Schiaffino Simone, Gristina Licia, Villa Alessandro, Tosto Simona, Monetti Francesco, Carli Franca, Calabrese Massimo
1 Department of Radiology, University of Genoa , Genoa , Italy.
2 Department of Radiology, Ospedale San Bartolomeo , Sarzana , Italy.
Br J Radiol. 2018 Jan;91(1081):20170484. doi: 10.1259/bjr.20170484. Epub 2017 Nov 9.
To determine the malignancy rate (defined in this study as stability or absence of malignancy developed on close imaging follow-up post-biopsy) of conservative management in patients with a vacuum-assisted breast biopsy (VAB) diagnosis of flat epithelial atypia (FEA), performed on single group of microcalcifications, completely removed during procedure.
This is a retrospective, monocentric, observational study, approved by IRB. Inclusion criteria were: VAB performed on a single group of microcalcifications; the absence of residual calcifications post-VAB; diagnosis of isolated FEA as the most advanced proliferative lesion; radiological follow-up at least of 12 months. The personal history of breast cancer or other high-risk lesions was an exclusion criteria. The patients enrolled were conservatively managed, without surgical excision, through close follow-up: the first two mammographies performed with an interval of 6 months after biopsy, followed by annual mammographic and clinical checks.
48 consecutive patients were enrolled in the study, all females, with age range of 39-76 years (mean 53,3 years) and radiological follow-up range of 13-75 months (mean 41.5 months). All the lesions were classified as BI-RADS 4b. The diameter range of the group of calcifications was 3-10 mm (mean 5, 6 mm). In each patient, 7 to 15 samples (mean 11) were obtained. Among all the patients, there was only one case (2%) of new microcalcifications, developed in the same breast, 26 months after and 8 mm from the site of previous VAB, and interpreted as ADH at surgical excision. All the checks of the other patients were negative.
Even with a limited follow-up, we found a malignancy rate lower than 2%, through a defined population. Further studies with bigger number of patients and extended follow-up are needed to reinforce this hypothesis. Advances in knowledge: Surgical excision may not be necessary in patients with VAB diagnosis of isolated FEA, without residual microcalcifications post-procedure and considered concordant with the mammographic presentation, considering the low rate of malignancy at subsequent follow-ups.
确定在一组微钙化灶经真空辅助乳腺活检（VAB）诊断为扁平上皮异型增生（FEA）且手术过程中完全切除的患者中，保守治疗的恶性率（本研究定义为活检后密切影像学随访中无恶性病变出现或病变稳定）。
这是一项经机构审查委员会批准的回顾性、单中心观察性研究。纳入标准为：对一组微钙化灶进行VAB；VAB后无残留钙化；诊断为孤立性FEA作为最严重的增生性病变；放射学随访至少12个月。排除标准为有乳腺癌或其他高危病变的个人史。纳入的患者通过密切随访进行保守治疗，不进行手术切除：活检后前两次乳腺X线摄影间隔6个月，随后每年进行乳腺X线摄影和临床检查。
48例连续患者纳入本研究，均为女性，年龄范围39 - 76岁（平均53.3岁），放射学随访时间范围13 - 75个月（平均41.5个月）。所有病变均分类为BI-RADS 4b。钙化灶组直径范围为3 - 10毫米（平均5.6毫米）。每位患者获取7至15个样本（平均11个）。所有患者中，仅1例（2%）在同一乳房出现新的微钙化灶，发生在先前VAB部位26个月后且距离该部位8毫米处，手术切除时诊断为非典型导管增生（ADH）。其他患者的所有检查均为阴性。
即使随访有限，通过明确的人群我们发现恶性率低于2%。需要更多患者和更长随访时间的进一步研究来强化这一假设。知识进展：对于经VAB诊断为孤立性FEA、术后无残留微钙化且与乳腺X线表现一致的患者，考虑到后续随访中恶性率较低，可能无需手术切除。
