Breast Screening and Assessment Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP, UK.
Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK.
Eur J Surg Oncol. 2019 Apr;45(4):519-527. doi: 10.1016/j.ejso.2018.12.008. Epub 2018 Dec 11.
Provide evidence to support evolving management strategies for high-risk (B3) breast lesions by assessing risk of carcinoma in subgroups of B3 lesions using systematic review and meta-analysis.
Databases identified observational studies between 1980 and 2015 that reported on underestimation of malignancy following B3 lesion diagnosis at core needle biopsy. Critical appraisal, quality assessment, data extraction and meta-analysis was undertaken to calculate rate of malignancy of the whole B3 group and individual lesions. Study heterogeneity and association between variables and underestimation rate was investigated using random effects logistic modelling.
Meta-analysis, using data from 129 studies, assessed 11 423 lesions of which 2160 were upgraded to malignancy after surgical excision biopsy (17% malignancy rate, 95% CI 15-19%). Malignancy rates varied from 6% in radial scars with no atypia (95% CI 2-13%, I2 72.8%), to 32% in papillomas with atypia (95% CI 23-41%, I2 57.4%). Differences in upgrade rates between atypical and non-atypical lesions were statistically significant (p < 0.05). Study heterogeneity could not be explained by differences in core biopsy size or year of publication.
This comprehensive, inclusive assessment of all published literature, provides an accurate estimate of malignancy risk in subgroups of B3 lesions, to guide tailored management strategies. Some lesions have a high risk of malignancy, while others have a much lower risk, and could be safely managed with surveillance strategies rather than surgery.
通过对 B3 病变亚组进行系统评价和荟萃分析，评估在核心针活检后 B3 病变诊断低估恶性肿瘤的风险，为高危（B3）乳腺病变的不断发展的管理策略提供证据。
数据库检索了 1980 年至 2015 年期间发表的关于在核心针活检后 B3 病变诊断低估恶性肿瘤的观察性研究。采用临界评价、质量评估、数据提取和荟萃分析，计算整个 B3 组和个别病变的恶性肿瘤发生率。采用随机效应逻辑模型研究研究异质性和变量与低估率之间的关系。
荟萃分析使用来自 129 项研究的数据，评估了 11423 个病变，其中 2160 个在外科切除活检后升级为恶性肿瘤（17%的恶性肿瘤发生率，95%CI 15-19%）。恶性肿瘤发生率从无非典型性的放射状瘢痕的 6%（95%CI 2-13%，I2 72.8%）到伴有非典型性的乳突瘤的 32%（95%CI 23-41%，I2 57.4%）不等。非典型和非典型病变之间的升级率差异具有统计学意义（p<0.05）。研究异质性不能用核心活检大小或发表年份的差异来解释。
这项对所有已发表文献的全面、综合评估，为 B3 病变亚组的恶性肿瘤风险提供了准确的估计，以指导量身定制的管理策略。一些病变恶性肿瘤风险高，而另一些病变风险低得多，可以通过监测策略而不是手术安全管理。
