进行统计分析。
最终分析共纳入238例患者。良性病理患者的年龄分布显著低于恶性病理患者（p < 0.001）。核心针吸活检中的非典型性与最终病理诊断为恶性显著相关（OR = 2.73）。从良性核心针吸活检到最终病理样本中恶性的升级率为14.4%；然而，只有3.7%为浸润性癌。
该国际数据集是已发表文献中与乳腺乳头状瘤相关的最大数据集之一。恶性的总体风险与年龄较大以及核心针吸活检中存在非典型性显著相关。根据年龄和核心针吸活检结果对高风险患者进行分层，从而避免对低风险患者进行手术可能是可行的。
