Coutant C, Canlorbe G, Bendifallah S, Beltjens F
Département d'oncologie chirurgicale, centre de lutte contre le cancer Georges-François-Leclerc - Unicancer, 1, rue Professeur-Marion, BP 77980, 21079 Dijon cedex, France; Université de Bourgogne-Franche Comté, esplanade Erasme, 21078 Dijon cedex, France.
Inserm UMRS938, service de gynécologie obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):980-95. doi: 10.1016/j.jgyn.2015.09.037. Epub 2015 Nov 3.
In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations.
在过去几年中，随着经皮乳腺活检数量的增加，对高危乳腺病变（非典型导管增生[ADH]、扁平上皮异型增生[FEA]、小叶瘤变：非典型小叶增生[ALH]、小叶原位癌[LCIS]、放射状瘢痕[RS]、普通导管增生[UDH]、腺病、硬化性腺病[SA]、乳头状乳腺病变、黏液囊肿样病变[MLL]）的诊断有所增加。这些病变的处理很大程度上取决于乳腺癌风险的增加，这与术后发现癌症的可能性增加、可能的恶性转化（原位癌或浸润癌）或长期发生癌症的可能性增加有关。文献综述报告了关于这些病变处理和随访的C级建议：对于经皮活检诊断为ADH、FEA、ALH、LCIS、RS、伴有异型性的MLL，建议手术切除；对于基于真空辅助芯针活检诊断且无异型性的FEA或RS的放射学信号完全消失的情况，手术放弃是多学科会议认可的有效替代方案。对于与导致放射学信号的良性病变相关的ALH（偶然发现），可建议放弃；对于经皮活检诊断为UDH、腺病、无异型性的MLL，必须确保放射学和组织病理学结果的一致性。尚无数据推荐手术；对于ADH、FEA、ALH、LCIS（除多形性类型外）、RS、MLL的非根治性切除，似乎无需手术；对于既往有ADH、ALH、LCIS的情况，建议根据法国卫生高级管理局（HAS）的建议进行特定随访。对于FEA和RS或伴有异型性的MLL，目前几乎没有数据来区分其处理方式与其他伴有异型性的病变；对于UDH、普通硬化性腺病、无异型性的RS、纤维囊性疾病，根据HAS的建议，不建议进行特定随访。
