Bong Tiffany Sin Hui, Tan Jun Kiat Thaddaeus, Ho Juliana Teng Swan, Tan Puay Hoon, Lau Wing Sze, Tan Tuan Meng, Wong Jill Su Lin, Tan Veronique Kiak Mien, Tan Benita Kiat Tee, Madhukumar Preetha, Yong Wei Sean, Lim Sue Zann, Wong Chow Yin, Ong Kong Wee, Sim Yirong
Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.
Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore.
J Breast Cancer. 2022 Feb;25(1):37-48. doi: 10.4048/jbc.2022.25.e7.
This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making.
This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010-2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination.
Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound ( 0.018) or mammography ( 0.026), microcalcifications ( 0.047), diffuse microcalcification distribution ( 0.034), mammographic parenchymal density ( 0.008). and ≥ 3 separate ADH foci found on biopsy ( 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005-0.35; 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21-25.2; 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831-1.920; 0.002) remained significant in multivariate analysis and were included in the nomogram.
Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74-0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.
本研究确定了在粗针活检（CNB）中诊断为非典型导管增生（ADH）的恶性升级预测因素，并开发了一种列线图以促进基于证据的决策。
这项回顾性分析纳入了2010 - 2015年在新加坡国立癌症中心（NCCS）被诊断为ADH的女性。采用Cox比例风险回归来确定与恶性升级相关的临床、放射学和组织学因素。使用多变量分析中关联最强的变量构建列线图。多变量逻辑回归系数用于估计每种因素组合的升级预测概率。
2010年至2015年间，238,122名女性在国家乳腺癌筛查计划下接受了乳腺钼靶筛查。在29,564名被召回的女性中，进行了5,971次CNB。其中，2,876次CNB在NCCS进行，88名患者（90个病灶）被诊断为ADH，26个病灶在切除活检时升级为乳腺恶性肿瘤。在单变量分析中，与恶性升级相关的因素包括超声检查发现肿块（P = 0.018）或乳腺钼靶检查发现肿块（P = 0.026）、微钙化（P = 0.047）、弥漫性微钙化分布（P = 0.034）、乳腺钼靶实质密度（P = 0.008）以及活检发现≥3个独立的ADH病灶（P = 0.024）。乳腺钼靶实质密度（风险比[HR]，0.04；95%置信区间[CI]，0.005 - 0.35；P = 0.014）、超声检查发现肿块（HR，10.50；95% CI，9.21 - 25.2；P = 0.010）和ADH病灶数量（HR，1.877；95% CI，1.831 - 1.920；P = 0.002）在多变量分析中仍然显著，并被纳入列线图。
我们的模型对乳腺癌风险预测具有良好的辨别能力（C统计量为0.81；95% CI，0.74 - 0.88），并筛选出了恶性升级低风险（2.1%）的女性亚组，这些女性在CNB诊断为ADH后可能避免手术切除。
