Lamb Leslie R, Bahl Manisha, Gadd Michele A, Lehman Constance D
Department of Radiology, Massachusetts General Hospital, Boston, MA.
Department of Radiology, Massachusetts General Hospital, Boston, MA.
J Am Coll Surg. 2017 Dec;225(6):696-701. doi: 10.1016/j.jamcollsurg.2017.08.022. Epub 2017 Oct 31.
Our aim was to determine upgrade rates of pure flat epithelial atypia (FEA) to malignancy and higher-risk lesions and to identify patients with FEA at low risk for upgrade.
Medical chart review from 2007 to 2016 identified 208 consecutive patients with pure FEA diagnosed by image-guided core needle biopsy who underwent surgical excision (96.2% [200 of 208]) or had at least 2 years of imaging follow-up (3.8% [8 of 208]). Medical records were reviewed for risk factors and surgical outcomes.
Overall upgrade rate of FEA to malignancy was 2.4% (5 of 208). All 5 upgraded cases were ductal carcinoma in situ at operation. The upgrade rate to atypical ductal hyperplasia, lobular carcinoma in situ, or atypical lobular hyperplasia was 29.8% (62 of 208). The FEA lesions in patients with a genetic mutation were more likely to upgrade to malignancy than FEA lesions in patients without a genetic mutation (33.3% [1 of 3] vs 2.0% [4 of 205]; p < 0.01). The FEA lesions in patients with a personal history of breast cancer were more likely to upgrade to higher-risk lesions than those without a personal history (47.8% [11 of 23] vs 27.6% [51 of 185]; p = 0.046) but were not more likely to be upgraded to malignancy (0% [0 of 23] vs 2.7% [5 of 185]; p = 0.42).
The overall risk of upgrade of FEA to malignancy is low at 2.4%; however, the upgrade rate to a higher-risk lesion is nearly 30%. Surveillance rather than surgical excision of FEA can be a reasonable option for patients without a genetic mutation who opt against chemoprevention.
我们的目的是确定单纯扁平上皮异型增生（FEA）进展为恶性肿瘤及更高风险病变的升级率，并识别FEA升级风险较低的患者。
回顾2007年至2016年的病历，确定208例经影像引导下粗针穿刺活检诊断为单纯FEA的连续患者，这些患者接受了手术切除（96.2%[208例中的200例]）或至少有2年的影像随访（3.8%[208例中的8例]）。审查病历以了解风险因素和手术结果。
FEA进展为恶性肿瘤的总体升级率为2.4%（208例中的5例）。所有5例升级病例在手术时均为导管原位癌。进展为非典型导管增生、小叶原位癌或非典型小叶增生的升级率为29.8%（208例中的62例）。有基因突变的患者的FEA病变比没有基因突变的患者的FEA病变更有可能进展为恶性肿瘤（33.3%[3例中的1例]对2.0%[205例中的4例]；p<0.01）。有乳腺癌个人史的患者的FEA病变比没有乳腺癌个人史的患者的FEA病变更有可能进展为更高风险的病变（47.8%[23例中的11例]对27.6%[185例中的51例]；p=0.046），但进展为恶性肿瘤的可能性并无增加（0%[23例中的0例]对2.7%[185例中的5例]；p=0.42）。
FEA进展为恶性肿瘤的总体风险较低，为2.4%；然而，进展为更高风险病变的升级率近30%。对于不选择化学预防的无基因突变患者，对FEA进行监测而非手术切除可能是一个合理的选择。
