Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2017 Nov;24(12):3549-3558. doi: 10.1245/s10434-017-6059-0. Epub 2017 Aug 22.
No consensus exists on whether flat epithelial atypia (FEA) diagnosed percutaneously should be surgically excised. A systematic review and meta-analysis of the frequency of upgrade to cancer or an atypical ductal hyperplasia (ADH) at surgical excision of FEA was performed.
Embase, MEDLINE, Scopus, and Web of Science databases from January 2003 to November 2015 were searched. The inclusion criteria required a manuscript in English with original data on FEA diagnosed percutaneously, data including the presence or absence of other concurrent high-risk lesions, and data including outcome of cancer at surgical excision. Studies were assessed for quality, and two reviewers extracted data. Random-effects meta-analysis was used to pool estimates. The impact of study-level characteristics was assessed by stratified meta-analysis and meta-regression.
The inclusion criteria was met by 32 studies. A total of 1966 core needle biopsies showed pure FEA, and 1517 (77%) showed surgical excision. The proportions of patients with upgrade to cancer varied from 0 to 42%, with an overall pooled estimate of 11.1%. Heterogeneity was observed, with the greatest impact based on whether a study included cases of FEA diagnosed before 2003. With restriction of the investigation to 16 higher-quality studies, the cancer upgrade pooled estimate was 7.5% (95% confidence interval [CI], 5.4-10.4%), and the rate of invasive cancer was 3% (95% CI 1.9-4.5%). For upgrade to ADH, data from 22 studies including 937 patients were analyzed. The proportion of patients upgraded to ADH ranged from 0 to 60%, with a pooled estimate of 17.9% overall and 18.6% among high-quality studies.
With patient management change potential for approximately 25% of patients, this analysis supports a general recommendation for surgical excision of FEA diagnosed by core biopsy.
经皮诊断的平坦上皮不典型（FEA）是否应行手术切除尚无共识。对经皮切除 FEA 后癌症或非典型导管增生（ADH）升级的频率进行了系统评价和荟萃分析。
检索 2003 年 1 月至 2015 年 11 月期间的 Embase、MEDLINE、Scopus 和 Web of Science 数据库。纳入标准为：英文手稿，有经皮诊断为 FEA 的原始数据，包括是否存在其他高危病变，以及手术切除时癌症结果的数据。评估研究质量，由两位审查者提取数据。采用随机效应荟萃分析汇总估计值。通过分层荟萃分析和荟萃回归评估研究水平特征的影响。
32 项研究符合纳入标准。共 1966 例经皮活检显示单纯 FEA，1517 例（77%）行手术切除。升级为癌症的患者比例从 0%到 42%不等，总体汇总估计值为 11.1%。存在异质性，最大影响因素是研究中是否包括 2003 年前诊断为 FEA 的病例。限制调查范围至 16 项高质量研究后，癌症升级的汇总估计值为 7.5%（95%置信区间 [CI]：5.4%10.4%），浸润性癌的发生率为 3%（95% CI：1.9%4.5%）。对于升级为 ADH，分析了包括 937 例患者的 22 项研究的数据。升级为 ADH 的患者比例从 0%到 60%不等，总体汇总估计值为 17.9%，高质量研究的汇总估计值为 18.6%。
大约 25%的患者有潜在的治疗管理变化，这一分析支持对经皮活检诊断的 FEA 行手术切除的一般建议。
