Shehata Mariam N, Rahbar Habib, Flanagan Meghan R, Kilgore Mark R, Lee Christoph I, Ryser Marc D, Lowry Kathryn P
Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington.
Department of Surgery, University of Washington, Seattle, Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
J Am Coll Radiol. 2020 Oct;17(10):1207-1219. doi: 10.1016/j.jacr.2020.07.036. Epub 2020 Aug 27.
Lobular neoplasia (LN) detected on breast core needle biopsy is frequently managed with surgical excision because of concern for undersampled malignancy. The authors performed a systematic review and meta-analysis to estimate the risk for upgrade to malignancy in the setting of imaging-concordant classic LN diagnosed on core biopsy.
PubMed and Embase were searched for original articles published from 1998 to 2020 that reported rates of upgrade to malignancy for classic LN, including atypical lobular hyperplasia (ALH) and classic lobular carcinoma in situ (LCIS). Two reviewers extracted study data and assessed the following quality criteria: exclusion of variant LCIS, exclusion of imaging-discordant lesions, and outcome reporting for ≥70% of lesions. For studies meeting all criteria, pooled risks for upgrade to any malignancy (invasive carcinoma or ductal carcinoma in situ) and invasive malignancy for all LN, ALH, and LCIS were estimated using random-effects models.
For 65 full-text articles included in the review, the risk for upgrade to any malignancy ranged from 0% to 45%. Among the 16 studies that met all quality criteria for the meta-analysis, pooled risks for upgrade to any malignancy were 3.1% (95% confidence interval [CI], 1.8%-5.2%) for all LN, 2.5% (95% CI, 1.6%-3.9%) for ALH, and 5.8% (95% CI, 2.9%-11.3%) for LCIS. Risks for upgrade to invasive malignancy were 1.3% (95% CI, 0.7%-2.4%) for all LN, 0.4% (95% CI, 0.0%-4.2%) for ALH, and 3.5% (95% CI, 2.0%-5.9%) for LCIS.
The risk for upgrade to malignancy for LN found on breast biopsy is low. Imaging surveillance can likely be offered as an alternative to surgical management for LN, particularly for ALH.
由于担心乳腺粗针活检中未充分取样的恶性肿瘤，在乳腺粗针活检中检测到的小叶瘤变（LN）通常采用手术切除治疗。作者进行了一项系统评价和荟萃分析，以估计在粗针活检诊断为影像一致的经典LN情况下升级为恶性肿瘤的风险。
检索PubMed和Embase数据库，查找1998年至2020年发表的原始文章，这些文章报告了经典LN（包括非典型小叶增生（ALH）和经典小叶原位癌（LCIS））升级为恶性肿瘤的发生率。两名研究者提取研究数据并评估以下质量标准：排除变异型LCIS、排除影像不一致的病变以及对≥70%的病变进行结局报告。对于符合所有标准的研究，使用随机效应模型估计所有LN、ALH和LCIS升级为任何恶性肿瘤（浸润性癌或导管原位癌）和浸润性恶性肿瘤的合并风险。
纳入该评价的65篇全文文章中，升级为任何恶性肿瘤的风险范围为0%至45%。在符合荟萃分析所有质量标准的16项研究中，所有LN升级为任何恶性肿瘤的合并风险为3.1%（95%置信区间[CI]，1.8%-5.2%），ALH为2.5%（95%CI，1.6%-3.9%），LCIS为5.8%（95%CI，2.9%-11.3%）。所有LN升级为浸润性恶性肿瘤的风险为1.3%（95%CI，0.7%-2.4%），ALH为0.4%（95%CI，0.0%-4.2%），LCIS为3.5%（95%CI，2.0%-5.9%）。
乳腺活检中发现的LN升级为恶性肿瘤的风险较低。对于LN，尤其是ALH，影像监测可能是手术治疗的替代方案。
