Lavoué Vincent, Fritel Xavier, Antoine Martine, Beltjens Françoise, Bendifallah Sofiane, Boisserie-Lacroix Martine, Boulanger Loic, Canlorbe Geoffroy, Catteau-Jonard Sophie, Chabbert-Buffet Nathalie, Chamming's Foucauld, Chéreau Elisabeth, Chopier Jocelyne, Coutant Charles, Demetz Julie, Guilhen Nicolas, Fauvet Raffaele, Kerdraon Olivier, Laas Enora, Legendre Guillaume, Mathelin Carole, Nadeau Cédric, Naggara Isabelle Thomassin, Ngô Charlotte, Ouldamer Lobna, Rafii Arash, Roedlich Marie-Noelle, Seror Jérémy, Séror Jean-Yves, Touboul Cyril, Uzan Catherine, Daraï Emile
Department of Gynecology, Rennes University Hospital, France; ER440, Oncogenesis, Stress and Signaling, INSERM Labeled, CRLCC Eugène Marquis, Rennes, France; University of Rennes 1, France.
University of Poitiers, CIC 1402, Poitiers University Hospital, Poitiers, France; CESP Inserm U1018, Kremlin-Bicêtre, France.
Eur J Obstet Gynecol Reprod Biol. 2016 May;200:16-23. doi: 10.1016/j.ejogrb.2016.02.017. Epub 2016 Feb 28.
Screening with breast ultrasound in combination with mammography is needed to investigate a clinical breast mass (Grade B), colored single-pore breast nipple discharge (Grade C), or mastitis (Grade C). The BI-RADS system is recommended for describing and classifying abnormal breast imaging findings. For a breast abscess, a percutaneous biopsy is recommended in the case of a mass or persistent symptoms (Grade C). For mastalgia, when breast imaging is normal, no MRI or breast biopsy is recommended (Grade C). Percutaneous biopsy is recommended for a BI-RADS category 4-5 mass (Grade B). For persistent erythematous nipple or atypical eczema lesions, a nipple biopsy is recommended (Grade C). For distortion and asymmetry, a vacuum core-needle biopsy is recommended due to the risk of underestimation by simple core-needle biopsy (Grade C). For BI-RADS category 4-5 microcalcifications without any ultrasound signal, a minimum 11-G vacuum core-needle biopsy is recommended (Grade B). In the absence of microcalcifications on radiography cores additional samples are recommended (Grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, radial scar and mucocele with atypia, surgical excision is commonly recommended (Grade C). Expectant management is feasible after multidisciplinary consensus. For these lesions, when excision margins are not clear, no new excision is recommended except for LCIS characterized as pleomorphic or with necrosis (Grade C). For grade 1 phyllodes tumor, surgical resection with clear margins is recommended. For grade 2 phyllodes tumor, 10mm margins are recommended (Grade C). For papillary breast lesions without atypia, complete disappearance of the radiological signal is recommended (Grade C). For papillary breast lesions with atypia, complete surgical excision is recommended (Grade C).
对于临床乳腺肿块（B级）、血性单孔乳腺乳头溢液（C级）或乳腺炎（C级），需要联合乳腺超声和乳腺钼靶进行筛查。建议使用BI-RADS系统对异常乳腺影像学检查结果进行描述和分类。对于乳腺脓肿，若存在肿块或持续症状，建议进行经皮活检（C级）。对于乳腺疼痛，若乳腺影像学检查正常，不建议进行MRI或乳腺活检（C级）。对于BI-RADS 4-5类肿块，建议进行经皮活检（B级）。对于持续性乳头红斑或非典型湿疹样病变，建议进行乳头活检（C级）。对于乳腺结构扭曲和不对称，由于单纯粗针活检有低估风险，建议进行真空粗针活检（C级）。对于无任何超声信号的BI-RADS 4-5类微钙化，建议至少进行11G真空粗针活检（B级）。若放射状粗针活检未发现微钙化，建议取额外样本（B级）。对于非典型导管增生、非典型小叶增生、小叶原位癌、扁平上皮不典型增生、放射状瘢痕和非典型黏液囊肿，通常建议手术切除（C级）。多学科会诊后可进行观察处理。对于这些病变，若切除切缘不清晰，除具有多形性或坏死特征的小叶原位癌外，不建议再次切除（C级）。对于1级叶状肿瘤，建议进行切缘清晰的手术切除。对于2级叶状肿瘤，建议切缘为10mm（C级）。对于无非典型性的乳头状乳腺病变，建议放射学信号完全消失（C级）。对于有非典型性的乳头状乳腺病变，建议进行完整手术切除（C级）。
