Department of Surgery, The Permanente Medical Group, Vallejo, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Ann Surg Oncol. 2019 Jun;26(6):1695-1703. doi: 10.1245/s10434-019-07180-7. Epub 2019 Feb 8.
There is no consensus regarding the management of benign papillary breast lesions diagnosed on image-guided core needle biopsy (IGCNB).
This is a retrospective review of 407 patients within Kaiser Permanente Northern California diagnosed between 2012 and 2013. The study focused on patients presenting with a mass lesion and who were diagnosed with a benign papillary breast lesion (BPBL) on IGCNB. Patients who did not have surgical excision of the IGCNB papilloma were followed for at least 2 years.
A total of 327 patients (80%) underwent surgical excision, 61 patients (15%) had follow-up imaging, and 19 patients (5%) had no surgery or imaging. Overall among women with surgical excision, 9.5% had a high-risk lesion, 3.4% had in situ cancer, and 2.4% had invasive cancer. An upgrade to an in situ cancer or invasive cancer was more common among women with a lesion greater than 1 cm, a palpable breast mass, age > 50 years, or if the lesion was > 5 cm from the nipple. No cancers were diagnosed in 61 women followed by imaging surveillance.
This is the largest, single-cohort study of benign papillary mass lesions diagnosed on IGCNB. On surgical excision, the overall rate of upgrade to in situ cancer and invasive cancer was low, and almost all cancers diagnosed had favorable features. Because no cancers were found in women who were followed by imaging, we conclude that outcomes for BPBL diagnosed on IGCNB are favorable whether surgical excision or surveillance is the treatment choice.
对于在影像引导核心针活检（IGCNB）诊断为良性乳头状乳腺病变的处理，目前尚无共识。
这是对 2012 年至 2013 年期间在 Kaiser Permanente Northern California 就诊的 407 例患者进行的回顾性研究。本研究主要关注的是出现肿块病变且在 IGCNB 诊断为良性乳头状乳腺病变（BPBL）的患者。对未对 IGCNB 乳头状瘤进行手术切除的患者进行了至少 2 年的随访。
共有 327 例患者（80%）接受了手术切除，61 例患者（15%）进行了随访影像学检查，19 例患者（5%）未进行手术或影像学检查。总体而言，在接受手术切除的女性中，9.5%存在高危病变，3.4%存在原位癌，2.4%存在浸润性癌。病变>1cm、可触及乳腺肿块、年龄>50 岁或病变距乳头>5cm 的女性，其原位癌或浸润性癌升级的情况更为常见。在接受影像学监测的 61 例女性中，未诊断出癌症。
这是最大的、单队列研究，研究了在 IGCNB 诊断为良性乳头状乳腺肿块病变。在手术切除后，总体原位癌和浸润性癌升级率较低，且诊断出的几乎所有癌症均具有良好的特征。由于在接受影像学监测的女性中未发现癌症，我们得出结论，无论选择手术切除还是监测，在 IGCNB 诊断为 BPBL 的情况下，其预后均较好。
