Huang Yang Y, Park Hyerin, McLaren Sally, Thirunavukkarasu Palan, Lin Joshua T W, Rajakaruna Ramela, Dhillon Ravinder, Ponniah Ananda K
Department of Breast Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Department of Surgery, The University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia.
ANZ J Surg. 2020 Dec;90(12):2521-2526. doi: 10.1111/ans.16315. Epub 2020 Sep 23.
B3 breast lesions identified on core needle biopsy have uncertain malignant potential. Traditional management of these lesions has been surgical excision, but there is growing interest in less invasive and more cost-effective alternatives such as vacuum-assisted excisional biopsy (VAEB). Determining the rate of malignant upgrade for B3 lesions is important as it may identify low-risk lesions where VAEB could be considered.
A retrospective study was conducted of women undergoing an elective excisional biopsy for a B3 lesion identified on core needle biopsy at a tertiary Australian breast centre. The pre-operative biopsy diagnosis and subsequent excisional biopsy diagnosis were used to calculate the proportion of cases where the diagnosis was upgraded to malignancy.
A total of 299 eligible patients were identified. Pre-operative diagnosis of papillary lesion with atypia was associated with the highest upgrade rate (50%, n = 12). The next highest upgrade rates occurred in those with flat epithelial atypia (37.50%, n = 8); atypical ductal hyperplasia (24.71%, n = 85); lobular carcinoma in situ (LCIS)/atypical lobular hyperplasia with calcification (17.65%, n = 17); and papillary lesion without atypia (4.72%, n = 106). Patients with radial scar (n = 51), classical LCIS without calcification (n = 7) and mucocoele-like lesion (n = 8) had a 0% upgrade rate.
VAEB may be appropriate for low malignant risk lesions such as papillary lesion without atypia, mucocoele-like lesion and radial scar lesion without atypia. Open-surgical-excisional biopsy remains appropriate for high upgrade lesions such as atypical ductal hyperplasia, papillary lesion with atypia, flat epithelial atypia and classical LCIS with calcification. Long-term prospective randomized multicentre studies and continuing multidisciplinary approach is recommended for future clinical implementation.
在粗针活检中发现的B3级乳腺病变具有不确定的恶性潜能。这些病变的传统治疗方法是手术切除，但人们对侵入性较小且成本效益更高的替代方法（如真空辅助切除活检术（VAEB））的兴趣与日俱增。确定B3级病变的恶性升级率很重要，因为这可能有助于识别可考虑采用VAEB的低风险病变。
对在澳大利亚一家三级乳腺中心因粗针活检发现的B3级病变而接受择期切除活检的女性进行了一项回顾性研究。术前活检诊断和随后的切除活检诊断用于计算诊断升级为恶性肿瘤的病例比例。
共确定了299例符合条件的患者。术前诊断为非典型性乳头状病变的患者升级率最高（50%，n = 12）。升级率其次高的是扁平上皮非典型增生患者（37.50%，n = 8）；非典型导管增生（24.71%，n = 85）；小叶原位癌（LCIS）/伴有钙化的非典型小叶增生（17.65%，n = 17）；以及无非典型性的乳头状病变（4.72%，n = 106）。患有放射状瘢痕（n = 51）、无钙化的经典LCIS（n = 7）和黏液囊肿样病变（n = 8）的患者升级率为0%。
VAEB可能适用于低恶性风险病变，如无非典型性的乳头状病变、黏液囊肿样病变和无非典型性的放射状瘢痕病变。开放性手术切除活检仍适用于升级率高的病变，如非典型导管增生、非典型性乳头状病变、扁平上皮非典型增生和伴有钙化的经典LCIS。建议未来进行长期前瞻性随机多中心研究并持续采用多学科方法用于临床实践。
