Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, ML 0761, Cincinnati, OH 45267-0761 (R.A.W., S.J.L., M.E.M., M.C.M.); and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (B.Z.).
Radiol Imaging Cancer. 2021 Jan 22;3(1):e200116. doi: 10.1148/rycan.2021200116. eCollection 2021 Jan.
To perform a systematic review and meta-analysis to calculate the pooled upgrade rate of pure flat epithelial atypia (FEA) diagnosed at core needle biopsy (CNB).
A PubMed and Embase database search was performed in December 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality and publication bias were assessed. The upgrade rate of pure FEA to cancer, invasive carcinoma, and ductal carcinoma in situ (DCIS), as well as the co-occurrence rate of atypical ductal hyperplasia (ADH), with 95% CIs were calculated. A random effect model was used to integrate the proportions and their corresponding 95% CI. Study heterogeneity was calculated using τ and .
A total of 2482 cases of pure FEA across 42 studies (mean age range, 46-59 years) met inclusion criteria to be analyzed. Significant study heterogeneity was identified (τ = 0.001, = 67%). The pooled upgrade rates reported for pure FEA were 5% (95% CI: 3%, 6%) for breast cancer, 1% (95% CI: 0%, 2%) for invasive carcinoma, and 2% (95% CI: 1%, 3%) for DCIS. When more than 90% of calcifications were removed at CNB, the pooled upgrade rate was 0% (95% CI: 0%, 2%). The pooled co-occurrence rate of ADH at surgical excision was 17% (95% CI: 12%, 21%). Study quality was medium to high with a risk of publication bias ( < .01).
Pure FEA diagnosed at CNB should be surgically excised due to the pooled upgrade rate of 5% for breast cancer. If more than 90% of the targeted calcifications are removed by CNB for pure FEA, close imaging follow-up is recommended. Biopsy/Needle Aspiration, Breast, Mammography© RSNA, 2021.
进行系统评价和荟萃分析，计算在核心针活检（CNB）诊断为单纯平坦上皮不典型（FEA）的患者中进行升级治疗的总体发生率。
我们于 2019 年 12 月在 PubMed 和 Embase 数据库中进行了检索。我们遵循了系统评价和荟萃分析的 Preferred Reporting Items 指南。评估了研究质量和发表偏倚。计算了单纯 FEA 升级为癌症、浸润性癌和导管原位癌（DCIS）的发生率，以及非典型导管增生（ADH）的合并发生率，均以 95%置信区间（CI）表示。使用随机效应模型对比例及其相应的 95%CI 进行整合。使用 τ 和 计算研究异质性。
共有 42 项研究的 2482 例单纯 FEA 病例符合纳入标准进行分析（平均年龄范围为 46-59 岁）。研究存在显著的异质性（τ=0.001， =67%）。报告的单纯 FEA 升级率为乳腺癌 5%（95%CI：3%，6%）、浸润性癌 1%（95%CI：0%，2%）和 DCIS 2%（95%CI：1%，3%）。当 CNB 去除 90%以上的钙化时，总体升级率为 0%（95%CI：0%，2%）。在手术切除时，ADH 的合并发生率为 17%（95%CI：12%，21%）。研究质量为中高度，存在发表偏倚的风险（ <.01）。
由于 CNB 诊断为单纯 FEA 的患者乳腺癌的总体升级率为 5%，因此应进行手术切除。如果 CNB 去除单纯 FEA 中 90%以上的目标钙化，则建议进行密切的影像学随访。
