University of Iowa Hospitals and Clinics, Department of Surgery, 1500 JCP, 200 Hawkins Dr, Iowa City, IA 52242, USA.
Good Samaritan Hospital Medical Center, The Cancer Institute, 111 Beach Dr, West Islip, NY 11795, USA.
Am J Surg. 2022 Jan;223(1):94-100. doi: 10.1016/j.amjsurg.2021.07.020. Epub 2021 Jul 21.
Lobular carcinoma in situ (LCIS), atypical ductal and lobular hyperplasia (AH) increase breast cancer risk. We examined risk management recommendations (RMR) and acceptance in AH/LCIS.
All patients with AH/LCIS on core needle biopsy from 2013 to 2016 at our institution were identified; cancer patients were excluded. Univariate and multivariate analysis examined factors associated with management.
98 % of patients were evaluated by breast surgeons and 53 % underwent risk model calculation (RC). 77 % had new RMR. RMR of MRI screening (MRI), genetic counselling (GC) and medical oncology (MO) referral were 41 %, 18 %, 77 %, respectively. MRI screening was more likely recommended in those with strong family history (p = 0.01), and high RC (p < 0.001). Uptake of at least one RMR did not occur in 84 % of patients. Use of RC correlated with MO acceptance (p = 0.049).
Diagnosis of atypia has the potential to change risk management for most, however only 16 % of patients accepted all RMR.
乳腺原位癌（LCIS）和不典型导管增生和小叶增生（AH）会增加乳腺癌的风险。我们研究了 AH/LCIS 的风险管理建议（RMR）和接受程度。
我们在本院对 2013 年至 2016 年间所有接受核心针活检的 AH/LCIS 患者进行了识别；排除癌症患者。单因素和多因素分析检查了与管理相关的因素。
98%的患者由乳腺外科医生进行评估，53%的患者进行了风险模型计算（RC）。77%的患者有新的 RMR。MRI 筛查（MRI）、遗传咨询（GC）和肿瘤内科（MO）转诊的 RMR 分别为 41%、18%和 77%。具有强烈家族史（p=0.01）和高 RC（p<0.001）的患者更有可能推荐 MRI 筛查。84%的患者未接受至少一项 RMR。RC 的使用与 MO 的接受程度相关（p=0.049）。
不典型增生的诊断可能会改变大多数患者的风险管理，但只有 16%的患者接受了所有 RMR。
