不典型导管增生：临床病理因素不能预测切除活检后的升级。
Atypical ductal hyperplasia: Clinicopathologic factors are not predictive of upgrade after excisional biopsy.
机构信息
Oregon Health & Science University, Department of Surgery, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, 1040 NW 22nd Ave, Suite 560, Portland, OR, 97227, USA.
出版信息
Am J Surg. 2019 May;217(5):848-850. doi: 10.1016/j.amjsurg.2018.12.020. Epub 2018 Dec 17.
INTRODUCTION
National Comprehensive Cancer Network (NCCN) guidelines currently recommend excisional biopsy for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) due to the possibility of pathologic upgrade to breast cancer upon excisional biopsy. We aimed to quantify the current rate of upgrade and identify risk factors.
METHODS
A retrospective review of women in the Legacy Health Care System with a diagnosis of ADH was performed for 2014 through 2015. Initial pathology and patient factors were reviewed for potential predictors of upgrade.
RESULTS
91 women with ADH were identified. 84 (92%) underwent excisional biopsy; 16 (19%) were upgraded to breast cancer. Those upgraded were significantly older than non-upgraded patients (64.6 versus 56.7 years, p < 0.01), and 15 (94%) had greater than one duct involved by ADH.
CONCLUSION
The principal clinicopathologic factor associated with upgrade is increasing patient age, however this is not sufficiently predictive. Excisional biopsy in patients diagnosed with ADH on CNB should continue. Further study may provide an avenue for selective excisional biopsy in patients with ADH.
简介
由于在核心针活检 (CNB) 中诊断为不典型导管增生 (ADH) 后可能会出现病理升级为乳腺癌，因此国家综合癌症网络 (NCCN) 指南目前建议对其进行切除性活检。我们旨在量化目前的升级率并确定危险因素。
方法
对 2014 年至 2015 年 Legacy 医疗保健系统中诊断为 ADH 的女性进行了回顾性研究。回顾了初始病理学和患者因素，以寻找升级的潜在预测因素。
结果
共确定了 91 例 ADH 患者。84 例（92%）接受了切除性活检；16 例（19%）升级为乳腺癌。升级患者明显比未升级患者年龄更大（64.6 岁 vs 56.7 岁，p<0.01），并且 15 例（94%）有一个以上的导管受到 ADH 的影响。
结论
与升级相关的主要临床病理因素是患者年龄的增加，但这并不能充分预测。在 CNB 中诊断为 ADH 的患者应继续进行切除性活检。进一步的研究可能为 ADH 患者的选择性切除性活检提供途径。
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